SIU Today Winter 2021 - 21

Law Update
By Eric Moch
" I've Fallen, and I Can't Get Up
(Just As We Planned)! "
Federal Indictment of Slip-and-Fall Conspiracy Provides Window
into the Planning and Execution of Organized Insurance Fraud
BACKGROUND
Of all the injury claims that trigger suspicions in SIU investigators
and defense counsel, slip-and-falls at businesses may be in a
class by themselves. The facts vary from claim to claim but
the dubious patterns are well established: unwitnessed falls on
almost non-existent imperfections in flooring, patrons who
trip over seemingly nothing and simply drop to the ground
and sprawl before calling out for help, and alleged victims who
despite their supposed injuries seem far more eager to lead
staff to the precise condition on which they slipped and fell.
Sometimes closed-circuit video proves beyond doubt that the
claim is a set-up. Other times, dogged claim investigations
including witness interviews and consultations with experts
reveal the fiction. When we know the patterns of suspicious
premises claims before they even land on our desk, we are already
well along the path to a successful investigation.
A recent federal indictment in New York provides an intriguing
case study of just how dedicated and regimented fraud rings can
be in perpetrating commercial slip-and-fall claims at scale. The
case peels the lid off a scheme that has all the hallmarks of modern
conspiracies to commit injury claim fraud: mass recruitment of
specifically targeted injury claimants, personal injury attorneys
who direct medical care, participating physicians who go so far as
to perform unnecessary surgeries in furtherance of the scheme, or
even an appearance by a litigation funding business. Probably no
large city is immune from elaborate insurance fraud conspiracies,
so this case has much to teach us.
U.S.A. V. GEORGE CONSTANTINE, MARC
ELEFANT, ANDREW DOWD, SADY RIBEIRO AND
ADRIAN ALEXANDER (21 CRIM 530 U.S. DIST. CT.
SOUTHERN DIST. N.Y.)
On October 20, 2021, the United States Attorney for the
Southern District of New York announced an indictment
charging Adrian Alexander with conspiracy to commit mail
and wire fraud, mail fraud, and wire fraud in connection
with a scheme to obtain insurance settlements and other
compensation for fraudulent trip-and-fall injury claims. A
prior indictment in the case charged New York lawyers George
Constantine and Marc Elefant and New York doctors Sady
Ribeiro and Andrew Dowd for their participation in the fraud
scheme. Constantine and Elefant are New York personal injury
attorneys. Dowd and Ribeiro are New York doctors. Alexander
is New York litigation financier who funded the fraud scheme.
He also owns an MRI facility.
OVERVIEW OF THE FRAUD SCHEME
Between 2013 and 2018, the defendants allegedly recruited
over 400 financially destitute and even homeless New
Yorkers to stage trip-and-falls in area businesses. Claimants
would either lie and say they suffered unwitnessed falls
at establishments or actually go through the motions of
intentionally falling to the ground in the presence of others
for dramatic effect. Doing so would create witnesses, and
ensure that ambulances would transport the claimants
to local emergency rooms, leading to the preparation of
medical records that would provide the slip and fall injury
claims more credibility. The scheme prioritized claims of
serious injuries to knees, shoulders and backs, as the charges
for treatment and rehabilitation of these body parts can
become exorbitant in New York. The same is generally true
in just about every major metropolitan area. In Chicagoland,
for example, there are over forty Level I and II trauma
hospitals. A patient who receives medical attention at one
of these facilities for any sort of trauma will soon have
sizeable medical bills even if she sees no other physicians
after discharge.
The claimants, through attorneys Constantine and Elefant,
presented injury claims to businesses and insurers, and filed
lawsuits. At the core of their injury claims was fraudulent billing
by Dr. Dowd, an orthopedic surgeon, and Dr. Ribeiro, a pain
management specialist, for medical treatment including surgeries
WINTER 2021 | SIU TODAY 21
SIU Today Winter 2021

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