A Kearny man was sentenced to one year and a day in prison after pleading guilty to his role in a car accident insurance fraud scheme, U.S. Attorney Craig Carpenito announced.
Luis G. Aguirre, 57, previously pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court to an information charging him with one count of conspiracy to commit health care fraud. Chesler imposed the sentence today via videoconference.
Aguirre helped to orchestrate an automobile accident scheme in Bergen County by acting as a “runner” who identified and recruited accident victims to the scheme, according to court documents.
Aguirre subsequently introduced the victims to various chiropractors, medical imaging centers, and others, who billed PIP insurance plans for medically unnecessary services.
Aguirre and an employee from an auto body shop in West New York, identified only as Individual 1, found and recruited individuals who had been in car accidents through word of mouth in the community and through relationships with health care providers in northern New Jersey.
From there, Aguirre paid Individual 1 for each accident victim that Individual 1 helped identify and recruit to the scheme. Individual 1, in turn, paid accident victims for participating in the scheme, according to the criminal complaint.
Aguirre also ensured that the victims had filed police reports to support subsequent insurance claims, authorities said.
He then directed the accident victims to visit specific health care providers to obtain medically unnecessary medical exams and services, such as X-rays and MRIs, for fake or exaggerated injuries that they supposedly suffered during the automobile accidents.
Aguirre was paid approximately $500 in cash by the health care providers for each individual accident victim that he delivered. Aguirre thereby caused health care providers to submit insurance claims to PIP insurance plans on behalf of the accident victims.
For example, on September 25th, 2018, someone from North Bergen, identified only as Individual 3, was involved in an automobile accident in Elizabeth.
Based on a police report of the incident, the accident was minor: Individual 3 was rear-ended by another car when both were stopped at a red light.
According to the police report, Individual 3 refused medical treatment at the scene, stating that Individual 3 would seek separate medical attention. At the time of the accident, Individual 3 had an automobile insurance policy through provider “Auto Insurer 1”, which included PIP coverage.
Additionally, Aguirre learned from Individual 1 that Individual 3 was willing to participate in the scheme in exchange for cash payment.
As a result, on October 12th, 2018, Aguirre directed Individual 3 to visit the proprietor, Individual 2) of an MRI Center in Rochelle Park, where Individual 3 underwent a series of medically unnecessary X-rays.
Then, on October 16th, 2018, the MRI Center billed Individual 3’s PIP insurance policy.
Aguirre’s participation in the conspiracy caused an estimated loss to PIP insurance plans of over $250,000, while the total loss caused by the conspiracy exceeded $3.5 million.
In addition to the prison term, Chesler sentenced Aguirre to three years of supervised release and ordered him to pay restitution of $53, 710.
Carpenito credited special agents of the Department of Labor – Office of Inspector General, under the direction of Special Agent in Charge Michael C. Mikulka, and special agents of the FBI, under the direction Special Agent in Charge George M. Crouch Jr. in Newark, with the investigation that led to today’s sentencing.