By Michael E. Miller
By Ryan Yousefi
By Kyle Munzenrieder
By Sabrina Rodriguez
By Michael E. Miller
By Carlos Suarez De Jesus
By Luther Campbell
By Kyle Munzenrieder
The other driver's insurance company, eager to avoid the hassle and expense of going to court, will often settle the claim. The lawyer and the doctor then each take a hefty percentage of the settlement — to cover legal fees and treatment costs — and the client will get whatever small portion remains.
411-PAIN denies any wrongdoing, and a lawyer for the company has called the lawsuit "frivolous." They claim doctors in their network are treating people with legitimate injuries.
James Quiggle, communications director for the nonprofit Coalition Against Insurance Fraud in Washington, D.C., did not have direct knowledge of the 411-PAIN lawsuit but said that generally, in personal injury cases, it can be difficult to prove whether medical treatment was justified or doctors are exaggerating to inflate their fees.
"Many clinics carefully tread a thin line between legal abuse and criminal fraud," Quiggle says. "These clinics try to dance right to the edge of a legal cliff without falling off. The operators can rake in big insurance dollars while making it hard for prosecutors to prove outright fraud."
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When Rodriguez got a 411-PAIN operator on the phone in June, he explained that he and Sohan had been in a car crash and that his back was hurting. Neither man has a primary-care doctor. The operator told Rodriguez where Broward Rehab was located and got him an appointment for a few hours later.
The two men drove to the office, located in a battered West Oakland Park Boulevard strip mall. The clinic's floor-to-ceiling windows were made of reflective glass and shielded by black shades.
The Broward Rehab waiting room was ordinary — magazines in one corner, TV mounted on another wall. Rodriguez filled out piles of paperwork detailing his injury and Sohan's auto insurance information, since Sohan was the driver of the car.
Sohan didn't see a doctor that day. "I was kind of skeptical about it," he says. "I know I can't afford to pay for a chiropractor." But the next day, when he returned with Rodriguez, he was in so much pain that he too decided to get an appointment. Thus began an almost-daily slog of doctor visits. Although the men wouldn't see the bills right away, they started racking up.
Sohan's visit began with three x-rays of his back. Then he was told to lie on a bed while a machine emitted tiny shock waves that forced the muscles in his back to clench and relax. This was called electric muscle stimulation (EMS), a therapy designed to relieve inflammation and pain.
Then, he received a ten-minute back massage from a massage therapist. Next, Sohan met with a chiropractor. She had him lie on a bed with levers to move his back up and down. This was called "mechanical traction," a chiropractic technique designed to stretch and relax his spinal muscles. "That made it worse," Sohan says. "It never cracked my back."
Like many people, Sohan did not have a full grasp of the medical terminology and technology, but he trusted the doctors to make the right decision for his health.
The therapies he received, while perhaps medically debatable, are not uncommon in the chiropractic world. But Sohan — young, healthy, unaccustomed to dealing with doctors — didn't probe too deeply. Every time he came to the clinic, employees had Sohan sign off on a document spelling out each service he received. And he scrawled his initials, although he didn't know what EMS or mechanical traction were.
Sohan always left the clinic without paying. He wouldn't see a written bill until months later, when he'd stopped going to Broward Rehab. That's when he discovered he was billed for many things he doesn't remember receiving. There were 19 ultrasounds, although he says he only got one or two, and 17 charges for therapeutic exercises at $150 a pop, which he says he never did.
This is precisely the problem McChristian, the insurance advocate, rails against.
"The individual may not know that they're being billed for certain services or that their insurance companies are being billed for treatment they never received," McChristian explains. "The individual isn't getting the $10,000. In their name, services are being billed."
Then, there was the legal trouble. During his first Broward Rehab visit, the receptionist gave Rodriguez the name and number of a lawyer he should call. Askins, of the Division of Insurance Fraud, says a referral to a lawyer is common practice for accident clinics. "That seems to always happen — they just have a personal injury lawyer waiting in the wings," he says.
Sohan and Rodriguez were referred to a Pompano Beach lawyer who did little except read them a contract outlining his fee — 33.3 percent of any settlement up to $1 million, provided they settled the case before the other driver's insurance company filed an answer to their complaint. If the case dragged on longer, the fee went up to 40 percent.
"'We're gonna win this case,'" Rodriguez remembers the lawyer saying. "'Keep going to therapy, as much as they say.'"