The Racket Club

There's good money to be made in the game of insurance fraud. Maybe that's why some greedy people are so willing to hustle for clients, fake injuries, stage car accidents, and tell lies.

In general Brod criticizes Florida's statutes against soliciting for being "so broadly drafted that almost anything is defined as solicitation." And he argues that accident victims actually suffer because of the laws in that they cannot easily be made aware of the services and attorneys available to them. "Victims of injuries," Brod says, "are really on their own in this state."

Luis Acosta -- in the form of undercover fraud investigator Andy Moya Awas never on his own for very long. After Rangel referred him to attorney Raul Delgado's office, a secretary arranged a medical appointment for him. On January 17, 1991, Acosta made his first visit to Miami X-R Medical Center on Flagler Street in Little Havana.

His first contact at the clinic was with the receptionist, a sweet-tempered, gray-haired, grandmotherly figure by the name of Doris Blanco. (During this and subsequent appointments, investigator Moya wore a hidden tape recorder.) She was appalled when "Acosta" told her the accident had occurred almost a month earlier and he was only now seeing a doctor. The insurance company, she chided, would certainly use that delay against him. She told Acosta she would change his records to indicate that his initial visit to the clinic took place on December 21, just two days after the accident.

Acosta first saw Dr. Octavio de la Osa, an 80-year-old Cuban emigre. When Acosta was ushered into the examining room, the two men talked for a few minutes, during which time De la Osa wrote down basic information about his patient, such as his pulse and temperature A which seemed odd to Acosta, given that De la Osa had not bothered to check either.

"Now I am going to tell you where it hurts," De la Osa explained to Acosta as he showed the patient a chart of the human body. According to investigators, De la Osa then pointed to the neck and back on the diagram and told Acosta: "It has to forcibly hurt here, the neck."

After the initial exam, Acosta met again with receptionist Doris Blanco, who explained that they would also have to backdate any x-rays to show that they were taken on December 21. But again Blanco told Acosta not to worry; she would handle everything. On January 24 Acosta returned to the medical clinic to have x-rays taken. During that visit, Blanco handed him a sheet of paper listing about twenty dates, from December 21, 1990, through January 24, 1991. She told him to place his signature next to each date. This would verify that he had come to the clinic and had received treatment on each of those days.

On March 18, 1991, Acosta visited the clinic for the third time. Blanco again had a sheet for him to sign that listed more than a dozen dates of phony visits he had supposedly made to the clinic. But first she wanted Acosta to review the dates she had selected to make sure he hadn't been out of town on any of them. One time, she recalled, she had listed a number of dates for a client and learned he had been in jail on those days.

Acosta then met with another doctor at the clinic, Guido Alvarez, who asked him how he felt. As recorded by his hidden tape machine, Acosta told the doctor he felt fine and that he wasn't experiencing any lingering pain from the accident, which had occurred three months earlier. Alvarez then went over Acosta's x-ray with him and noted that he couldn't see anything wrong. After a quick check of Acosta's blood pressure and pulse, the visit was concluded.

Less than three weeks later U.S. Security Insurance received a report assessing Acosta's condition. The report, purportedly signed by Dr. Alvarez, indicated that Acosta had been examined six times, when in fact he had made only three visits to the clinic. It noted that Acosta was "evidencing unquestionable limitation in motions from the areas of the trauma." In addition, the report claimed that Acosta suffered a "marked tenderness to palpation over the entire cervical spinous process" and "marked spasms bilaterally affecting all muscles and ligaments; motions painful and limited."

The report, allegedly prepared by Alvarez, further claimed that Acosta complained of pain during the "head compression test," and concluded that "the patient be considered as left with a 5-6 percent permanent partial impairment of the body, as a whole, as the result of his injuries."

Two days after the arrival of that report, the insurance company received a bill from Miami X-R Medical Center for $2920. As Doris Blanco had promised, the bill stated that Acosta's first appointment took place December 21, 1990. And although Acosta actually had been to the medical center a total of three times, thanks to Blanco the insurance company was billed for 39 visits. (Neither Blanco nor Alvarez returned calls seeking comment for this story.)

On May 13, 1991, Acosta called the medical clinic to ask what he should do next. Blanco gave him the name and phone number of another doctor, Pedro Alonso, who would provide a second opinion to corroborate Alvarez's diagnosis. A few weeks later Acosta met with Alonso at his Little Havana office. Acosta told Alonso that at one time his neck did hurt, but he no longer felt any pain. This, their one and only meeting, lasted a total of four minutes.

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