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The BEST LAWYER ANYONE COULD ASK FOR!!! Todd changed our lives! He’s not JUST a lawyer representing us for a case. Todd and his office have become Family. When we entered his office in August of 2022, we entered with such anxiety, uncertainty, and so much stress. Honestly we were very lost. My husband and I felt alone. How could a lawyer who didn’t know us, know our family, know our background represents us, When this could change our lives for the next 5-7years that my husband was facing in Federal jail. By the time our free consultation was over with Todd, we left his office at ease. All our questions were answered and we had a sense of relief.

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New York No-Fault Insurance Fraud Lawyer

New York Criminal Lawyers Defending No-Fault Insurance Fraud Cases

New York Criminal Lawyers with our firm represent healthcare professionals and other individuals accused of No-Fault Insurance Fraud in state and federal courts. Our clients include physicians, physician assistants, physical therapists, attorneys, and others. We have years of experience defending white-collar criminal cases, especially those involving healthcare and insurance fraud.

Understanding No-Fault Insurance Fraud

First, let’s understand what New York No-fault law is. In New York, every car registered in the state must have “no-fault car insurance”. This allows the driver and all passengers of the car to collect up to $50,000 in benefits per each person in case of an accident-related injury no matter whose fault the accident was (hence the name No-Fault). To simplify and speed up the way claimants get reimbursed for medicaid treatment, the No-fault law doesn’t require that the injured parties sue to recover the payments. Instead, the patients can authorize the insurance company to reimburse healthcare providers involved in their treatment directly through an assignment. Basically, once the reimbursement is assigned, the healthcare providers can bill the insurance companies directly for all the medical treatment they provided to the patients. If the patient wants to receive additional damages, separate from the $50,000
allowed by the No-Fault Law, the patient can file a lawsuit to demonstrate that he or she suffered serious injuries as a result of the accident.

No-Fault fraud occurs when medical service provides such as medical clinics, physical therapists, rehab centers, etc. operate as a billing mill that
bill car insurance companies under the No-Fault Law for medical treatments that were either never provided or were medically unnecessary.

Ownership and Control in No-Fault Fraud Cases

One issue that commonly occurs in No-Fault Fraud cases is who owns and controls the medical practice that provides the service. In New York, the law requires that all healthcare business entities including medical clinics must be incorporated, owned, operated, and controlled by a licensed medical practitioner. If a clinic is owned, controlled, or operated by someone who is not a licensed medical practitioner, the clinic is ineligible for reimbursement and insurance companies will not pay its bills for any of the services it provided.

