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 his subsequent medical report, Alonso wrote that Acosta "evidenced pain and moderate spasms over the spinous process." Alonso also found that during one test, Acosta complained of pain at the base of the neck, "radiating to the left shoulder." Alonso's diagnosis: "I consider that he will be left with a six percent permanent physical impairment of his cervical spine with loss of whole body functions as a result of his injuries and the fibrosis of the muscles caused by the sprain."

Dr. Pedro Alonso did not respond to New Times's requests for an interview, but his attorney, Ed Carhart, says his client made the best diagnosis possible and that the process of determining a patient's physical impairment can be very subjective. It would be wrong, Carhart asserts, for anyone to second-guess Dr. Alonso's statements or to ascribe sinister motives to his actions.

With Acosta's medical files now in place, his attorney, Raul Delgado, wrote U.S. Security Insurance. Given the serious, permanent nature of Acosta's injuries, he demanded that the company settle the case for $8000. On instructions from fraud investigator John Askins, the insurance company evaluated the claim using its normal procedures. Its counteroffer: a measly $1500. Instead of fighting for more money, Delgado accepted the $1500, despite the medical opinions. Delgado took $500 in attorney's fees and another $140 for his costs. Acosta was given a check for the remaining $860.

The doctors fared no better. U.S. Security Insurance agreed to pay Miami X-R Medical Center a mere $348 of the $2920 it had billed. Likewise, Dr. Pedro Alonso received only $120 for his four-minute examination, rather than the $300 he had requested.

During Acosta's final meeting with Raul Delgado, he discussed with the attorney the unpaid portion of the medical bills. According to a subsequent report prepared by fraud investigator Susan Alberti, "Delgado told Acosta that the doctors could attempt to collect the bill, but that [Luis] Rangel had told him that Acosta had received almost no treatment by the doctors." Acosta then confirmed that he had had a total of only four medical appointments, not forty. Delgado, according to investigator Alberti, responded by noting that "this could be used as a basis for not paying the bill...." (Raul Delgado did not respond to repeated requests for comment regarding this article.)

After nearly a year of undercover work, the case that began with Luis Rangel and insurance company employee Patty Rodriguez still required several more months of work while charges were being prepared. Then Hurricane Andrew struck. With only five investigators to probe all allegations of insurance fraud in Dade and Monroe counties, each member of John Askins's squad is often forced to juggle upward of 80 cases simultaneously. The storm and its aftermath piled on more work than they could possibly handle.

Nobody knows better than the bad guys that Askins's office is undermanned. "He just doesn't have the staff," says Raymond, the former runner who asked that his last name not be used. "He didn't back when I was doing this and he doesn't now. And the folks who are still doing this today know that."

"It's very frustrating," says Susan Alberti, a former South Miami police officer who has been an investigator with the division of insurance fraud for five years. "Each one of us could dedicate all our time just trying to go after runners or some other type of fraud case, but we just don't have the manpower or the resources to do that.

"There is this perception that it's a victimless crime because it's not like a robbery or a murder," she adds. "You're talking about an insurance company as the victim, and people don't feel much compassion for insurance companies. But what people don't realize is that it all comes back to us. The insurance companies are just going to raise their premiums to cover their losses."

Those losses, of course, mean that others are making hefty profits. "We've seen these people become very wealthy," says Askins. "And once you start investigating them and get to the point of charging them, the money they have accumulated will buy them the very best defense attorneys in town. It makes it harder and harder to get them convicted. And even then, they are going to get slapped on the wrist, because you don't know what judge you're going to get. They may be standing before a judge who used to be an ambulance-chaser himself. There are certainly judges here who were high-volume personal-injury lawyers and they parlayed that into a lot of money. And money talks and then they become a judge."

Fellow fraud investigator Alberti agrees. "I've had two judges who wouldn't sign warrants in ambulance-chasing cases because they told me they didn't really think it was a crime," she says, though she declines to identify the judges. "I went so far with one that I pulled out the statute and had him read it along with me to see that it was a crime, and he still wouldn't sign it. Some of them don't want to put the ink to paper against a fellow attorney."

This past October, nearly three years after having first spoken with Patty Rodriguez, 41-year-old Luis Rangel was arrested and charged with soliciting clients. At the same time two doctors -- Guido Alvarez, age 64, and Pedro Alonso, 62 -- as well as Alvarez's receptionist, 68-year-old Doris Blanco, were each charged with insurance fraud and grand theft.

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