Jury Convicts Three Chiropractors and One Recruiter in Staged Automobile Accident Scheme
Ninety-Three Defendants Have Been Charged to Date in Operation Sledgehammer I-VI
|U.S. Attorney’s Office April 22, 2014|
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Jose A. Gonzalez, Special Agent in Charge, Internal Revenue Service, Criminal Investigation (IRS-CI); Jeff Atwater, Florida Chief Financial Officer; and Dave Aronberg, State Attorney, Office of the State Attorney for Palm Beach County, announced that after a six-week trial before U.S. District Judge Kenneth A. Marra, a federal jury in West Palm Beach convicted defendants Kenneth Karow, 54, chiropractor, of West Palm Beach; Hermann J. Diehl, 44, chiropractor, of Miami; Hal Mark Kreitman, 50, former chiropractor, of Miami Beach; and Joel Antonio Simon Ramirez, 29, staged automobile accident recruiter, of West Palm Beach, for their participation in a massive staged automobile accident scheme based in Palm Beach and Miami-Dade Counties.
All of the defendants were convicted of one count of conspiracy to commit mail fraud, in violation of Title 18, United States Code, Section 1341, all in violation of Title 18, United States Code, Section 1349; and one count of conspiracy to commit money laundering, in violation of Title 18, United States Code, Sections 1956(a)(1), all in violation of Title 18, United States Code, Section 1956(h). Defendant Karow was convicted of 48 substantive counts of mail fraud, in violation of Title 18, United States Code, Sections 1341 and 2, and 11 substantive counts of money laundering, in violation of Title 18, United States Code, Sections 1956(a)(1)(A)(i), 1956(a)(1)(B)(i), 1956(a)(1)(B)(ii) and 2. Defendant Diehl was convicted of two substantive counts of mail fraud and three substantive counts of money laundering. Defendant Kreitman was convicted of 21 substantive counts of mail fraud and two substantive counts of money laundering. Defendant Simon-Ramirez was convicted of eight substantive counts of mail fraud and one substantive count of money laundering.
According to the superseding indictment, these four defendants were charged with defrauding insurance companies out of personal injury protection (PIP) insurance payments through the use of the United States mail. This indictment alleges that the fraud was committed in a number of ways, including (1) by soliciting licensed chiropractors, including defendants Karow and Diehl, who would serve as the “named owners” of chiropractic clinics although others would maintain financial control over the businesses in order to avoid Florida’s licensing restrictions; (2) by recruiting individuals to participate in staged automobile accidents or persons who had been in real automobile accidents but who had not suffered any injuries to attend chiropractic clinics and make claims for reimbursement for treatments that were neither needed nor received; (3) submitting fraudulent claims to insurance companies stating that the bills were for treatments that were medically necessary and were actually received when neither was true; (4) submitting claims to insurance companies without attempting to collect co-pays and deductibles from the insureds and without disclosing that fact to the insurance companies; and (5) converting the money collected from the insurance companies to cash which would be used to pay recruiters, patients, and other participants and to enrich the members of the conspiracy.
This superseding indictment was the latest in a series of federal and state charges that have been part of a four-year investigation into a massive staged automobile accident/fraudulent chiropractic clinic scheme based in Palm Beach and Miami-Dade Counties. The joint federal and state law enforcement investigation, dubbed Operation Sledgehammer, has resulted in charges filed against 93 defendants for their participation in this automobile insurance fraud scheme. Of those 93 defendants, 57 have been charged federally by the U.S. Attorney’s Office, resulting in court-ordered restitution of more than $11 million to the defrauded insurance companies. With today’s verdicts, 51 of those 57 defendants have been convicted by jury or by guilty plea. The remaining six defendants are fugitives. Another 36 defendants have been charged by the Palm Beach County State Attorney’s Office.
According to the evidence presented at trial, between October 2006 and December 2012, the defendants and their co-conspirators staged automobile accidents and thereafter caused the submission of false insurance claims through chiropractic clinics they controlled. To execute the scheme, the true owners of the chiropractic clinics allegedly recruited individuals, who had the medical or chiropractic licenses required by the state to open a clinic, to act as “nominee owners” of the clinics. The defendants, including Simon Ramirez, also recruited individuals, whom they referred to as “Macho” and the “Hembra” or the “Perro” and “Perra,” to participate in the accidents, and others to help the clinics launder the insurance proceeds. The defendants also hired complicit chiropractors, including Diehl, Karow, and Kreitman, and therapists who prescribed and billed for unnecessary treatments and/or for services that had not been rendered. Thereafter, complicit clinic employees prepared and submitted claims to the automobile insurance companies for payment for these unnecessary or non-rendered services. Twenty-one clinics participated in this scheme.
The defendants face a maximum sentence of 20 years in prison each count of conspiracy to commit mail fraud, substantive mail fraud, conspiracy to commit money laundering, and substantive money laundering. Restitution to the victims of these offenses is mandatory. Sentencing for all four defendants is set for July 3, 2014, before Judge Marra in West Palm Beach.
Mr. Ferrer commended the efforts of the FBI, IRS-CI, the Florida Division of Insurance Fraud, the Palm Beach County State Attorney’s Office, and the Greater Palm Beach County Health Care Fraud Task Force for their outstanding work in this case. Mr. Ferrer also recognized the National Insurance Crime Bureau (NICB) for its collaboration and assistance in this investigation. This case was handled by Assistant U.S. Attorneys A. Marie Villafaña and E.J. Yera.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls.