Attorneys, Physicians Charged in $31M Trip-and-Fall Fraud Scheme

By Claims Journal staff | August 27, 2021

Two attorneys and two doctors are charged in a $31 million insurance fraud scheme where plaintiffs were allegedly recruited from New York City homeless shelters to stage accidents at locations with identified trip hazards, federal prosecutors say.

The conspirators left behind a string of e-mails that revealed the doctors cooperated with the lawyers and a litigation funding company to perform surgeries on some 400 “patients” who had filed injury claims, according to a press release by the U.S. Attorney for Southern District of New York. The patients paid from $1,000 to $1,500 after they competed surgeries.

“In carrying out the scheme, the defendants allegedly preyed upon the most vulnerable members of society,” stated Manhattan U.S. Attorney Audrey Strauss. “Now, thanks to the FBI, the defendants are in custody and facing federal charges.”

Attorneys George Constantine and Marc Elefant and physicians Andrew Dowd and Sady Ribeiro were charged with conspiracy to commit mail fraud and wire fraud, mail fraud and wire fraud in a grand jury indictment unsealed on Wednesday.

Prosecutors say recruiters for the lawyers would find extremely poor individuals to participate in the scheme, often by visiting homeless shelters. They would direct participants to go to stage trip-and-fall accidents by deliberately falling in specific locations, typically places there were openings for cellar doors, potholes or cracks on sidewalks. The “victims” were told to visit specific attorneys, including Constantine and Elefant.

The attorneys, in turn, would file fraudulent lawsuits and direct the plaintiffs to visit specific physicians, including Dowd and Ribeiro. The purported victims were told they would have to undergo surgeries—typically two—before they were paid, prosecutors say.

FBI investigators say they uncovered emails that reveal the nature of the scheme. For example, Ribeiro allegedly sent this message to an unidentified litigation funding company in New Jersey: “I will play very honest ‘game’ with you . . . I see the patient and I generate a very good dictation that justifies the treatment—there is a cost for that and I hope a profit.”

The scheme organizers also gave explicit directions in emails to the doctors. For example, one of the participants in the scheme instructed Dowd to “write us an additional report today stating that (a patient’s) Lt. shoulder has worsened (so that I can) book this surgery for you.”

Dowd provided the requested report and recommended that the patient undergo arthroscopic surgery, according to the press release.

Prosecutors say the funding companies paid the fraudsters’ referral fees, typically $1,000 to $2,500, for each patient who signed a funding agreement. In exchange for paying for medical and legal costs, the funding companies charged the patients high interest rates, sometimes up to 50% on medical loans and up to 100% on personal loans, the indictment says.

“The interest rates were so high that oftentimes the majority (if not all) of the proceeds that were awarded in the fraudulent lawsuits were paid to the funding companies, Constantine, Elefant, Dowd, Ribeiro and others, with the patients receiving a much smaller percentage of the remaining recovery,” the press release says.

Constantine, 58, and Elefant, 49, are New York-licensed attorneys who allegedly filed hundreds of fraudulent lawsuits, prosecutors say. Dowd, 45, is an orthopedic surgeon who performed hundreds of knee and shoulder surgeries at an average cost of $9,500. Ribeiro, 51, is a pain management physician who paid kickbacks in exchange for patient referrals and treated nearly 200 patients during the fraud scheme, prosecutors say.

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