In January of this year, podiatrist Peter Ajemian of New Jersey pleaded guilty to the charge of submitting false insurance claim reports on behalf of employees of the Long Island Railroad. These employees thought they would take an early retirement at the expense of the other employees, and the taxpayers who contributed to the Long Island Railroad’s retirement system. The Long Island Railroad is the second largest commuter railroad in this country.
I realize the Long Island Railroad is an east coast operation, but I believe the nature of the crime these people participated in made it a worth while subject for discussion here in California. If this type of fraud is being done to the degree Dr. Ajemian operated at I know it is going on in other places right now. The Coalition for Insurance Fraud stated that if the good doctor had not been stopped, the fraud could have easily reached $1 billion.
The podiatrist is reported to have assisted at least 700 employees by providing a medical opinion that enabled the employees to qualify as occupationally disabled. The story goes that the employees would pay Dr. Ajemian anywhere from $700 to $1,200 to qualify them as unfit for further employment. In addition the Doctor would provide false medical records and x-rays to support the fraudulent claims.
Dr. Ajemian had taken at least $2.5 million in bribes from the employees before the spree ended. Dr. Ajemian also is accused of billing millions for worthless x-rays and hospital visits as well as physical therapy.
The Doctor’s illegal behavior lasted nine years before he was stopped. As many as 16 conspirators have now pleaded guilty to participating in the insurance fraud and received amnesty from prosecution in return. One of the individuals who turned on the Doctor was his own office manager.
The investigation of Dr. Ajemian was quite extensive, as an example, one of the participants in the fraud was a train conductor, Mr. Christopher Parlante, who took $295,000 in benefits. The conductor complained of pain in his back and his neck; however he managed to work a reported 1,150 hours of overtime during the two years prior to his retirement. He was apprehended shoveling snow from his driveway in January of 2013, and he has since pleaded guilty to the charge of insurance fraud.
Mr. Daniel Denis, who worked as a ticket agent for the railroad, indicated that he was disabled and with Dr. Ajemian’s help, obtained his disability benefits. However, Mr. Denis worked 651 hours of overtime the year prior to his retirement and when he finally left the railroad he worked as a bartender, gardener and completed several of his home improvement projects. Mr. Denis has also pleaded guilty to insurance fraud.
Dr. Ajemian faces a 10 year prison sentence and will be charged with the repayment of at least the $233 million he is reported as having taken in this scheme.
It is estimated that in 2013 the income from insurance fraud will top out at $80 billion. If insurance fraud was an industry it would be on the Fortune 500’s list. If you believe you have been defrauded in some type of insurance scheme, or if you know of one currently going on at the present time, here are at least two constructive things you can do:
1) Call the insurance company which you believe is being defrauded; most insurance companies will have some type of a hot line and will take your call on an anonymous basis.
2) Call the National Insurance Crime Bureau at 1-800-835-6422. This organization will not only notify the insurance company being harmed, but they also investigate the charges.
Perhaps if more involvement took place by people who care, our premiums would come down. Remember, it is your insurance premium money that you are being defrauded of.