Five years ago, Alan Cohen, former director of a Lawrence chiropractic clinic, was fined $ 2,000 for his 90-day jail sentence and 1,000 hours of community service for the fake accident fraud cases that made him a multimillionaire.
But last month a Suffolk Supreme Court judge ruled that Cohen’s fraudulent behavior should cost him part of the assets he was demanding from insurance companies.
Judge C. Cratsley cited Cohen’s August 10, 2006 guilty guilty plea for conspiracy in auto insurance fraud in a final verdict asking him, his brother Marc, and their now defunct clinics to pay $ 6.7 million to four insurance companies.
The judge stated: “Cohen admitted under oath that he had conspired with runners Carlos Pinales and Jose Ansiani to stage car accidents and have the accident victims referred to Lawrence Back & Neck as patients.” The clinic would then make fraudulent medical claims for unnecessary and excessive treatment.
Cohen made more than $ 3.2 million at Lawrence Back & Neck in 2003 alone – the highest-billing clinic in the state and one of six Cohen clinics (three in Lawrence) named in the lawsuit. The other two clinics Cohen operates in town are Primer Quiropractico and South Lawrence Chiropractic & Rehabilitation. Primer was once the top 11 billing clinic in the state at $ 1.2 million, while South Lawrence billed $ 987,000.
The lawsuit also named Cohen’s two Dorchester clinics – Champion Spine Center ($ 1.7 million) and First Injury Chiropractic ($ 1.5 million) – ranked fourth and sixth, respectively, in the state. Along with the sixth clinic – West Lynn Chiropractic Rehab ($ 767,000), the six Cohen clinics billed more than $ 9 million in 2003 – a year before Cohen lost his chiropractic license, according to The Eagle-Tribune verified insurance industry data.
The landmark court ruling is only a fraction of what Cohen’s empire believes the industry has done. Commerce Insurance Co., the state’s largest auto insurer, will receive $ 3.8 million – including triple damages for violations of the Federal Racketeer Influenced and Corrupt Organizations (RICO) Act and nearly $ 600,000 in legal fees, according to court records.
The ruling also includes payouts to premier ins. Co. ($ 1.3 million), Encompass Insurance Co. ($ 1.2 million), and The Norfolk & Dedham Group ($ 454,000).
Cratsley noted that the Cohens ‘widespread use of “runners” to stage fake car accidents and a “prepackaged treatment” for accident victims who became patients at Cohens’ clinics was fraudulent.
The judge also found in his ruling that the insurers “presented indisputable evidence that Alan and Marc Cohen, and thus the Subject Cohen Clinics, were administering a corrupt group of companies involved in extortion activities through their fraudulent use of US mail . “
“The Cohens have committed fraudulent secrecy by filing claims to insurers for patients who have been asked by runners and have not been involved in real accidents,” the judge concluded.
Attorney David O. Brink, litigation manager of the Braintree law firm Smith & Brink, which represented the insurance companies in the case, hailed the ruling as “a milestone” in the fight against auto insurance fraud.
“Hopefully this will deter others from participating in such programs in the future,” Brink said in a telephone interview last week.
“This is possibly a very important decision, as it was one of the first cases I knew of in Massachusetts where the court had an opportunity to examine the role of the runner in a civil law context in automotive lawsuits,” Brink said who specialized in fighting insurance for a quarter of a century.
The case began when the Cohens and their Blue Hill Chiropractic Group, Inc. sued Commerce, Encompasse and Premier for alleging insurers failed to pay Personal Injury Protection (PIP) for claims made on behalf of patients, who have received chiropractic treatment. They also accused the insurers of breach of contract and price fixing.
After the cases were consolidated and moved to the Superior Court, insurers sued Blue Hill, claiming the Cohens and their clinics had a coordinated practice of inappropriate and fraudulent billing. They alleged violations of federal law by RICO.
In October 2008, the court dismissed Blue Hill’s claims and left the insurers’ claims pending. Shortly thereafter, the Cohen brothers and their secretary announced through their attorneys their intention to uphold a privilege under the Fifth Amendment and not to testify in court.
In individual statements for the lawsuit, runners Pinales and Ansiani both confirmed Cohen’s 2006 admission that he had hired her to stage fake accidents and refer participants to Cohen clinics.
“The Cohens did not submit any evidence in response to this specific lawsuit, and so the summary of the judgments relating to these fraudulent transactions is completely undisputed,” the judge concluded.
“The widespread use by Cohens of a pre-determined treatment prescription (‘the Cohen Prescription’) administered to patients by chiropractic assistants prior to the chiropractic consultation, combined with confirmatory misrepresentations that Cohens presented to insurers that such treatment was appropriate necessary, also constituted fraud, “ruled the judge.
Court documents showed that while the clinics treated multiple applicants from the same insured vehicles, each applicant received essentially the same diagnosis and treatment. They also found that the same patients were often treated for multiple accidents and that the vehicles involved in the reported accidents suffered little or no damage, despite being billed thousands of dollars for chiropractic treatment. Despite allegedly extensive chiropractic treatment, the patients made only a few claims for wages.
Cohen, his Essex Street clinic, and other operations that grossed $ 10 million nationwide were featured in the five-part Eagle Tribune investigative series, “At Fault: Inside the Culture of Auto Insurance Fraud.”
Governor Mitt Romney later credited the June 2004 series for helping pass an “anti-runners law” that made it a criminal offense for attorneys and healthcare professionals to pay “runners” to provide clients bring.
The Eagle Tribune series described Cohen as an entrepreneur who had built an empire of chiropractic clinics that grossed him millions of dollars, along with the unwelcome attention of investigators. Within weeks of the series’ release, the Massachusetts Board of Registration of Chiropractors suspended Cohen’s license for 30 months. An Essex County grand jury later called and indicted Cohen along with 15 others, including chiropractors, attorneys, an insurance broker and clerks, on charges of fraud and conspiracy. Cohen was unavailable for comment.