July 18, 2025 • 22 mins
Get ready for this Deep Dive! This episode breaks down the federal Racketeer Influenced and Corrupt Organizations Act (RICO) lawsuit brought by Union Mutual Fire Insurance Company against Liakas Law, P.C., and Dean Liakas. We discuss the Defendants' request for a pre-motion conference to dismiss the complaint.
In response, Plaintiff's counsel from Willis Law Group not only refutes these points, asserting Union Mutual's direct injury as an insurer, they detail specific of the allegations and it details an unbelievable story of alleged fraud, connections, and an incredible and complex web of fraudulent activity, medical negligence, and so much more! All in all emphasizing the sufficiency and detail of their RICO pleading, and distinguishing cited case law regarding litigation activity as a predicate act in this context.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:08):
Okay, picture this, a scheme, So elaborate, it
weaves together completely fakeaccidents, medically unnecessary
and sometimes incredibly harmfulsurgeries, and then add a whole
complex web of legal and medicalprofessionals, all allegedly
conspiring to defraud millions.
SPEAKER_02 (00:28):
Yeah, it sounds like something straight out of a
thriller novel, doesn't it?
But what we're about to unpacktoday is very much grounded in
the real world, in actual legaldocuments.
SPEAKER_00 (00:38):
Exactly.
And that's precisely why wewanted to dig into this one.
Today, we're taking a deep diveinto a really fascinating,
complex, and frankly, prettyshocking case unfolding right
now in New York.
Right.
We've got a whole load of legaldocuments here related to a
civil lawsuit, union mutual fireinsurance company versus Liaca's
Law, PC, and others.
SPEAKER_02 (00:56):
Quite a stack of paper.
SPEAKER_00 (00:57):
It really is.
So our mission today is tounpack these sources, pull out
the most important bits ofinformation, the key insights,
and help you understand the coreallegations, who the alleged
players are, and the surprising,almost unbelievable details of
how this whole thing supposedlyoperated.
SPEAKER_02 (01:11):
It's a perfect example of how, you know, even
official information like legalfilings can be overwhelming.
But when you start seeing thepatterns, wow, it tells a wild
story.
SPEAKER_00 (01:22):
Definitely.
So let's get into it.
Where do we start with thisalleged fraud scheme and
conspiracy?
SPEAKER_02 (01:29):
Okay, so at its core, the central claim is this
widespread fraud scheme andconspiracy.
It allegedly started back in atleast 2018.
SPEAKER_00 (01:38):
OK.
SPEAKER_02 (01:40):
But there seems to have been a big jump, a real
escalation since about 2020.
And we're not talking about justa few random incidents.
The allegation is this was anorganized enterprise.
SPEAKER_00 (01:50):
An enterprise.
And what was the main goal?
What were they allegedly tryingto achieve?
SPEAKER_02 (01:53):
Well, the purpose, according to the lawsuit, was
pretty straightforward,systematically defraud of
insurance companies like UnionMutual Fire Insurance in this
case.
SPEAKER_00 (02:01):
How?
What were the alleged methods?
SPEAKER_02 (02:03):
It allegedly involved orchestrating fake trip
and fall accidents, thenmanufacturing injuries, or at
least grossly exaggerating minorones.
Then came providing medicallyunnecessary treatments, and this
is key, including majorsurgeries.
And finally, filing fraudulentpersonal injury lawsuits to get
these huge inflated settlements.
(02:23):
Wow.
The documents put it prettybluntly.
The aim was to, and I'm quotingloosely here, get desperate
people to fake or exaggerateaccidents and injuries and
undergo needless surgeries todraw out out the lawsuits and
get these fraudulent windfallsettlements.
SPEAKER_00 (02:38):
That's incredibly direct.
SPEAKER_02 (02:40):
It is.
And they even compare it in thefilings to a previous criminal
conviction, United States versusRainford, suggesting this isn't
a totally new playbook.
SPEAKER_00 (02:49):
Okay.
So if it's an enterprise, ascheme this widespread, there
must have been a lot of peopleinvolved.
Who are the alleged players inthis?
SPEAKER_02 (02:55):
Oh, it's quite the cast of characters spanning
several professions.
At the center, allegedlyorchestrating the whole thing,
you have the legal servicedefendants, that's Lyakos Law,
PC, and Dean The law.
Yes.
They're accused of being themasterminds, the coordinators.
Yeah.
They allegedly directed peoplecalled runners to find
claimants, arrange the funding,controlled who the claimants saw
(03:18):
for medical treatment to getfalse documentation.
And then they initiated andpushed forward these allegedly
fraudulent lawsuits usingdocuments they knew were false,
like verified complaints andbills of particulars.
SPEAKER_00 (03:31):
You mentioned runners.
What exactly was their role?
How did they fit in?
SPEAKER_02 (03:36):
There were apparently crucial.
These are the people the runnerdefendants referred to as John
Doe's one through 25 in thesuit.
SPEAKER_01 (03:42):
OK.
SPEAKER_02 (03:43):
Their job was allegedly to recruit potential
claimants and not just recruit,but to coach them on how to
stage an accident or exaggeratetheir injuries convincingly.
SPEAKER_00 (03:52):
So sort of teaching them how to perform the injury.
SPEAKER_02 (03:54):
That's the allegation.
Internally, they're apparentlycalled investigators or brokers.
Sometimes maybe to sound morelegitimate, they were called
paralegals or client servicesliaisons.
Receptive titles.
Seems like it.
SPEAKER_00 (04:07):
OK, so beyond the law firm and the runners, the
documents also name fundingdefendants like Prime Case LLC.
What was their part in all this?
Sounds like they were greasingthe wheels.
SPEAKER_02 (04:19):
That's a good way to put it.
This is where the financialmechanics get really
interesting.
These companies allegedlyprovided high-interest
litigation funding loansdirectly to the claimants.
SPEAKER_00 (04:30):
Okay, so money for the person who fell.
SPEAKER_02 (04:32):
Yes, but here's the really critical part.
They also allegedly made upfrontpayments directly to the medical
providers.
SPEAKER_00 (04:39):
Ah, paying the doctors up front.
SPEAKER_02 (04:41):
Exactly, to secure their cooperation in the scheme,
as the lawsuit puts it.
And these advances were oftenstructured cleverly as ownership
interest in future case payouts.
SPEAKER_00 (04:51):
Why structure it like that?
SPEAKER_02 (04:53):
Well, allegedly, to shield them from usury laws,
laws that cap interest rates.
The filings call this fundingessential for the whole
operation to work.
SPEAKER_00 (05:01):
Makes sense.
If you need doctors to dounnecessary things, paying them
up front seems like a way toensure that happens.
SPEAKER_02 (05:06):
Precisely.
SPEAKER_00 (05:07):
And that brings us to the medical providers
themselves.
This is where the alleged harmto individuals really seems to
hit home.
The list is pretty long.
