First Guilty Plea in No-Fault PIP Auto Insurance Fraud Scheme
The first of four defendants charged in a scheme to defraud an auto insurer by submitting bogus bills for unnecessary and unprovided physical therapy services under insureds’ personal injury protection (“PIP”) coverage has admitted her guilt.
Anna Barenboym, 46, pleaded guilty to one count of conspiracy to commit mail fraud on March 17, before U.S. District Court Judge, Judge Richard G. Stearns. The judge scheduled Ms. Barenboym’s sentencing for July 28, 2022.
Charges for defrauding an insurer on PIP Benefits arising from auto accidents
On February 3, 2021, a federal grand jury in Boston indicted Gyulnara Bayryshova, 55, of Brighton; Anna Barenboym, of Wayland; Slava Pride, 41, of West Roxbury; and Raya Bagardi, 36, of Brighton, on a total of nineteen counts including conspiracy to commit mail and health care fraud, mail fraud, and health care fraud. In addition, the grand jury charged the defendants, Barenboym, Pride, and Bagardi, each with three counts of making false statements in connection with a health care benefit program.
Ms. Barenboym was a licensed physical therapist employed at Brighton Physical Therapy (“Brighton”), a Brighton-based physical therapy clinic owned by Ms. Bayryshova. Mr. Pride and Ms. Bagardi were also employed at Brighton as licensed physical therapist assistants. From October 2018 through June 2020, Ms. Barenboym and her co-defendants conspired to cause an insurance company to reimburse them for physical therapy services that were either:
Not actually provided but billed to the insurer.Not medically necessary; orProvided by individuals not licensed to provide the services.
Brighton’s paid for auto accident patient referrals and received kickbacks from lawyers settling auto cases based on Brighton’s fraudulent treatment billings
Because the four defendants were all indicted for conspiracy, this article does not identify their individual actions for simplicity’s sake and because each defendant in a conspiracy is criminally liable for the actions of all other conspirators in furtherance of the common scheme. Thus, all the actions allegedly done in the indictment by a particular defendant may be simply stated as being done by “Brighton.”
The indictment of Brighton came about because of information provided by a person that the indictment only identifies as a “confidential human source.” (“Source”).
This Source went to Brighton on October 25, 2018, and told two of the defendants that he had suffered a neck injury in an automobile accident. Brighton told the Source to return in a few hours to meet with an attorney and a physical therapist.
The Source visited Brighton 24 times supposedly to receive physical therapy for his injury. On none of these occasions did the Source receive the treatment that was billed to the insurance company under the Source’s PIP coverage. His treatment consisted of, on almost every occasion, 15 minutes of electrical stimulation and no other treatment. On a few occasions, he also received from Brighton some instructions for strengthening exercises. However, the billings to the insurance company and the treatment note submitted by Brighton showed more extensive treatment resulting in Brighton during the insurance company resulting in the insurer paying Brighton four checks totaling $5,895.00
CheckPatientCheck DateCheck NumberCheck AmountISource1/25/20195410291157$3,457.002Source2/19/20195410298021$1,124.003Source3/6/20195410302590$686.004Source3/28/20195410309160$628.00Payment history (above) of Brighton’s fraudulent billings for treatment of the FBI’s Source
The FBI’s Source brings an undercover agent claiming an auto accident injury to Brighton
While the Source was still visiting Brighton for “treatment,” the Source introduced an undercover FBI agent (“Agent”) to Brighton.
Like the Source, the Agent told Brighton that they had suffered a neck injury in an automobile accident. Brighton had the Agent fill out paperwork and referred the Agent to an attorney to handle his automobile personal injury claim. While the Agent was being initially treated by Brighton, Ms. Bayryshova told the Source that she would pay a referral fee for referring the Agent and for any other persons the Source referred that claimed they were injured in an automobile accident.
The Agent visited Brighton 28 times to supposedly receive physical therapy treatment. Like the Source, the Agent received, on most occasions, only 15 minutes of electrical stimulation. After the first 17 treatments, the Agent told Brighton that they were feeling “fine.” Brighton, at first, stated that they would discharge the Agent, but when he asked if that would be good for his “case,” Brighton told the Agent to keep coming for additional visits. After 11 more visits, the Agent ceased visiting Brighton for treatment.
The billings submitted by Brighton to the insurer that the FBI was using for this sting, did not match in any material way that actual treatment that the Agent received.
When the Agent stopped treating, Brighton paid the Source $500 in cash for referring the Agent and confirmed that it would pay the Source for any further referrals on people claiming injuries from automobile accidents.
Brighton submitted fraudulent physical therapy bills totaling $3,896.78 for the Agent’s visits.
5Agent4/8/20205410385100$1,807.926Agent4/7/20205410384894$548.707Agent6/26/20205510028465$345.968Agent8/3/20205510029889$1,194.12 Payment history (above) of Brighton’s fraudulent billings for treatment of the undercover FBI agent
As a result of the fraudulent billing records submitted by Brighton to the automobile insurer about the neck injury of the Agent, the automobile insurer, assuredly working with the FBI, paid the attorney referred by Brighton to the Agent, a $10,000 settlement.
As per the allegations of the indictment, this unidentified attorney paid the Agent $6007.76 and paid $750 to a different but related physical therapy company in East Boston with the memorandum on the check stating, “S. Tavares outstanding meds.” (“S. Tavares” being the Agent’s pseudonym for Brighton). The attorney’s check was not cashed by the East Boston company but instead deposited in Brighton’s account.
The plea agreement between U.S. Attorney and Ms. Barenboym on one count with a sentencing guideline of between 27 and 33 months to serve
Before pleading guilty, Ms. Barenboym signed a plea agreement with the United States Attorney that became part of the court record.
As part of the plea agreement, she admitted she committed the crime specified in the conspiracy to commit mail fraud count and that she was “in fact guilty of this crime.” The U.S. Attorney, for her part, agreed to dismiss the other eighteen of the indictment at the time of sentencing.
The plea agreement also had the defendant’s and the U.S. Attorney agreeing on the calculation the court should consider for the sentencing range under the Federal Sentencing Guidelines.
Under these guidelines, Ms. Barenboym’s “offense level” under the Guidelines was “18,” based on the following calculation:”
Her base offense level was seven because the offense of conviction has a statutory maximum term of imprisonment of twenty years.Since the insurance company’s loss was more than $550,000 but less than $1,500,000, her offense level is increased by fourteen, 21.However, because Ms. Barenboym accepted responsibility for her crime the guidelines, she gained a three-level reduction to an offense level of eighteen.
Under the sentencing guidelines, a level 18 offense carries an expected sentence of between twenty-seven and thirty-three months to serve.
The judge may deviate or vary from the sentencing guidelines
While judges most often follow the sentencing guidelines as a matter of policy, they have the discretion to deviate downward or upward based upon the nature of the crime. They also have the right to vary the sentence based upon the particular factors relating to a defendant and the nature of their involvement in the crime or their unique circumstances, if any.
The prosecution team involved in securing the charges against Brighton defendants
United States Attorney Rachael S. Rollins; Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division; Anthony DiPaolo, Chief of Investigations of the Insurance Fraud Bureau of Massachusetts; Boston Police Acting Commissioner Gregory Long; and Quincy Police Chief Paul Keenan made the announcement of the guilty plea. Assistant U.S. Attorney Laura J. Kaplan of Rollins’ Organized Crime & Gang Unit is prosecuting the case in court.
