Top doctors arrested in insurance scam

7 senior physicians allegedly provided fake medical documents in operation to stage road accidents.

By REBECCA ANNA STOIL
December 25, 2007 08:52
4 minute read.
Top doctors arrested in insurance scam

Natl Insurance 224.8. (photo credit: Ariel Jerozolimski)

 
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In a surprise roundup of suspects including senior medical experts, police said Tuesday that they had cracked an insurance fraud ring they allege defrauded the National Insurance Institute and private insurance companies of tens of millions of shekels. The operation, known as "White Coat," was conducted by the National Economic Crimes Unit (NECU), together with the National Insurance Institute and the Avner insurance company. With the arrest of 15 suspects, police revealed the details of the scam, through which they believe dozens of people defrauded the NII and insurance companies of tens of millions of shekels over the past decade - all with the help of seven prominent doctors. Police believe that suspects staged, exaggerated and even caused vehicle collisions and work accidents in order to claim payoffs for life insurance and for bodily injury. All 15 of the suspects who are currently behind bars were arrested early Tuesday morning. Among them were three psychiatrists, including an assistant district psychiatrist, an orthopedist, a radiologist, and a orthopedic surgeon. The evidence collected thus far includes dozens of personal NII files, insurance claims, the testimony of some of the people suspected of involvement in the case and intelligence information. Police said that the evidence paints a picture of a "well-oiled industry" which they claim was operated by a number of suspects. Detectives constructed a complex web of relationships, showing that a long list of relatives, friends and neighbors of two central suspects - 52-year-old Rishon Lezion resident Zemach Yosef and Reuven Avado, 41, from Kfar Saba - all benefited from insurance payoffs received after claiming injury as a result of accidents. Yosef and Avado, detectives allege, acted as "fixers," offering "professional" instruction to would-be insurance recipients. Beneficiaries were allegedly told to take out insurance policies and then wait for six months so as not to arouse suspicion. The would-be beneficiaries were then instructed how to stage vehicle collisions - including, allegedly, details on how to stop short in the middle of intersections in order to cause pile-ups. In the next stage of the scheme, the fixers would arrange for the "accident victims" to secure medical documents, claiming severe percentages of disability - both physical as well as psychological - as a result of the collisions. At times, police believe, the fixers would even tell the victims to report to specific emergency rooms where doctors on the take were on duty. In other cases, police say, the doctors allegedly filled out the necessary forms and offered professional opinions without even seeing the client. Police emphasized Tuesday that "detectives were shocked to discover the unbearable ease with which senior doctors allegedly became 'rubber stamps' for the enterprise" - in exchange, police claim, for cash payoffs. Avado and Yosef, investigators claim, would take approximately 50 percent of the sum awarded as payment for their creative services and would also allegedly "share the wealth" with the medical professionals involved in the scheme. The investigation was initiated after warning bells were sounded in the internal oversight department of the NII concerning a number of claimants who had all purchased life insurance and submitted insurance claims to the NII, citing reduced ability to work. Suspicions were further aroused by the fact that a large number of the claimants were either related to each other or otherwise connected. At a relatively early stage, they noticed that the common factor in a large number of the cases was Yosef, a former career IDF member who had also faced trial during his army career for using false medical documentation. Even at that earlier stage, information had been gathered against him indicating that he had bribed doctors. Investigators were further intrigued when they realized that in all of the cases, the modus operandi seemed to be quite similar, even identical, in terms of the descriptions of the circumstances surrounding the collisions, the injuries suffered, the wording of the claims filed as well as that of claims filed for "deterioration of condition" later. And - naturally, police say - the same doctors had "coincidentally" signed off on the forms in all of the cases. Meanwhile, the Avner insurance company also discovered a similar pattern, in which dozens of claims were filed by interrelated claimants and also using similar methods and wording. They too allegedly discovered direct links among the suspects. The two organizations combined information and upon discovering the similarities between the two cases decided it was time to alert police. After pooling the evidence amassed, investigators quickly realized that the two lead suspects had also apparently ensured that their children, in-laws, siblings and even cousins had all filed claims with the NII and insurance companies. A wide variety of family members and acquaintances of the two, police found, claimed to have been involved in car collisions, almost all of which were similar, and suffered from similar injuries. NECU investigators believe that some of the crashes were staged, while others simply never occurred. "Victims" allegedly submitted to the NII exaggerated or forged pay stubs to increase their reimbursements for loss of work. In some of the cases, police say, the driver hitting the "victims'" car was simply an innocent driver who happened to have been traveling behind the wrong car, whereas in other cases, detectives believe, the second driver was also involved in the scheme. The remands of Yosef and Avado - as well as those of Yosef's two children and of at least four of the doctors - were extended Tuesday evening by Ramle Magistrate's Court Judge Liora Frankel, for periods ranging between two to seven days. Frankel did, however, agree to the doctors' attorneys' request to place a gag order on printing the names, places of work or any other identifying details pertaining to the seven suspect medical practitioners.

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