Let's start with TotalOrthopedics, Drs.
Avinasov, Lerman, and Levin.
SPEAKER_02 (05:20):
Right.
These are orthopedic surgeons.
They're accused of recommendingand performing surgeries that
weren't medically needed andwere very expensive.
And get this.
One of them, Dr.
Lerman, actually had hisauthorization to treat injured
workers denied by the New YorkState Workers' Comp Board.
SPEAKER_01 (05:36):
Denied?
Why?
SPEAKER_02 (05:38):
The reason cited was performing highly invasive
surgeries without proper medicaljustification.
They said he showed wantondisregard that amounted to
professional misconduct.
SPEAKER_00 (05:48):
Wow.
That's a serious finding.
SPEAKER_02 (05:51):
It is.
And here's another detail.
Operative report written by drlerman and dr levin were
allegedly identical verbatimcopy paste jobs used across
numerous different patient cases
SPEAKER_00 (06:01):
wait identical reports for different people
undergoing surgery
SPEAKER_02 (06:05):
that's the allegation dr lerman's report
for example supposedly popped upin 25 other separate cases
SPEAKER_00 (06:10):
that just sounds blatant it's not even changing
the details
SPEAKER_02 (06:13):
it suggests a template a standardized process
rather than individualizedpatient care and it wasn't just
them McCulloch OrthopedicSurgical Services, with Dr.
Cappiola, another orthopedicsurgeon, is accused of using
similar identical operativereports.
SPEAKER_00 (06:30):
Okay, so a pattern emerges there.
What about neurosurgery?
Gotham Neurosurgery and Dr.
Anders Cohen are mentioned.
SPEAKER_02 (06:37):
Yes.
Dr.
Cohen is a neurosurgeon allegedto have performed unnecessary
spinal fusions.
And a particularly concerningdetail is that these fusions
were often done with only halfof the standard instrumentation.
SPEAKER_00 (06:50):
Half.
What does that mean practically?
SPEAKER_02 (06:52):
It often led predictably to the fusions
failing and causing more spinaldamage for the patient down the
SPEAKER_00 (06:58):
line.
That's horrific.
SPEAKER_02 (06:59):
It gets more complicated.
His wife apparently used to be amedical coordinator for the
Lyakas firm.
SPEAKER_00 (07:04):
Oh, a connection there.
SPEAKER_02 (07:06):
Mm-hmm.
And there are allegations ofkickback arrangements, including
him traveling from New York to aspecific hospital in New Jersey
to do these surgeries.
SPEAKER_00 (07:12):
Which hospital was that?
Was it involved too?
SPEAKER_02 (07:14):
Yes.
Hudson Regional Hospital in NewJersey.
They allegedly got directpayments from the funding
companies inside submittedhighly inflated leap-ins,
basically, claims for payment onthe patient cases.
SPEAKER_00 (07:27):
So the hospital was in on it, too, allegedly.
SPEAKER_02 (07:29):
They're accused of being part of the kickback
scheme, yes, and even arrangingtransport for the New York
patients to get out to theirfacility in Jersey.
SPEAKER_00 (07:37):
Okay, this web is getting wider.
What about the diagnostics?
You need scans, MRIs, right?
Accelerate Radiology and Dr.
Prakash are named.
SPEAKER_02 (07:45):
Right, they're accused of producing knowingly
falsified clinical anddiagnostic findings.
Essentially, writing MRI reportsthat routinely deviate from what
the scans actually showed aboutthe claimant's conditions.
SPEAKER_00 (07:58):
Falsified reports.
SPEAKER_02 (07:59):
That's the claim.
And here's a striking detail.
The company allegedly operatesout of an office that doesn't
even have an MRI machine.
SPEAKER_00 (08:06):
So where were the scans done?
SPEAKER_02 (08:08):
They relied on undisclosed facilities.
Plus, the owner of the companythat came before Accelerate
Radiology allegedly altered MRIreports.
So it raises serious questionsabout the evidence base for
these injuries.
SPEAKER_00 (08:19):
Definitely.
And pain management.
Obviously.
Often a step before surgery.
SPEAKER_02 (08:22):
Yes.
Pain physicians of New York withdoctors Kosharsky and Reifman.
They allegedly provided themanufactured justification for
surgeries.
SPEAKER_01 (08:30):
How?
SPEAKER_02 (08:31):
Through false clinical exam reports and giving
unnecessary injections, kind ofbuilding a paper trail through
surgery.
Dr.
Reifman in particular has tiesto a previous illegal patient
referral and kickback scheme.
SPEAKER_00 (08:43):
History repeats itself, maybe.
SPEAKER_02 (08:45):
Potentially.
SPEAKER_00 (08:45):
Yeah.
SPEAKER_02 (08:46):
And lastly, there's Jean-Paul Errol Toussaint
accused of creating knowinglyfalse and or materially
misleading records andspecifically falsifying range of
motion reports, which are keyfor assessing injury severity.
SPEAKER_00 (08:58):
OK, so we've got this extensive network, the
lawyers coordinating, therunners recruiting, the funders
paying, the doctors operatingand diagnosing.
How did it all actually worktogether day to day?
Was there like a playbook?
SPEAKER_02 (09:11):
That's exactly how it's described.
A cookbook approach, apredetermined step by step
process.
SPEAKER_00 (09:15):
OK, walk us through it.
SPEAKER_02 (09:16):
So it starts with a claimant, often someone who
doesn't speak English well,allegedly being recruited and
coached on how to exaggeratetheir fallen injuries.
SPEAKER_01 (09:24):
Right.
SPEAKER_02 (09:25):
They're then directed straight to the Lyakas
firm.
They're told, allegedly told,that having surgeries will
significantly boost theirpotential payout.
SPEAKER_00 (09:34):
Ah, incentivizing surgery from the start.
SPEAKER_02 (09:36):
Exactly.
And then they're offered thislitigation funding, but it's
contingent on them sticking tothe plan, participating in these
predetermined rote protocoltreatments.
SPEAKER_00 (09:46):
So it's not driven by medical new book, but by this
alleged cookbook.
SPEAKER_02 (09:50):
That's the core allegation.
The medical providers, allegedlyworking together, order
unnecessary tests, MRIs of likeevery major joint just in case.
Wow.
And then they allegedly rely noton the actual scan images, but
on these falsified reports.
This rote protocol treatment andthese falsified findings create
the justification on paper forthese preplanned cookbook
(10:12):
surgeries.
SPEAKER_00 (10:13):
Let's make this concrete.
The documents give specificclaimant examples, right?
These are the moments thatreally show the alleged pattern.
What about claimant A?
SPEAKER_02 (10:20):
Okay, claimant A allegedly fell from just
standing height.
Minor incident, you'd think, butended up needing a spinal
fusion.
SPEAKER_00 (10:29):
Okay.
SPEAKER_02 (10:29):
For a condition that wasn't even found on his MRI.
