Plymouth Rock Cracks Down on Insurance Fraud in New Jersey

Car insurance group Plymouth Rock Assurance has filed three civil suits alleging several medical facilities and residents have violated the New Jersey Insurance Fraud Prevention Act. Plymouth Rock’s Special Investigation Unit launched the investigations which resulted in civil suits being filed to protect innocent drivers who could fall victim to insurance fraud and abuse in New Jersey.

“Ultimately, all car insurance customers bear the burden of the high cost of insurance fraud and abuse,” said Gerry Wilson, President and CEO of Plymouth Rock Management Company of New Jersey. “The direct victims who receive medical treatment from fraudulent individuals sometimes pay an even greater price–their health and well-being. That’s why we’re fighting hard to raise awareness about insurance fraud and take down the individuals responsible for it.”

October is Insurance Fraud Awareness Month in NJ, and Plymouth Rock hopes the announcement of their civil suits will call attention to the issue. In the first suit, six Paterson and Passaic residents are accused of material misrepresentation by reporting a car accident that did not occur. The drivers received cash incentives to stage the accident and seek treatment at specific medical facilities. The defendants are Ruben Padilla, Antonio Vidro, Pedro Anaya, Maria Anaya, Jenfry M. Ramos-Rodriguez, and Natyira Nervado.

The other two suits accuse medical professionals of unlawful practices. Acupuncture facilities DSY Acupuncture, Alpina Acupuncture, Miracle Acupuncture, and New Jersey Acupuncture are alleged to have sought reimbursement from Plymouth Rock for treatments not performed or performed without informed consent and/or a valid referral from a licensed physician. MLS Medical Group of Park Ridge is alleged to have billed for services not rendered; recordedpatient injuries to parts of the body in numbers that make those injuries a medical impossibility; submitted test results that were below the acceptable standard of care, making the tests not medically useful; and selected an improper amount and type of muscles on which to perform a needle electromyography (EMG).

“Fraudulent and abusive health care providers put profits ahead of patients,” added Wilson. “The advice we give to policyholders is to consult your own doctor first in the unfortunate event you are injured in a car accident.”

Source: Plymouth Rock Assurance