Monday, June 3, 2024

New Jersey Man Sentenced To 10 Years In Prison For Leading One Of The Largest No-Fault Insurance Frauds In New York History

 

Damian Williams, the United States Attorney for the Southern District of New York, announced that BRADLEY PIERRE was sentenced to 10 years in prison by U.S. District Judge Paul G. Gardephe for conspiracy to commit bribery and conspiracy to defraud the Internal Revenue Service (“IRS”) in connection with his orchestration of a $60 million fraud targeting No-Fault automobile insurance companies.  PIERRE pled guilty before Judge Gardephe on December 18, 2023. 

U.S. Attorney Damian Williams said: “Bradley Pierre’s deceitful orchestration of a $60 million fraud — the largest in New York’s history — targeting No-Fault automobile insurance companies exemplifies a blatant disregard for justice and fairnessThrough bribery and manipulation, Pierre callously exploited the system, denying accident victims the rightful care they deservedWe commend the diligent work of the investigative team and career prosecutors whose dedication ensured accountability in this complex case.” 

According to the Indictment, the plea agreement, and statements made in court:  

New York and New Jersey No-Fault insurance laws require a driver’s automobile insurance company to pay automobile insurance claims automatically for certain types of motor vehicle accidents, provided that the claim is legitimate and below a particular monetary threshold.  Pursuant to these requirements, insurance companies will often pay medical service providers directly for the treatment they provide to automobile accident victims without the need to bill the victims themselves.  This process resolves automobile claims without apportioning blame or fault for the accident, thereby avoiding protracted disputes and the costs associated with an extended investigation of the accident. 

From at least in or about 2008 through in or about 2021, PIERRE agreed with others (the “Clinic Controllers”) to unlawfully own and run medical clinics located in the New York area, including, among others, Veda Medical, Sky Medical, Sun Medical, and Rutland Medical (the “Clinics”).  PIERRE knew that clinics are unable to bill insurance companies for No-Fault benefits if the medical facilities are controlled by non-physicians.  PIERRE nonetheless agreed with others, including doctors, to submit bills to insurance companies falsely representing that the Clinics were owned and operated by licensed doctors and to direct doctors to lie under oath during Examinations under Oath (“EUOs”) about the ownership, control, and finances of the Clinics.  PIERRE personally coached doctors to lie under oath in these EUOs.

PIERRE used his control of the Clinics for personal profit.  Between 2008 and 2021, PIERRE took over $20,000,000 from the Clinics by either transferring the funds directly to bank accounts under his control or using the Clinics’ bank accounts to pay his personal finances.  PIERRE also used his control of the Clinics to steer prescriptions to pharmacies in return for over a million dollars in kickbacks and to steer patients to seek legal representation from his wife’s law firm, the Law Firm of Nonna Shikh (the“Shikh Firm”).  The Shikh Firm then filed lawsuits against insurance companies on these patients’ behalf.  PIERRE maintained an office at the Shikh Firm and was actively involved in the legal practice as a “manager.”  The Shikh Firm made millions of dollars from the scheme and transferred over $4 million of illegal proceeds to PIERRE through a “marketing” arrangement between PIERRE’s shell companies and the Shikh Firm.

PIERRE used his control of the Clinics and his managerial role at the Shikh Firm to also steer patients to seek MRIs at a medical facility over which he exercised substantial control (the “MRI Facility”).  PIERRE also agreed with the purported sole owner of the MRI Facility, who was a doctor, that the doctor would falsely report injuries in MRI reports.  These falsified injuries allowed the Clinics to bill insurance companies for additional, unnecessary medical services and allowed attorneys to falsely claim injuries in lawsuits against insurance companies.  PIERRE and the doctor agreed that the doctor would lie to insurance companies during EUOs about PIERRE’s role in the MRI Facility.

PIERRE hid his control over several of the Clinics and the MRI Facility using phony loan arrangements.  These agreements claimed that PIERRE was making non-recourse loans to the Clinics and the MRI Facility, which would only have to be paid back if insurance companies paid the medical practices’ claims.  The agreements also set PIERRE’s “fee” as twice the amount loaned to the practices.  However, in reality, PIERRE took almost $10,000,000 in excess of what these purported loan agreements permitted.

PIERRE further agreed to pay bribes to fill the Clinics and the MRI Facility with patients.  From at least in or about 2015 up to and including 2021, PIERRE agreed with others to pay bribes to hospital employees, 911 dispatchers, and other individuals (collectively, “lead sources”) for the confidential names and numbers of motor vehicle accident victims.  PIERRE agreed that others, including Anthony Rose, a/k/a “Todd Chambers,” would then call victims and lie to them to induce victims to receive medical treatment at the Clinics and legal representation from the Shikh Firm.  PIERRE helped Rose expand his bribery operation to New Jersey by recommending clinics and attorneys in the state that would pay kickbacks for referrals.  PIERRE also recommended that Rose open a shell company to hide the illegality of the payments, which Rose in fact did.  PIERRE paid Rose over $800,000 as part of the bribery scheme.

PIERRE further recruited his own lead sources to participate in the bribery scheme.  For instance, in or about 2017, PIERRE recruited Andrew Prime, knowing that Prime was bribing 911 operators and a hospital employee for confidential information.  PIERRE paid Prime over $800,000 as part of the bribery scheme.  PIERRE also personally recruited and bribed several of his own lead sources, including 911 operators and a source in 2019 that PIERRE codenamed the “Motherload” or “ML.”

PIERRE also agreed to bribe medical offices to send patients to the MRI Facility for MRIs.  These medical offices included, among others, Epione Medical Center and Modern Brooklyn Medical.  PIERRE facilitated these bribe payments through several intermediaries, including Anthony Rose, Jelani Wray, and others.  PIERRE paid Jelani Wray over $800,000 in connection with these bribes.

PIERRE then engaged in tax evasion.  PIERRE utilized two companies in connection with the healthcare fraud and bribery schemes: Medical Reimbursement Consultants (“MRC”) and Marketing 4 You (“M4Y”).  PIERRE hid income from the IRS by concealing multiple bank accounts for MRC and using a series of check cashers for checks made out to MRC and M4Y.  PIERRE also paid personal expenses from MRC and M4Y’s bank accounts but improperly reported these payments as “business expenses.”  These included payments for his wedding, home renovations, jewelry, furniture, luxury clothing, travel, and gifts.  In total, PIERRE underreported income, falsely reported expenses of over $4 million, and deprived the IRS of approximately $1.5 million in taxes due.

In addition to the prison term, PIERRE, 41, of Closter, New Jersey, was sentenced to three years of supervised release.  PIERRE was also ordered to forfeit a money judgment of $3,500,000 and pay $1,500,000 in restitution.

Mr. Williams praised the investigative work of the Federal Bureau of Investigation.

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