SPEAKER_00 (10:32):
How is that
SPEAKER_02 (10:33):
possible?
Good question.
And the operative report for hissurgery.
Identical, allegedly, to 17other cases.
He later needed correctivesurgery because the first one
wasn't right.
SPEAKER_00 (10:44):
Unbelievable.
SPEAKER_02 (10:45):
And it gets stranger.
Several of his family membersalso had suspiciously similar
trip and fall accidents, endedup with the same law firm, same
doctors.
SPEAKER_00 (10:52):
That really strains coincidence, doesn't it?
SPEAKER_02 (10:55):
It certainly raises eyebrows.
SPEAKER_00 (10:56):
Okay, what about claimant B?
There was something about anoccult meniscal tear.
SPEAKER_02 (11:00):
Yes.
This one's quite technical butrevealing.
Claimant B was diagnosed beforeknee surgery with an occult
meniscal tear.
SPEAKER_00 (11:08):
What does occult mean here?
SPEAKER_02 (11:10):
It means hidden, something you can't see on
preoperative imaging like anMRI.
It can only be discovered duringthe surgery itself.
SPEAKER_00 (11:17):
So diagnosing it before surgery makes no sense.
SPEAKER_02 (11:20):
Exactly.
It's a medical contradiction.
A preoperative diagnosis of anoccult tear is basically
impossible.
Later, this same Clayman had alumbar spine fusion by Dr.
Levin based on what the suitcalls imagined justification
with no diagnostic support.
SPEAKER_00 (11:37):
Just wow.
OK.
Clayman D's story also seemedtelling, especially the timing
and the type of surgery.
SPEAKER_02 (11:43):
Right.
Clayman D's alleged fallhappened just seven days after
his brother's fall.
Right around the corner fromeach
SPEAKER_00 (11:49):
other.
Seven days apart.
Same area.
SPEAKER_02 (11:51):
And both represented by Liaka's law.
Then, Dr.
Cohen allegedly performed aone-sided spinal fusion on
claimant D.
SPEAKER_00 (11:59):
One-sided?
But what was the actual problem?
SPEAKER_02 (12:01):
The condition noted was bilateral affecting both
sides, but the surgery onlyaddressed one side.
SPEAKER_00 (12:06):
Why do that?
That seems incomplete, medicallynegligent even.
SPEAKER_02 (12:10):
The allegations suggest it wasn't about complete
medical care.
He also allegedly used acookbook operative report from a
case back in 2019 and this onesided approach.
It allegedly caused the surgeryto fail for the brother who then
needed revision surgery.
SPEAKER_00 (12:24):
So the surgery itself seemed designed to fit
the template, not the patient'sactual needs.
SPEAKER_02 (12:29):
That appears to be the claim.
The audacity is notable.
SPEAKER_00 (12:32):
Absolutely.
What about claimant F?
The one who went to the ER withjust a scratch.
SPEAKER_02 (12:37):
Yes.
Klamath presents the emergencyroom.
Records show only a superficialabrasion.
Crucially, no complaints of neckpain.
SPEAKER_01 (12:45):
Okay.
SPEAKER_02 (12:46):
Six days later, a doctor finds him totally
disabled.
Nine days after the fall, Dr.
Cohen diagnoses neck pain andperforms a C3-C4 neck surgery.
SPEAKER_00 (12:55):
But what did the scans show?
SPEAKER_02 (12:57):
Two separate MRIs showed nothing wrong with his
neck.
SPEAKER_00 (13:00):
Nothing wrong, but he gets neck surgery.
SPEAKER_02 (13:02):
That's the allegation.
Dr.
Cohen's operative report forthis surgery was called utterly
fictional in the lawsuit andagain was allegedly used
verbatim in four other cases.
SPEAKER_00 (13:11):
So why?
Why do such a risky, apparentlybaseless surgery?
SPEAKER_02 (13:16):
The source material points towards a possible
financial incentive from thecompany that made this specific
implant used in that surgery.
SPEAKER_00 (13:23):
A direct link between the device and the
decision to operate.
That's a powerful allegation.
It is.
And claimant G, her storysounded like a surgical
nightmare.
SPEAKER_02 (13:31):
It really does.
She needed spinal surgery for anerve issue on her left side.
Dr.
Cohen operated, but allegedly.
He operated on the right side.
SPEAKER_01 (13:40):
The wrong side.
SPEAKER_02 (13:41):
And installed screws on the wrong side.
And then, allegedly, omittedmentioning a key implant, a TLIF
cage, that should have beeninserted from the operative
report.
SPEAKER_00 (13:52):
Just completely wrong.
SPEAKER_02 (13:53):
A post-op CT scan apparently showed that Dr.
Cohen's description of what hedid and the results were utterly
incompatible with the actualsurgical outcome.
SPEAKER_00 (14:02):
What happened with her case?
SPEAKER_02 (14:04):
It was eventually settled at a falsely
manufactured and fraudulentlyinflated amount.
The alleged care It'sstaggering.
SPEAKER_00 (14:12):
Truly is.
Okay, one more.
It does
SPEAKER_02 (14:21):
raise questions.
No pain, no objective
SPEAKER_00 (14:29):
injury.
SPEAKER_02 (14:30):
Right.
without any diagnostic films toback it up.
And Dr.
Cohen performed a one-sided backsurgery, even though her
conditions were bilateral.
And guess which side he operatedon?
SPEAKER_00 (14:43):
Let me guess, not the side that needed it more.
SPEAKER_02 (14:45):
Allegedly, he focused on the side with less
imperative conditions.
And perhaps most damningly, allthe internal hospital documents
listed her condition as chronicand degenerative, not dramatic
from a recent fall.
SPEAKER_00 (14:59):
So the hospital's own records contradicted the
claim of a recent injury causingthis.
SPEAKER_02 (15:04):
That appears to be the case based on the filings.
It's hard to square a minorfall, no objective findings, and
chronic conditions conditionswith the surgeries performed.
SPEAKER_00 (15:13):
OK, so we see the alleged pattern through these
examples.
Let's talk about the moneyagain.
How did the financial flowactually work to benefit
everyone in the scheme?
SPEAKER_02 (15:21):
Right.
It's described as thisself-sustaining cycle of alleged
profit.
The medical providers, theyprofit from these hugely
inflated liens on the cases,plus those upfront payments from
the funders.
The Lyakas firm, the lawyers,they get their cut through
contingency fees from the biginflated settlements they
allegedly engineer.
SPEAKER_00 (15:40):
Right.
but on inflated amounts.
SPEAKER_02 (15:43):
Exactly.
And the funding defendants, theymake their money back, allegedly
with astronomical interest, onthe advances they made.
SPEAKER_00 (15:50):
So everyone in the alleged network gets paid well.
What about the claimant, theperson who actually had the
fall, the surgery?