George FernandezGeorge Fernandez
14:16 30 Apr 24
Excellent 10 out of 10, Helped resolve my case. Jeremy explained everything and made everything easy to understand.
RajRaj
21:33 24 Apr 24
If you are looking for a lawyer that listens, is aggressive where needed, and holds his word above all else, Todd is the best pick. I had hired multiple attorneys prior to hiring the Spodek Group for a white collar case. The first thing that stood out to me was the cost, as anyone going through the process and dealing with the system, money was tight at that time - especially after hiring and firing multiple lawyers. The cost was not as high as others which was definitely a plus. Todd's intake process was also unlike other attorneys. He took the time to actually listen. He cared. He was trying to put himself in my shoes while I was explaining the situation to him and he really took the time to understand the whole situation. Other lawyers will give you 15 mins and send you a retainer agreement. Not Todd, I think he spent almost two hours with me as I was explaining everything.Not only was he great during the onboarding process, he was supportive and very informative through the entire plea process and eventually sentencing. After hiring him, I asked if I should hire a prison consultant, he told me to save my money as he would do everything they would. He was right and held up to his word. Later on I would hear from others that went with the prison consultants that they were a waste of money - I am glad I listened to Todd!When it came time for sentencing, two days prior to sentencing, the prosecutor tried increasing my proposed prison time by almost double - apparently a normal move. Todd and his team worked with me non-stop through the weekend prior to sentencing to ensure that I was not given additional prison time. Again, he took the time to listen and came up with a strategy to explain the case with great detail.Unfortunately, I did plead guilty as that was my best option. Todd and his whole team wrote up nearly 300 pages of a summary of what happened and why I should not be given prison time. If I breakdown the amount I spent with Todd versus the amount of work that I saw being done, I am shocked I was not charged four times as much. The other benefit was, a lot of criminal defense lawyers were just a single attorney with a paralegal or two. Todd had a team of people that I dealt with (5-7 people that I interacted with), but he was ALWAYS accessible. It would never take him more than an hour to reply unless he was in court.I was sentenced to prison and I was emotionally distraught. Todd and his team did whatever they could even after sentencing to make sure I was alright. He personally stayed in touch with my family to ensure I was doing alright and offered support to them. Most lawyers would consider the job complete at sentencing, not Todd.After prison, Todd still spent time with me to make sure I was on the right track and avoiding any potential risks in the future. He has also been giving advice on how to navigate probation etc and has not been looking at the clock for billing.Although I wish I had never been arrested in the first place, I am glad I had Todd and his team in my corner. Without them I likely would have had to spend a lot more time in prison than I did.Thank you, Todd, and the entire Spodek Law team, for helping turn what was a nightmare into a manageable situation!
Yelva Saint-PreuxYelva Saint-Preux
19:26 19 Apr 24
I am immensely grateful to the entire team at Spodek Law Group for their unwavering dedication and exceptional expertise throughout my case. From our initial consultation to the final resolution, their professionalism and tireless advocacy made all the difference. Their strategic approach and attention to detail instilled confidence in me every step of the way.Thanks to their hard work and commitment, we achieved a truly favorable outcome that exceeded my expectations. Not only did they navigate the complexities of my case with precision, but they also provided invaluable support and guidance during what was undoubtedly a challenging time. I cannot recommend Spodek Law Group highly enough, especially attorneys Todd Spodek and Claire Banks; they are beacons of excellence in the legal profession.YSP.
Katherine SunKatherine Sun
18:08 18 Apr 24
my lawyer is Alex Zhik. Efficient, patient and professional
Nun yaNun ya
17:48 18 Apr 24
Todd, Ralph and Alex are amazing. Helped my husband get from a double digit number with multiple charges to a single digit, by the time I blink he will be out. They very professional and help with all your needs. They dealt with my anxiety and worry very well and they understand that your family member needs to get home as soon as possible.
Keisha ParrisKeisha Parris
20:45 15 Mar 24
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko BeautyTaïko Beauty
16:26 15 Mar 24
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence.Thank you team!
K MarK Mar
01:37 25 Jan 24
I recently had Spodek Law Group represent me for a legal matter in NYC and I am thoroughly impressed with their services.Alex Zhik secured the best possible outcome for my case.It was a seamless journey from the initial consultation to the resolution of my legal matter. From the moment I spoke to Todd about my case, his enthusiasm to help was evident, setting a positive tone for the entire experience. The efficiency and professionalism displayed by the team is commendable.A particularly noteworthy aspect of their service is their user-friendly portal to upload your documents/evidence. This not only simplified the process, but showcases their commitment to streamline the client experience.Lastly, in an industry where legal fees can often be a concern, I found their pricing to be very reasonable, making needing legal assistance feel accessible and stress-free.I am grateful for their support and wouldn't hesitate to turn to them again in the future.
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In a common scheme, a non-licensed individual who is the real business operator, will pay a fee or salary to doctors, physical therapists, or other licensed medical professionals so that they would incorporate a professional corporation, open up a bank account, sign the lease for clinic, sign the bills for treatments under the No-Fault Law; and write prescriptions and referrals for additional treatments and medical supplies to other fraudulent medical clinics. These prescriptions are often unnecessary and the referrals are done for kickbacks, all of which is illegal.

One way the prosecutors can establish who is the real owner of the clinic is by examining how the clinic was started; who invested the initial funds; who negotiated the rent; who purchased the medical equipment; who brought the patients, and who received the proceeds from the clinics.

No-Fault Fraud and Illegal Kickbacks/Runners

Virtually every no-fault fraud criminal case we handled involved illegal kickbacks. In general terms, an illegal kickback means paying for referrals of patients whose treatment is covered by a government-run insurance company. In an average no-fault setting, the individual who operates the clinic refers patients to other providers to receive excessive and unnecessary medical treatments. These providers are called the modality clinics. The modality clinics usually include acupuncturists, chiropractors, physical therapists, MRI labs, pain management, orthopedics, durable medical equipment, and others. These providers bill the insurance companies under the No-Fault law and pay a certain percentage to the referring clinic (kickback).

