Doctor admits to role in trip-and-fall scams, performing unneeded surgeries
The fraud ring, which included owners of litigation-funding companies, attempted to defraud insurance companies of more than $31 million.
A New York-licensed pain management doctor and surgeon plead guilty to counts of conspiracy to commit mail fraud and conspiracy to commit wire fraud as part of a trip-and-fall scheme that attempted to bilk insurance companies for more than $31 million, according to the U.S. Attorney’s Office in Southern District of New York.
The doctor, Sady Ribeiro, was the second person to plead guilty in the case. Ribeiro performed back surgeries and other medical procedures on nearly 200 people. Adrian Alexander, the owner of a litigation funding company, admit his guilt earlier this year.
The fraudsters are alleged to have recruited more than 400 people to stage or falsely claim to have been injured in trip-and-fall accidents at locations throughout New York City, according to the U.S. Attorney’s Office. Common accident sites included cellar doors, cracks in sidewalks and potholes.
Following the faked accident, the supposedly injured person, or patient, was directed to a specific attorney, who would file personal injury suits against the owners of the accident site and insurance companies.
The patient would then be directed to undergo continuing chiropractic and medical treatment from doctors involved in the scheme. At this point, patients were told if they wanted to follow through with their lawsuits that they would have to undergo unnecessary surgeries. The fraudsters would offer “post-surgery” payments, typically $1,000-$1,500, to incentivize patients.
In an August 2015 email to Alexander, Ribeiro detailed the services he performs, writing: “I will play very honest ‘game’ with you . . . I see the patient and I generate a very good dictation that justifies the treatment-there is a cost for that and I hope a profit.”
According to the U.S. Attorney’s Office, the fraudsters would often target extremely poor individuals and drug addicts to serve as patients. Those involved in the scam often recruited participants directly from homeless shelters in the city.
“For example, it was common for patients to ask for food when they would appear for their intake meetings with the lawyers. Many of the patients did not have sufficient clothing to keep them warm during the wintertime and had poor-quality shoes,” the release stated.
Even if a patient had health insurance, be it company sponsored or government funded, their medical and legal expenses were typically paid for by a litigation funding company. In exchange for “agreeing” to front the legal and medical costs, the funding company would charge patients exorbitant interest rates, up to 50% on medical loans and 100% on personal loans. These high-interest rates allowed the scam perpetrators to collect nearly all of the proceeds, with patients receiving a small portion.
U.S. Attorney for the Southern District of New York Damian Williams said in a release: “As alleged, Sady Ribeiro abused his professional license and position of trust by performing medically unnecessary surgeries to increase the value of fraudulent trip-and-fall lawsuits. In carrying out the scheme, Adrian Alexander, who funded many of the fraudulent lawsuits, Sady Ribeiro, and their co-conspirators preyed upon the most vulnerable members of society in order to enrich themselves. Ribeiro and Alexander now await sentencing for their reprehensible crimes.”
As part of their plea agreements, Ribeiro and Alexander have agreed to forfeit $513,005 and $659,001, respectively. They also will each repay $3,928,133. Ribeiro’s sentencing is slated for January 2023, while Alexander’s trial is set for November 2022. Both face a maximum possible sentence of five years in prison.
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