SPEAKER_02 (15:57):
That's the really grim part, according to the
documents.
The claimants, the actualindividuals who went through all
this, often walk away with thesmallest portion of any money
recovered.
SPEAKER_00 (16:08):
So they bear the physical risk, the potentially
botched surgeries and get theleast financial benefit.
SPEAKER_02 (16:13):
That's the picture painted.
The lawsuit even gives examplesof what it calls alleged money
laundering, where proceeds over$10,000 were structured or
layered into legitimate incomestreams to hide where the money
came from.
SPEAKER_00 (16:25):
And they mention mail and wire fraud, too.
SPEAKER_02 (16:28):
Yes, extensively.
Things like mailing thefalsified bills of particulars
or medical records counts asalleged mail fraud.
using electronic filing systemsfor the lawsuits or for the UCC
statements related to thefunding liens that's alleged
wire fraud.
It shows how basicinfrastructure was allegedly
used to further the scheme.
SPEAKER_00 (16:47):
OK, this is clearly a massive, complex legal fight.
What are the specific legalclaims Union Mutual, the
insurance company, is makingagainst Liacus Law and all the
other defendants?
SPEAKER_02 (16:58):
They're bringing some very serious charges.
Multiple violations of ICO, theRacketeer Influenced and Corrupt
Organizations Act.
SPEAKER_00 (17:05):
ICO.
That's usually associated withorganized crime.
SPEAKER_02 (17:08):
It is.
And using it in a civil contextlike this is significant.
They're alleging racketeeringactivity, conspiracy to violate
ICO, and even using incomederived from that racketeering
to invest back into the scheme.
SPEAKER_00 (17:18):
Wow.
What else?
SPEAKER_02 (17:19):
Common law fraud, aiding and abetting fraud.
Unjust enrichment, basicallysaying the defendants got money
they weren't entitled to andviolations of New York's general
business law, Section 349, whichdeals with deceptive business
practices.
They want damages, obviously,but also injunctive relief to
stop these alleged practices.
SPEAKER_00 (17:40):
A full court press.
So how are the defendants,particularly Acas law,
responding?
What's their defense strategy?
SPEAKER_02 (17:47):
They're trying to get the whole case thrown out.
dismissed.
SPEAKER_00 (17:50):
On what grounds?
SPEAKER_02 (17:51):
Their main arguments are, first, that Union Mutual
doesn't have standing the legalright to sue because, they
claim, the insurance companydidn't suffer a direct injury.
SPEAKER_00 (18:01):
Hmm.
How can they argue the insurerwasn't directly injured by
paying out allegedly fraudulentclaims?
SPEAKER_02 (18:06):
Their argument seems to be that the injury is somehow
indirect, maybe filtered throughthe claimant.
They also argue the allegationsare conclusory, meaning they
lack enough specific factualdetail.
And critically, they argue thatnormal litigation That argument
about direct injury seems key.
SPEAKER_00 (18:38):
How does Union Mutual counter that?
SPEAKER_02 (18:41):
Union Mutual fires back pretty strongly.
They say their injury is directbecause under New York law, an
insurer's duty to defend kicksin the moment a claim is filed,
regardless of whether it'sultimately valid or fraudulent.
They have to start spendingmoney immediately.
SPEAKER_00 (18:56):
So the filing itself triggers a direct cost?
SPEAKER_02 (18:59):
Exactly.
And they cite specific case law,State Farm v.
Triborough, which they saydirectly refutes the defense's
point about litigation activity.
That case apparently establishedthat when you have these alleged
predetermined treatmentprotocols and pay-to-play
arrangements, litigation can bepart of our IACUSHA scheme.
SPEAKER_00 (19:15):
So the context matters.
SPEAKER_02 (19:17):
Right.
Union Mutual argues the wholescheme was specifically designed
to get around normal checks andbalances, like HIPAA privacy
rules and attorney-clientprivilege.
Forcing the insurance company torely on information that turned
out to be false.
SPEAKER_00 (19:30):
OK, so it's a complex legal back and forth.
We've gone through the allegedscheme, the players, the
examples, the legal arguments.
Let's pull back a bit.
Beyond the courtroom drama, whatdoes all this mean for you, the
listener?
What are the broaderimplications here?
SPEAKER_02 (19:45):
Yeah, this is really important.
This deep dive shows how ascheme like this, if the
allegations are true, has reallydramatic and widespread effects
on consumers, not just theinsurance companies.
How so?
Well, first, it clogs up thecourt system with fraudulent
cases.
It forces insurers to spend hugeamounts on needless
investigative, legal, otherclaims, and defense-related
(20:06):
spend.
And it leads to thesefraudulently obtained settlement
That's a massive waste ofresources across the board.
SPEAKER_00 (20:14):
And those wasted resources, that spending, it has
to come from somewhere, right?
It doesn't just vanish.
SPEAKER_02 (20:18):
Precisely.
It doesn't just hurt theinsurance company's bottom line.
It ultimately leads towrongfully driving up the cost
of legitimate insurance businessoperations.
SPEAKER_00 (20:29):
Which means?
SPEAKER_02 (20:30):
Which means needlessly escalating premiums
to the ultimate consumers ofliability insurance and the cost
of healthcare.
At the end of the day, that'severyone.
You.
Me.
We all end up paying morebecause of alleged fraud like
this.
SPEAKER_00 (20:44):
So it directly hits our wallets through higher
insurance costs and potentiallyhigher health care costs, too.
SPEAKER_02 (20:49):
Absolutely.
And this isn't just some obscurelegal theory.
We're seeing headlines aboutthis kind of thing now.
Things like MS-13, Russianmobsters use migrants in
elaborate injury scam, evengetting spinal surgery to pull
it off.
SPEAKER_01 (21:00):
Wow.
SPEAKER_02 (21:01):
Or construction workers in NY faking falls on
sites part of larger fraudscheme.
These headlines suggest thisisn't an isolated case, but but
points to a much broadersystemic vulnerability.
SPEAKER_00 (21:12):
So we've really unpacked an incredibly intricate
alleged fraud scheme today.
We've seen how all thesedifferent players, lawyers,
doctors, funders, runners couldpotentially fit together to form
this cohesive criminalenterprise, according to the
lawsuit.
SPEAKER_02 (21:28):
Yeah, it's a pretty sobering look at how deeply
these kinds of activities canapparently embed themselves
within our legal and medicalsystems.
SPEAKER_00 (21:34):
It really is.
This deep dive reveals how acomplex system, one undesigned,
you know, to provide justice andcare can allegedly be twisted
and exploited for massivepersonal gain.
SPEAKER_02 (21:47):
And often at the direct expense of vulnerable
people who get caught up in itand ultimately the wider public
footing the bill.
It definitely leaves youwondering about the hidden
costs, the ethical shortcutsthat might be lurking beneath
the surface of what look likeroutine processes.
SPEAKER_00 (22:02):
It really makes you think, doesn't it?
