New York, NY - The Inspector General for
the Social Security Administration (SSA), Gail S. Ennis, announced
the sentencing of Dr. Raymond Pierre Paul, a psychiatrist practicing in
Nassau County, New York. Dr. Pierre Paul helped facilitate a major
Social Security disability fraud scheme that involved hundreds of
individuals, many of them police officers and firefighters, some of whom
feigned disabilities stemming from the September 11, 2001 terrorist
attacks.
Dr. Pierre Paul cooperated with the investigation, and pleaded guilty
to grand larceny in the third degree. He was sentenced today to 200
hours of community service, forfeiture of his medical license, and
$15,000 restitution to SSA.
https://www.nytimes.com/2014/01/08/nyregion/retired-new-york-officers-and-firefighters-charged-in-social-security-scheme.html
The SSA Office of the Inspector General (OIG) began its years-long
investigation of this scheme in 2008 after its New York Cooperative
Disability Investigations (CDI) Unit received a referral of suspicious
disability claims from New York State Disability Determination Services.
The OIG, jointly with the NYPD Internal Affairs Division, Manhattan
District Attorney's Office, and New York State Office of the Attorney
General, conducted an expansive investigation involving undercover
operations, two-year telephone and office non-consensual monitoring,
hundreds of surveillances, and social media warrants.
The investigation revealed more than 100 individuals had filed
similar Social Security Disability Insurance applications, from having
the same handwriting to nearly identical ailments, and all had the same
attorney, Raymond Lavallee, as their representative. Many applicants
were retired police officers and firefighters who had received a New
York City service-connected disability pension for an orthopedic
disability, which did not meet SSA's disability definition. However, all
of the claimants also had obtained documentation of psychiatric
conditions provided by Pierre Paul and other medical providers that met
SSA's guidelines.
Knowing that many applicants were retired law enforcement officers,
with permits to carry concealed weapons, investigators began looking to
uncover if they were presenting conflicting facts by confirming mental
capacity to NYPD, while alleging a mentally disabling condition to SSA.
This approach led them to identify dozens of permit holders who were
also disability beneficiaries and, more importantly, to the major
facilitators of the scheme.
The four ringleaders were Raymond Lavallee, an attorney and former
FBI agent and assistant district attorney; Joseph Esposito, a former
NYPD detective and Social Security Disability Insurance beneficiary;
John Minerva, a retired NYPD detective and disability consultant for New
York's Detectives' Endowment Association, a union representing NYPD
detectives; and the late Thomas Hale, chairman/president of a disability
consultancy firm.
The investigation determined many applicants were recruits of
Esposito, Minerva, and others who contacted them after they received a
NYC disability pension. As part of the scheme, they would confer with
Hale, who referred them to Pierre Paul or another psychiatrist. In
furtherance of the scheme, the applicants would not file for SSA
disability until Pierre Paul, or another psychiatrist, had treated them
for at least a year.
To participate in the scheme, the applicants agreed to pay
remuneration equaling their first 14 months of SSA disability benefits.
These kickbacks ranged from $20,000 to $50,000, which far exceeded the
maximum allowable attorney fee allowed under Federal law. They also
agreed to continue regular monthly appointments, many of which were
short phone calls.
This investigation led to 134 arrests and 116 criminal convictions,
as well as more than 25 civil monetary penalty actions for false
statements and material omissions to SSA. Lavallee, Hale, Esposito, and
Minerva all previously pleaded guilty to conspiracy and agreed to make
restitution of millions of dollars in exchange for reduced sentences.
Moreover, SSA terminated benefits of over 300 persons who were
involved in the scheme but not indicted. In all, the scheme resulted in
court-ordered restitution over $25 million and additional improper
benefit payments of over $49 million. Savings to Social Security, to
date, are estimated at $52 million to date as a result of the
investigation and dismantling of the scheme.
“Today's events are a closing chapter in a monumental investigation
that had a profound effect on our work to identify and shut down
third-party facilitator fraud schemes that undermine Social Security,”
said Inspector General Ennis. “I want to thank the New York State
disability examiners who referred these allegations to us; SSA for its
cooperation over years of investigation and administrative
determinations; and of course, the Manhattan District Attorney's Office
for its support and diligence in dismantling this scheme and recovering
these funds for Social Security.”
“Social Security has a strong fraud detection and referral process.
The process worked in this wide-ranging case--it was the diligent
employees of the New York Disability Determination Service (DDS, funded
and trained by Social Security to make medical determinations) who first
identified the criminal actions in this case. The DDS employees
suspected fraudulent medical evidence was being submitted and referred
the fraud allegation to Social Security, who referred it to OIG for
investigation,” said Andrew Saul, Commissioner of Social Security. “I
thank the OIG for their determination and persistence over many years of
investigating this fraud ring and the Manhattan District Attorney's
Office and New York State officials for their tenacity and support for
Social Security's programs and beneficiaries.”
Special Agent Peter J. Dowd led this investigation under the
supervision of John Grasso, Special Agent-in-Charge of the SSA OIG's New
York Field Division. Inspector General Ennis recognized the invaluable
efforts of our law enforcement partners in this case, including the NYPD
Internal Affairs Division, Manhattan District Attorney's Office, and
New York State Office of the Attorney General.