Another common issue is the way clinics arrange for patients to come. In most kickback schemes clinic owners employ the runners. The runners are people who recruit patients to the clinics. In return, they are paid for each patient referral. Runners can work with personal injury attorneys, hospital employees, and others. They can even instruct the patients about faking certain injuries to qualify for treatment.

In some cases, personal injury lawyers paid kickbacks to clinics for patient referrals so that they can file lawsuits for them.

No-Fault Fraud and Money Laundering

Many no-fault fraud cases in New York are prosecuted in federal courts. The US Attorney’s Office is likely to use several criminal charges including healthcare fraud conspiracy, RICO, and money laundering. In these cases, money laundering occurs when owners reinvest some of the proceeds of scheme back into the business, usually by paying fees and salaries to modality providers and doctors who participate in the scheme. The modality providers pay a portion of the kickback money to the clinic owner by “rent” payments for the use of space at clinic. This process may be considered money laundering.

Consequences of No-Fault Fraud Conviction

No-fault fraud is a serious crime that can result in prison sentences, severe fines, and lost of medical and other professional license. A healthcare provider convicted of no-fault fraud may also be excluded from participating in Medicaid and Medicare, essentially ending their professional career.

What Is No-Fault Insurance Fraud?

In addition to many widely-publicized cases of Medicaid and Medicare fraud, some health care providers in New York City may face charges of no-fault automobile insurance fraud. This is especially applicable in the case of health care providers that provide services commonly necessary for victims of automobile accidents, such as chiropractors, pain management specialists, neurologists, and others.

When such medical professionals are accused of assisting patients in submitting fraudulent claims in order to obtain reimbursement under New York?s no-fault law, charges may include health care fraud as well as mail fraud.

New York State Law requires every vehicle registered in New York State to have no-fault automobile insurance, which entitles the driver and passengers of a registered and insured vehicle to obtain benefits of up to $50,000 per person for injuries sustained in an automobile accident, no matter who was at fault in the accident (the ?No-Fault Law?).

The No-Fault Law provides for prompt payment for medical treatment, so that claimants do not need to file personal injury lawsuits in order to be reimbursed. Under the No-Fault Law, patients may assign their right to reimbursement from an insurance company to other parties, including medical clinics that provide treatment for their injuries.

New York State law also prescribes that all New York medical clinics be incorporated, owned, operated, and/or controlled by a licensed medical practitioner in order to be eligible for reimbursement under the No-Fault Law. Insurance companies will not reimburse claims for medical treatments from a medical clinic that is not actually owned, operated, and controlled by a licensed medical practitioner.

Any fraud that is designed to circumvent this law and to obtain insurance reimbursements to which the claimant or the medical provider is not entitled, constitutes health care fraud.

For example, in some cases, medical clinic owners pay licensed medical professionals, including doctors and chiropractors to form professional corporations for the clinic through which clinics then bill the insurer under the no-fault law. Since the owners retain control and ownership of the clinic in everything but name, such transactions are considered fraudulent.

Medical professionals who bill insurance carriers under the no-fault law for treatments that either did not take place or were not medically necessary, also commit health care fraud.

When a doctor or a medical clinic received kickbacks for referrals to for extraneous services or treatments, such as physical therapy, MRI, orthopedics, and others, they are also committing health care fraud.

Conviction on these charges can result in imprisonment and severe fines, as well as harsh professional consequences such as revocation of medical license and exclusion from government insurance programs. Practitioners should be aware that such exclusion doesn?t just mean one may not perform a treatment and bill a government program for it ? it means that one may not be involved in any aspect of submitting a claim to a government program, including purely administrative aspects.

If you are concerned that you or a clinic you are affiliated with is being investigated for no-fault insurance fraud, you should retain an experienced health care fraud defense attorney. You should be aware that even if the clinic retains its own attorney, in the event that your interests diverge in any way from the clinic?s, that attorney?s loyalty is to the clinic. You need your own attorney, whose knowledge and expertise will be completely at your service.

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Todd Spodek

Founding Partner

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RALPH P. FRANCHO, JR

Associate

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JEREMY FEIGENBAUM

Associate Attorney

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ELIZABETH GARVEY

Associate

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CLAIRE BANKS

Associate

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RAJESH BARUA

Of-Counsel

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CHAD LEWIN

Of-Counsel

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