What does this tell us aboutjust how vigilant we need to be?
How much critical thinking isrequired in a world just
saturated with That's the
SPEAKER_02 (22:12):
big question.
And maybe what other complexsystems out there might be
vulnerable to this kind ofsophisticated exploitation?
And how can we, just as informedcitizens trying to navigate it
all, get better at telling thereal story from the fake one?
Okay, picture this, a scheme, So elaborate, it
weaves together completely fakeaccidents, medically unnecessary
and sometimes incredibly harmfulsurgeries, and then add a whole
complex web of legal and medicalprofessionals, all allegedly
conspiring to defraud millions.
SPEAKER_02 (00:28):
Yeah, it sounds like something straight out of a
thriller novel, doesn't it?
But what we're about to unpacktoday is very much grounded in
the real world, in actual legaldocuments.
SPEAKER_00 (00:38):
Exactly.
And that's precisely why wewanted to dig into this one.
Today, we're taking a deep diveinto a really fascinating,
complex, and frankly, prettyshocking case unfolding right
now in New York.
Right.
We've got a whole load of legaldocuments here related to a
civil lawsuit, union mutual fireinsurance company versus Liaca's
Law, PC, and others.
SPEAKER_02 (00:56):
Quite a stack of paper.
SPEAKER_00 (00:57):
It really is.
So our mission today is tounpack these sources, pull out
the most important bits ofinformation, the key insights,
and help you understand the coreallegations, who the alleged
players are, and the surprising,almost unbelievable details of
how this whole thing supposedlyoperated.
SPEAKER_02 (01:11):
It's a perfect example of how, you know, even
official information like legalfilings can be overwhelming.
But when you start seeing thepatterns, wow, it tells a wild
story.
SPEAKER_00 (01:22):
Definitely.
So let's get into it.
Where do we start with thisalleged fraud scheme and
conspiracy?
SPEAKER_02 (01:29):
Okay, so at its core, the central claim is this
widespread fraud scheme andconspiracy.
It allegedly started back in atleast 2018.
SPEAKER_00 (01:38):
OK.
SPEAKER_02 (01:40):
But there seems to have been a big jump, a real
escalation since about 2020.
And we're not talking about justa few random incidents.
The allegation is this was anorganized enterprise.
SPEAKER_00 (01:50):
An enterprise.
And what was the main goal?
What were they allegedly tryingto achieve?
SPEAKER_02 (01:53):
Well, the purpose, according to the lawsuit, was
pretty straightforward,systematically defraud of
insurance companies like UnionMutual Fire Insurance in this
case.
SPEAKER_00 (02:01):
How?
What were the alleged methods?
SPEAKER_02 (02:03):
It allegedly involved orchestrating fake trip
and fall accidents, thenmanufacturing injuries, or at
least grossly exaggerating minorones.
Then came providing medicallyunnecessary treatments, and this
is key, including majorsurgeries.
And finally, filing fraudulentpersonal injury lawsuits to get
these huge inflated settlements.
(02:23):
Wow.
The documents put it prettybluntly.
The aim was to, and I'm quotingloosely here, get desperate
people to fake or exaggerateaccidents and injuries and
undergo needless surgeries todraw out out the lawsuits and
get these fraudulent windfallsettlements.
SPEAKER_00 (02:38):
That's incredibly direct.
SPEAKER_02 (02:40):
It is.
And they even compare it in thefilings to a previous criminal
conviction, United States versusRainford, suggesting this isn't
a totally new playbook.
SPEAKER_00 (02:49):
Okay.
So if it's an enterprise, ascheme this widespread, there
must have been a lot of peopleinvolved.
Who are the alleged players inthis?
SPEAKER_02 (02:55):
Oh, it's quite the cast of characters spanning
several professions.
At the center, allegedlyorchestrating the whole thing,
you have the legal servicedefendants, that's Lyakos Law,
PC, and Dean The law.
Yes.
They're accused of being themasterminds, the coordinators.
Yeah.
They allegedly directed peoplecalled runners to find
claimants, arrange the funding,controlled who the claimants saw
(03:18):
for medical treatment to getfalse documentation.
And then they initiated andpushed forward these allegedly
fraudulent lawsuits usingdocuments they knew were false,
like verified complaints andbills of particulars.
SPEAKER_00 (03:31):
You mentioned runners.
What exactly was their role?
How did they fit in?
SPEAKER_02 (03:36):
There were apparently crucial.
These are the people the runnerdefendants referred to as John
Doe's one through 25 in thesuit.
SPEAKER_01 (03:42):
OK.
SPEAKER_02 (03:43):
Their job was allegedly to recruit potential
claimants and not just recruit,but to coach them on how to
stage an accident or exaggeratetheir injuries convincingly.
SPEAKER_00 (03:52):
So sort of teaching them how to perform the injury.
SPEAKER_02 (03:54):
That's the allegation.
Internally, they're apparentlycalled investigators or brokers.
Sometimes maybe to sound morelegitimate, they were called
paralegals or client servicesliaisons.
Receptive titles.
Seems like it.
SPEAKER_00 (04:07):
OK, so beyond the law firm and the runners, the
documents also name fundingdefendants like Prime Case LLC.
What was their part in all this?
Sounds like they were greasingthe wheels.
SPEAKER_02 (04:19):
That's a good way to put it.
This is where the financialmechanics get really
interesting.
These companies allegedlyprovided high-interest
litigation funding loansdirectly to the claimants.
SPEAKER_00 (04:30):
Okay, so money for the person who fell.
SPEAKER_02 (04:32):
Yes, but here's the really critical part.
They also allegedly made upfrontpayments directly to the medical
providers.
SPEAKER_00 (04:39):
Ah, paying the doctors up front.
SPEAKER_02 (04:41):
Exactly, to secure their cooperation in the scheme,
as the lawsuit puts it.
And these advances were oftenstructured cleverly as ownership
interest in future case payouts.
SPEAKER_00 (04:51):
Why structure it like that?
SPEAKER_02 (04:53):
Well, allegedly, to shield them from usury laws,
laws that cap interest rates.
The filings call this fundingessential for the whole
operation to work.
SPEAKER_00 (05:01):
Makes sense.
If you need doctors to dounnecessary things, paying them
up front seems like a way toensure that happens.
SPEAKER_02 (05:06):
Precisely.
SPEAKER_00 (05:07):
And that brings us to the medical providers
themselves.
This is where the alleged harmto individuals really seems to
hit home.
The list is pretty long.
Let's start with TotalOrthopedics, Drs.
Avinasov, Lerman, and Levin.
SPEAKER_02 (05:20):
Right.
These are orthopedic surgeons.
They're accused of recommendingand performing surgeries that
weren't medically needed andwere very expensive.
And get this.
One of them, Dr.
Lerman, actually had hisauthorization to treat injured
workers denied by the New YorkState Workers' Comp Board.
