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Law

The Local Firm Leading the RICO Case Against Dozens of New York Healthcare Defendants

The Willis Law Group is representing a plaintiff claiming that New York construction workers are faking falls and making money for providers, medical facilities, and lawyers.
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What happens with construction safety classes become grooming opportunities to see which future workers might be open to staging an accident and committing insurance fraud? Who is to blame when workers stage accidents and have their non-existent injuries confirmed, treated, and charged by physicians?

These are the questions and allegations put forth by a New York plaintiff’s Racketeer Influenced and Corrupt Organizations Act case, which is how mafia conspiracy cases are often prosecuted. The federal lawsuit names dozens of defendants accused of participating in a scheme to defraud New York construction companies and property owners.

Forty-six defendants, hundreds of claims, and potentially hundreds of millions of dollars in damages are daunting tasks for the average law firm, but that’s the challenge facing Garland-based Willis Law Group, which has made a name for itself as a white-collar defense firm. The firm is stepping into the role of plaintiff’s counsel for the Roosevelt case.

Among the defendants are physicians, healthcare providers, caregivers, healthcare facilities, law firms, and litigation funding companies, which provide funds to law firms to finance the litigation and those suing their employer to entice the individuals to file suit, knowing they will still have income.

According to Bermuda-based reinsurer Roosevelt Road Re’s 99-page complaint, the plaintiff is attempting to recover funds it claims were fraudulently obtained by the defendants by exploiting the New York State Worker’s Compensation system. The complaint alleges that the defendants took advantage of vulnerable immigrant construction workers to employ what it calls the “Fraudulent Treatment Protocol.”

Roosevelt saw around $14 million in claim adjustment expenses in 2018 rise to more than $142 million in 2022. During that time, construction accidents in New York City decreased from 759 in 2018 to 554 in 2022. These increased costs of doing business are often passed on to renters and tenants.

Here is how it allegedly worked: Workers attending a mandatory Occupational Safety and Health Administration course to be able to work construction are told what to do if an accident occurs and, in the words of Willis’ team, coached how to fake an accident to get money out of the construction company and building owner. The classes are led by nonprofit organizations and are sponsored by law firms to teach the Spanish language OSHA classes and identify potential claimants who can later become the firm’s clients. Some of the coaching was caught on camera by the construction company’s security cameras. “For a lawsuit there must be a fall, some material falling on a person’s head or on another body part, that is a lawsuit,” the OSHA instructor told the workers in 2022.

“They have these so-called safety training classes, but they are classes to groom folks on how to fake an accident, get their legal representation, and receive money at the end of the day,” says Willis Law Group supervising partner William Clay.

After obtaining the OSHA cards enabling them to work with construction companies, workers would sign on to a crew and allegedly fake an accident. Others the construction company didn’t officially employ would wander onto a construction site when the team wasn’t there. “We have footage of people looking as though they are construction workers, and they will lay down until someone comes and discovers them on the site,” Willis Law Group CEO Kirk Willis says. He says many falls caught on camera don’t align with the reported injuries.

ABC7 in New York viewed some construction site footage connected to the lawsuit. The station described a video where a woman walked slowly down a makeshift stairway before falling down the last couple of steps. The fall appears to be minor, but the lawsuit she filed against the property owner and construction company says her injuries left her paralyzed and suffering from severe mental shock and anguish. Firms named in the lawsuit told ABC7 that they deny any wrongdoing.

The complaint says that after the alleged accidents, workers head to a clinic where a provider sees them. But the plaintiff argues that the exam, if it occurs at all, isn’t legitimate. The exams are a pretext to report similar or identical findings and justify unnecessary treatment for a number of workers. Prematurely obtained medical imaging is used to justify conservative and illegitimate treatment, which inevitably fails and is used to justify more unnecessary injections or surgeries performed at ambulatory surgery centers. The treatment benefits the facilities and providers, while the claimants’ tort lawyers can create a financial windfall by submitting documents to the construction firm’s insurance company and the state’s worker’s compensation board.

“We believe a number of these workers are getting surgeries that weren’t needed,” Clay says. Our doctors will say that the surgery performed was not the standard of care and that there’s no medical reason to have it.”

Willis says they have found around 700 cases they are analyzing as potentially fraudulent from the period in question. Court documents describe how the COVID-19 pandemic’s impact on healthcare spending meant that the claims were largely undetected until 2022. Willis says the total dollar amount increases by the day. The complaint says the median settlement amount for these claims was $2 million. If just a third of the 700 claims end up as fraudulent, it makes for hundreds of millions of dollars worth of fraud.

Willis says they are waiting on the responses from the dozens of defendants and hopes that the Department of Justice will take note of the case and conduct a criminal investigation for fraud. New York legislators are already taking notice. A state representative in the Empire State has introduced a bill that would make it a felony to stage a construction site accident for the purposes of fraud.

He says the firm has also been contacted by other companies that suspect they are victims of a similar scheme. “Other companies have said, ‘Reading this complaint brings a tear to my eye because I have been saying this for years and years, and finally someone has done something about it.'” Willis says. “I was pleased to hear they may want to join this endeavor.”

Author

Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…

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