Queens Tribune

A Queens doctor landed in hot water after allegedly billing insurers for costly medical tests he never performed

Queens District Attorney Richard A. Brown announced yesterday that a doctor formerly employed at a Jamaica, Queens medical clinic has been indicted by a Queens County grand jury for falsely billing insurance carriers over a nearly four-year period for costly medical tests never provided to motor vehicle accident victims. The defendant is charged with submitting old test results of other patients as false proof that he did the tests.

District Attorney Brown said in a statement following the announcement that insurance fraud is costly, hurts consumers and needs to be eradicated.

“Today’s arrest sends a clear message to those who are attempting to fleece the system for their own personal gain that law enforcement’s fight against insurance fraud is ongoing and that those who cheat will be sought out and vigorously prosecuted.”

The DA said that under New York’s no-fault insurance law, a person injured in a motor vehicle accident can receive up to $50,000 coverage for medical expenses incurred as a result of an accident. Most health providers are reimbursed directly by the insurance carriers for services provided.

Brown identified the defendant as Yakov Raufov, 44, of 21 Carlyle Drive in Glen Cove, Long Island, who practiced at L&B Medical, located at 153-25 Hillside Avenue in Jamaica, Queens.

Raufov was arraigned today before Queens Supreme Court Justice Kenneth Holder on a 33-count felony indictment, charging him with twelve counts of fourth-degree insurance fraud, twelve counts of first-degree falsifying business records, eight counts of fourth-degree grand larceny and one count of first-degree scheme to defraud. The defendant, who faces up to four years in prison and loss of his license to practice medicine if convicted, was released on his own recognizance and ordered to return to court on for pre-trial hearings on September 16.

District Attorney Brown said, according to the charges, between August 2003 and April 2007, the defendant engaged in an insurance fraud scheme in which he submitted insurance claims for costly nerve conduction studies and needle electromyographs “NCV/EMGs” that were never performed.

A NCV tests the flow of electrical currents across the nerves, and an EMG is a recording of the electrical activity in muscles and nerves. The defendant is alleged to have caused fraudulent claims for these false and unnecessary medical tests to be submitted to a number of no-fault insurance companies in an amount totaling more than $18,000.

The District Attorney noted that the matter would be referred to the New York State Department of Health’s Office of Professional Medical Conduct for a review of the defendant’s license to practice medicine.

Brown also expressed his appreciation to the insurance industry for their assistance in the investigation, with special thanks to Richard D’Amato, of AllState Insurance, Barbara Ann Chapman, of GEICO, and Brian Cook, of Progressive Insurance.