SPEAKER_01 (05:36):
Denied?
Why?
SPEAKER_02 (05:38):
The reason cited was performing highly invasive
surgeries without proper medicaljustification.
They said he showed wantondisregard that amounted to
professional misconduct.
SPEAKER_00 (05:48):
Wow.
That's a serious finding.
SPEAKER_02 (05:51):
It is.
And here's another detail.
Operative report written by drlerman and dr levin were
allegedly identical verbatimcopy paste jobs used across
numerous different patient cases
SPEAKER_00 (06:01):
wait identical reports for different people
undergoing surgery
SPEAKER_02 (06:05):
that's the allegation dr lerman's report
for example supposedly popped upin 25 other separate cases
SPEAKER_00 (06:10):
that just sounds blatant it's not even changing
the details
SPEAKER_02 (06:13):
it suggests a template a standardized process
rather than individualizedpatient care and it wasn't just
them McCulloch OrthopedicSurgical Services, with Dr.
Cappiola, another orthopedicsurgeon, is accused of using
similar identical operativereports.
SPEAKER_00 (06:30):
Okay, so a pattern emerges there.
What about neurosurgery?
Gotham Neurosurgery and Dr.
Anders Cohen are mentioned.
SPEAKER_02 (06:37):
Yes.
Dr.
Cohen is a neurosurgeon allegedto have performed unnecessary
spinal fusions.
And a particularly concerningdetail is that these fusions
were often done with only halfof the standard instrumentation.
SPEAKER_00 (06:50):
Half.
What does that mean practically?
SPEAKER_02 (06:52):
It often led predictably to the fusions
failing and causing more spinaldamage for the patient down the
SPEAKER_00 (06:58):
line.
That's horrific.
SPEAKER_02 (06:59):
It gets more complicated.
His wife apparently used to be amedical coordinator for the
Lyakas firm.
SPEAKER_00 (07:04):
Oh, a connection there.
SPEAKER_02 (07:06):
Mm-hmm.
And there are allegations ofkickback arrangements, including
him traveling from New York to aspecific hospital in New Jersey
to do these surgeries.
SPEAKER_00 (07:12):
Which hospital was that?
Was it involved too?
SPEAKER_02 (07:14):
Yes.
Hudson Regional Hospital in NewJersey.
They allegedly got directpayments from the funding
companies inside submittedhighly inflated leap-ins,
basically, claims for payment onthe patient cases.
SPEAKER_00 (07:27):
So the hospital was in on it, too, allegedly.
SPEAKER_02 (07:29):
They're accused of being part of the kickback
scheme, yes, and even arrangingtransport for the New York
patients to get out to theirfacility in Jersey.
SPEAKER_00 (07:37):
Okay, this web is getting wider.
What about the diagnostics?
You need scans, MRIs, right?
Accelerate Radiology and Dr.
Prakash are named.
SPEAKER_02 (07:45):
Right, they're accused of producing knowingly
falsified clinical anddiagnostic findings.
Essentially, writing MRI reportsthat routinely deviate from what
the scans actually showed aboutthe claimant's conditions.
SPEAKER_00 (07:58):
Falsified reports.
SPEAKER_02 (07:59):
That's the claim.
And here's a striking detail.
The company allegedly operatesout of an office that doesn't
even have an MRI machine.
SPEAKER_00 (08:06):
So where were the scans done?
SPEAKER_02 (08:08):
They relied on undisclosed facilities.
Plus, the owner of the companythat came before Accelerate
Radiology allegedly altered MRIreports.
So it raises serious questionsabout the evidence base for
these injuries.
SPEAKER_00 (08:19):
Definitely.
And pain management.
Obviously.
Often a step before surgery.
SPEAKER_02 (08:22):
Yes.
Pain physicians of New York withdoctors Kosharsky and Reifman.
They allegedly provided themanufactured justification for
surgeries.
SPEAKER_01 (08:30):
How?
SPEAKER_02 (08:31):
Through false clinical exam reports and giving
unnecessary injections, kind ofbuilding a paper trail through
surgery.
Dr.
Reifman in particular has tiesto a previous illegal patient
referral and kickback scheme.
SPEAKER_00 (08:43):
History repeats itself, maybe.
SPEAKER_02 (08:45):
Potentially.
SPEAKER_00 (08:45):
Yeah.
SPEAKER_02 (08:46):
And lastly, there's Jean-Paul Errol Toussaint
accused of creating knowinglyfalse and or materially
misleading records andspecifically falsifying range of
motion reports, which are keyfor assessing injury severity.
SPEAKER_00 (08:58):
OK, so we've got this extensive network, the
lawyers coordinating, therunners recruiting, the funders
paying, the doctors operatingand diagnosing.
How did it all actually worktogether day to day?
Was there like a playbook?
SPEAKER_02 (09:11):
That's exactly how it's described.
A cookbook approach, apredetermined step by step
process.
SPEAKER_00 (09:15):
OK, walk us through it.
SPEAKER_02 (09:16):
So it starts with a claimant, often someone who
doesn't speak English well,allegedly being recruited and
coached on how to exaggeratetheir fallen injuries.
SPEAKER_01 (09:24):
Right.
SPEAKER_02 (09:25):
They're then directed straight to the Lyakas
firm.
They're told, allegedly told,that having surgeries will
significantly boost theirpotential payout.
SPEAKER_00 (09:34):
Ah, incentivizing surgery from the start.
SPEAKER_02 (09:36):
Exactly.
And then they're offered thislitigation funding, but it's
contingent on them sticking tothe plan, participating in these
predetermined rote protocoltreatments.
SPEAKER_00 (09:46):
So it's not driven by medical new book, but by this
alleged cookbook.
SPEAKER_02 (09:50):
That's the core allegation.
The medical providers, allegedlyworking together, order
unnecessary tests, MRIs of likeevery major joint just in case.
Wow.
And then they allegedly rely noton the actual scan images, but
on these falsified reports.
This rote protocol treatment andthese falsified findings create
the justification on paper forthese preplanned cookbook
(10:12):
surgeries.
SPEAKER_00 (10:13):
Let's make this concrete.
The documents give specificclaimant examples, right?
These are the moments thatreally show the alleged pattern.
What about claimant A?
SPEAKER_02 (10:20):
Okay, claimant A allegedly fell from just
standing height.
Minor incident, you'd think, butended up needing a spinal
fusion.
SPEAKER_00 (10:29):
Okay.
SPEAKER_02 (10:29):
For a condition that wasn't even found on his MRI.
SPEAKER_00 (10:32):
How is that
SPEAKER_02 (10:33):
possible?
Good question.
And the operative report for hissurgery.
Identical, allegedly, to 17other cases.
He later needed correctivesurgery because the first one
wasn't right.
SPEAKER_00 (10:44):
Unbelievable.
SPEAKER_02 (10:45):
And it gets stranger.
