An indictment has been unsealed in the United States District Court for the Southern District of New York charging four individuals in an alleged trip-and-fall scheme defrauding victims of more than $31 million.
Indictment Charges Ortho and Pain Docs in Trip-And-Fall Scheme
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Dr. Dowd, an orthopedic surgeon, and Dr. Ribeiro, a pain management specialist and surgeon, reportedly participated in the scheme. In order to increase the value of the fraudulent claims, patients would allegedly be required to undergo surgeries. Patients were supposedly paid between $1,000 and $1,500 per surgery. As alleged, “patients generally were told to undergo two surgeries.”
Dr. Dowd and Dr. Ribeiro allegedly conducted surgeries regardless of the legitimate medical need for the procedures. As claimed in the indictment, the procedures included discectomies, spinal fusions, knee and shoulder surgeries, and non-surgical epidural injections.
The indictment alleged two separate fraud schemes that operated in substantially the same manner. The indictment listed six charges: conspiracy to commit mail and wire fraud, mail fraud, wire fraud, conspiracy to commit mail and fraud, mail fraud, and wire fraud. The indictment named the following as defendants: George Constantine; Marc Elefant; Andrew Dowd, M.D.; and Sady Ribeiro, M.D.
It claimed that fraud scheme participants would recruit individuals to stage trip-and-fall accidents. The accidents were purportedly staged when the individual would go to a specific location and deliberately fall.
The indictment asserts that the individuals recruited were extremely poor and/or drug addicts, and many were recruited from homeless shelters. It was common, the indictment alleges, “for patients to ask for food when they would appear for their intake meetings with the lawyers.”
Lawyers Constantine and Elefant are charged in the fraud scheme. The lawyers allegedly would commence personal injury lawsuits “against the property owners of the accident sights and/or the property owners’ insurers.” The lawyers purportedly would not disclose that the falls were deliberate, and in some instances, never occurred at all.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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