Charges laid in fraudulent auto injury claims investigation

Published on Friday January 18, 2013

 Michele Henry

Staff Reporter

A Toronto man studying to be an anesthetist and two medical rehabilitation clinics are among those charged by the province in connection with an alleged scheme to submit false injury claims to auto insurers.

Danny Grossi, who has medical training but is not a practicing doctor in Ontario, and the two Toronto clinics were among the subjects of a Toronto Star investigation in 2011.

The Financial Services Commission of Ontario, which investigates cases involving insurance, charged Grossi, three other men and two clinics — the Fairview Assessment Centre and the Pacific Assessment Centre, both on Finch Ave. W.

Commission investigators allege the men and clinics “knowingly made false or misleading statements” to obtain payments from an auto insurer.

The charges against the men have not been tested in court. The Star was unable to reach Grossi Thursday. The clinics are no longer in business.

Philip Howell, superintendent of the commission, said insurance rates for all drivers rise when insurance companies pay out on bogus treatment claims.

Speaking about the issue in general, Howell said his commission will “continue to crack down on those who cheat Ontario drivers by abusing the auto insurance system.”

The Star looked at a number of insurance clinics when it tackled the issue in 2011. It found instances of large claims being paid out that, after investigation, the insurers determined were invalid because the person either was not injured or was hurt but did not need the equipment or treatment prescribed.

The Star found that tow truck drivers or paralegals often directed accident victims to rehab clinics in return for a finder’s fee. The accident victims, who often spoke little or no English, would then be handed forms authorizing the clinic to submit claims to their insurance company.

Doctors interviewed by the Star said they themselves had been victims of irregularities. One doctor said his signature was used to verify claims he had never heard of.

Grossi, who at the time of the Star story was training to be an anesthetist, was earlier the subject of a lawsuit by Economical Insurance. The insurer alleged he and others used information about 55 car accident victims to submit fake invoices to three insurers.

The lawsuit alleged Grossi submitted fake invoices and his name appears as “provider” of the medical services.

Grossi defended himself against the statement of claim, denying “any role in the conspiracies alleged.”

His lawyer wrote to the Star saying that Grossi himself was a victim and that he had “serious and significant concerns with respect to Dr. Grossi’s signature being misappropriated by third parties.”

The lawyer referred to Grossi as “Dr.” in correspondence to the Star. However, the college that regulates physicians said he had not attained that designation. A search at the college Thursday turned up no listing for Grossi.

The Insurance Bureau of Canada created a tracking system to collect information on people suspected of making false claims. In 2011, about 300 clinics were believed to be loosely connected, allegedly sharing information and participating in the same scheme.

Some insurers estimate bogus claims cost the industry millions of dollars a year overall, but nobody has been able to determine the true amount. The volume of all claims in Ontario is so high that investigators believe many are paid (often for small amounts) because it is too much work to investigate them.

Among fake invoices the Star found related to a variety of clinics were $2,363 for “aqua fitness therapy,” $1,247 for a portable acupuncture machine, and $1,980 for a “whole body vibrating plate.” There was also a $1,293 invoice for a long-handled Swiffer and cleaning material for a man who allegedly needed help cleaning his house after a minor injury.

Conviction under the charges is punishable by a maximum fine of $250,000 on the first conviction and a maximum $500,000 penalty on each subsequent conviction.

The other three men facing charges are Alexandre Lobatch, Yaniv Tamsout and Vitali Tourko.