Several of his family membersalso had suspiciously similar
trip and fall accidents, endedup with the same law firm, same
doctors.
SPEAKER_00 (10:52):
That really strains coincidence, doesn't it?
SPEAKER_02 (10:55):
It certainly raises eyebrows.
SPEAKER_00 (10:56):
Okay, what about claimant B?
There was something about anoccult meniscal tear.
SPEAKER_02 (11:00):
Yes.
This one's quite technical butrevealing.
Claimant B was diagnosed beforeknee surgery with an occult
meniscal tear.
SPEAKER_00 (11:08):
What does occult mean here?
SPEAKER_02 (11:10):
It means hidden, something you can't see on
preoperative imaging like anMRI.
It can only be discovered duringthe surgery itself.
SPEAKER_00 (11:17):
So diagnosing it before surgery makes no sense.
SPEAKER_02 (11:20):
Exactly.
It's a medical contradiction.
A preoperative diagnosis of anoccult tear is basically
impossible.
Later, this same Clayman had alumbar spine fusion by Dr.
Levin based on what the suitcalls imagined justification
with no diagnostic support.
SPEAKER_00 (11:37):
Just wow.
OK.
Clayman D's story also seemedtelling, especially the timing
and the type of surgery.
SPEAKER_02 (11:43):
Right.
Clayman D's alleged fallhappened just seven days after
his brother's fall.
Right around the corner fromeach
SPEAKER_00 (11:49):
other.
Seven days apart.
Same area.
SPEAKER_02 (11:51):
And both represented by Liaka's law.
Then, Dr.
Cohen allegedly performed aone-sided spinal fusion on
claimant D.
SPEAKER_00 (11:59):
One-sided?
But what was the actual problem?
SPEAKER_02 (12:01):
The condition noted was bilateral affecting both
sides, but the surgery onlyaddressed one side.
SPEAKER_00 (12:06):
Why do that?
That seems incomplete, medicallynegligent even.
SPEAKER_02 (12:10):
The allegations suggest it wasn't about complete
medical care.
He also allegedly used acookbook operative report from a
case back in 2019 and this onesided approach.
It allegedly caused the surgeryto fail for the brother who then
needed revision surgery.
SPEAKER_00 (12:24):
So the surgery itself seemed designed to fit
the template, not the patient'sactual needs.
SPEAKER_02 (12:29):
That appears to be the claim.
The audacity is notable.
SPEAKER_00 (12:32):
Absolutely.
What about claimant F?
The one who went to the ER withjust a scratch.
SPEAKER_02 (12:37):
Yes.
Klamath presents the emergencyroom.
Records show only a superficialabrasion.
Crucially, no complaints of neckpain.
SPEAKER_01 (12:45):
Okay.
SPEAKER_02 (12:46):
Six days later, a doctor finds him totally
disabled.
Nine days after the fall, Dr.
Cohen diagnoses neck pain andperforms a C3-C4 neck surgery.
SPEAKER_00 (12:55):
But what did the scans show?
SPEAKER_02 (12:57):
Two separate MRIs showed nothing wrong with his
neck.
SPEAKER_00 (13:00):
Nothing wrong, but he gets neck surgery.
SPEAKER_02 (13:02):
That's the allegation.
Dr.
Cohen's operative report forthis surgery was called utterly
fictional in the lawsuit andagain was allegedly used
verbatim in four other cases.
SPEAKER_00 (13:11):
So why?
Why do such a risky, apparentlybaseless surgery?
SPEAKER_02 (13:16):
The source material points towards a possible
financial incentive from thecompany that made this specific
implant used in that surgery.
SPEAKER_00 (13:23):
A direct link between the device and the
decision to operate.
That's a powerful allegation.
It is.
And claimant G, her storysounded like a surgical
nightmare.
SPEAKER_02 (13:31):
It really does.
She needed spinal surgery for anerve issue on her left side.
Dr.
Cohen operated, but allegedly.
He operated on the right side.
SPEAKER_01 (13:40):
The wrong side.
SPEAKER_02 (13:41):
And installed screws on the wrong side.
And then, allegedly, omittedmentioning a key implant, a TLIF
cage, that should have beeninserted from the operative
report.
SPEAKER_00 (13:52):
Just completely wrong.
SPEAKER_02 (13:53):
A post-op CT scan apparently showed that Dr.
Cohen's description of what hedid and the results were utterly
incompatible with the actualsurgical outcome.
SPEAKER_00 (14:02):
What happened with her case?
SPEAKER_02 (14:04):
It was eventually settled at a falsely
manufactured and fraudulentlyinflated amount.
The alleged care It'sstaggering.
SPEAKER_00 (14:12):
Truly is.
Okay, one more.
It does
SPEAKER_02 (14:21):
raise questions.
No pain, no objective
SPEAKER_00 (14:29):
injury.
SPEAKER_02 (14:30):
Right.
without any diagnostic films toback it up.
And Dr.
Cohen performed a one-sided backsurgery, even though her
conditions were bilateral.
And guess which side he operatedon?
SPEAKER_00 (14:43):
Let me guess, not the side that needed it more.
SPEAKER_02 (14:45):
Allegedly, he focused on the side with less
imperative conditions.
And perhaps most damningly, allthe internal hospital documents
listed her condition as chronicand degenerative, not dramatic
from a recent fall.
SPEAKER_00 (14:59):
So the hospital's own records contradicted the
claim of a recent injury causingthis.
SPEAKER_02 (15:04):
That appears to be the case based on the filings.
It's hard to square a minorfall, no objective findings, and
chronic conditions conditionswith the surgeries performed.
SPEAKER_00 (15:13):
OK, so we see the alleged pattern through these
examples.
Let's talk about the moneyagain.
How did the financial flowactually work to benefit
everyone in the scheme?
SPEAKER_02 (15:21):
Right.
It's described as thisself-sustaining cycle of alleged
profit.
The medical providers, theyprofit from these hugely
inflated liens on the cases,plus those upfront payments from
the funders.
The Lyakas firm, the lawyers,they get their cut through
contingency fees from the biginflated settlements they
allegedly engineer.
SPEAKER_00 (15:40):
Right.
but on inflated amounts.
SPEAKER_02 (15:43):
Exactly.
And the funding defendants, theymake their money back, allegedly
with astronomical interest, onthe advances they made.
SPEAKER_00 (15:50):
So everyone in the alleged network gets paid well.
What about the claimant, theperson who actually had the
fall, the surgery?
SPEAKER_02 (15:57):
That's the really grim part, according to the
documents.
The claimants, the actualindividuals who went through all
this, often walk away with thesmallest portion of any money
recovered.
SPEAKER_00 (16:08):
So they bear the physical risk, the potentially
botched surgeries and get theleast financial benefit.
SPEAKER_02 (16:13):
That's the picture painted.
The lawsuit even gives examplesof what it calls alleged money
laundering, where proceeds over$10,000 were structured or
layered into legitimate incomestreams to hide where the money
came from.
SPEAKER_00 (16:25):
And they mention mail and wire fraud, too.
SPEAKER_02 (16:28):
Yes, extensively.
Things like mailing thefalsified bills of particulars
or medical records counts asalleged mail fraud.
using electronic filing systemsfor the lawsuits or for the UCC
statements related to thefunding liens that's alleged
wire fraud.
It shows how basicinfrastructure was allegedly
used to further the scheme.
SPEAKER_00 (16:47):
OK, this is clearly a massive, complex legal fight.
What are the specific legalclaims Union Mutual, the
insurance company, is makingagainst Liacus Law and all the
other defendants?
SPEAKER_02 (16:58):
They're bringing some very serious charges.
Multiple violations of ICO, theRacketeer Influenced and Corrupt
Organizations Act.
SPEAKER_00 (17:05):
ICO.
That's usually associated withorganized crime.
SPEAKER_02 (17:08):
It is.
And using it in a civil contextlike this is significant.
They're alleging racketeeringactivity, conspiracy to violate
ICO, and even using incomederived from that racketeering
to invest back into the scheme.
SPEAKER_00 (17:18):
Wow.
What else?
SPEAKER_02 (17:19):
Common law fraud, aiding and abetting fraud.
Unjust enrichment, basicallysaying the defendants got money
they weren't entitled to andviolations of New York's general
business law, Section 349, whichdeals with deceptive business
practices.
They want damages, obviously,but also injunctive relief to
stop these alleged practices.
SPEAKER_00 (17:40):
A full court press.
So how are the defendants,particularly Acas law,
responding?
What's their defense strategy?
SPEAKER_02 (17:47):
They're trying to get the whole case thrown out.
dismissed.
SPEAKER_00 (17:50):
On what grounds?
SPEAKER_02 (17:51):
Their main arguments are, first, that Union Mutual
doesn't have standing the legalright to sue because, they
claim, the insurance companydidn't suffer a direct injury.
SPEAKER_00 (18:01):
Hmm.
How can they argue the insurerwasn't directly injured by
paying out allegedly fraudulentclaims?
SPEAKER_02 (18:06):
Their argument seems to be that the injury is somehow
indirect, maybe filtered throughthe claimant.
They also argue the allegationsare conclusory, meaning they
lack enough specific factualdetail.
And critically, they argue thatnormal litigation That argument
about direct injury seems key.
SPEAKER_00 (18:38):
How does Union Mutual counter that?
SPEAKER_02 (18:41):
Union Mutual fires back pretty strongly.
They say their injury is directbecause under New York law, an
insurer's duty to defend kicksin the moment a claim is filed,
regardless of whether it'sultimately valid or fraudulent.
They have to start spendingmoney immediately.
SPEAKER_00 (18:56):
So the filing itself triggers a direct cost?
SPEAKER_02 (18:59):
Exactly.
And they cite specific case law,State Farm v.
Triborough, which they saydirectly refutes the defense's
point about litigation activity.
That case apparently establishedthat when you have these alleged
predetermined treatmentprotocols and pay-to-play
arrangements, litigation can bepart of our IACUSHA scheme.
SPEAKER_00 (19:15):
So the context matters.
SPEAKER_02 (19:17):
Right.
Union Mutual argues the wholescheme was specifically designed
to get around normal checks andbalances, like HIPAA privacy
rules and attorney-clientprivilege.
Forcing the insurance company torely on information that turned
out to be false.
SPEAKER_00 (19:30):
OK, so it's a complex legal back and forth.
We've gone through the allegedscheme, the players, the
examples, the legal arguments.
Let's pull back a bit.
Beyond the courtroom drama, whatdoes all this mean for you, the
listener?
What are the broaderimplications here?
SPEAKER_02 (19:45):
Yeah, this is really important.
This deep dive shows how ascheme like this, if the
allegations are true, has reallydramatic and widespread effects
on consumers, not just theinsurance companies.
How so?
Well, first, it clogs up thecourt system with fraudulent
cases.
It forces insurers to spend hugeamounts on needless
investigative, legal, otherclaims, and defense-related
(20:06):
spend.
And it leads to thesefraudulently obtained settlement
That's a massive waste ofresources across the board.
SPEAKER_00 (20:14):
And those wasted resources, that spending, it has
to come from somewhere, right?
It doesn't just vanish.
SPEAKER_02 (20:18):
Precisely.
It doesn't just hurt theinsurance company's bottom line.
It ultimately leads towrongfully driving up the cost
of legitimate insurance businessoperations.
SPEAKER_00 (20:29):
Which means?
SPEAKER_02 (20:30):
Which means needlessly escalating premiums
to the ultimate consumers ofliability insurance and the cost
of healthcare.
At the end of the day, that'severyone.
You.
Me.
We all end up paying morebecause of alleged fraud like
this.
SPEAKER_00 (20:44):
So it directly hits our wallets through higher
insurance costs and potentiallyhigher health care costs, too.
SPEAKER_02 (20:49):
Absolutely.
And this isn't just some obscurelegal theory.
We're seeing headlines aboutthis kind of thing now.
Things like MS-13, Russianmobsters use migrants in
elaborate injury scam, evengetting spinal surgery to pull
it off.
SPEAKER_01 (21:00):
Wow.
SPEAKER_02 (21:01):
Or construction workers in NY faking falls on
sites part of larger fraudscheme.
These headlines suggest thisisn't an isolated case, but but
points to a much broadersystemic vulnerability.
SPEAKER_00 (21:12):
So we've really unpacked an incredibly intricate
alleged fraud scheme today.
We've seen how all thesedifferent players, lawyers,
doctors, funders, runners couldpotentially fit together to form
this cohesive criminalenterprise, according to the
lawsuit.
SPEAKER_02 (21:28):
Yeah, it's a pretty sobering look at how deeply
these kinds of activities canapparently embed themselves
within our legal and medicalsystems.
SPEAKER_00 (21:34):
It really is.
This deep dive reveals how acomplex system, one undesigned,
you know, to provide justice andcare can allegedly be twisted
and exploited for massivepersonal gain.
SPEAKER_02 (21:47):
And often at the direct expense of vulnerable
people who get caught up in itand ultimately the wider public
footing the bill.
It definitely leaves youwondering about the hidden
costs, the ethical shortcutsthat might be lurking beneath
the surface of what look likeroutine processes.
SPEAKER_00 (22:02):
It really makes you think, doesn't it?
What does this tell us aboutjust how vigilant we need to be?
How much critical thinking isrequired in a world just
saturated with That's the
SPEAKER_02 (22:12):
big question.
And maybe what other complexsystems out there might be
vulnerable to this kind ofsophisticated exploitation?
And how can we, just as informedcitizens trying to navigate it
all, get better at telling thereal story from the fake one?
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