february 2012 fifteen fraudsters charged in wpb … · investigation into a massive fraud ring in...
TRANSCRIPT
ldquoPhase one of the investigation called
Operation SledgeHammer
resulted in two federal indictments involving
15 subjectsrdquo
Volume 2 - Issue 8 February 2012
Beginning in June 2010 the Division of Insurance Fraud as part of a task force working with the Federal Bureau of Investigation the Internal Revenue Service the Secret Service and the National Insurance Crime Bureau initiated an investigation into a massive fraud ring in Palm Beach County involving staged accidents money laundering and insurance fraud Phase one of the investigation called Operation SledgeHammer resulted in two federal indictments involving 15 subjects
In July 2011 the first two subjects Oscar Franco Padron and Joaquin Ross Vasquez were arrested Three months later six additional defendants including massage therapists Lisbet Leon and Yida Bello were arrested for counts ranging from mail fraud to money laundering and structuring The indictments include more than $12 million in laundered assets and fraudulent claims
Last month five more defendants including massage therapist Ketty Gonzalez and staged accident organizers Ernesto Miralles and Julio Fernandez Delgado were charged
The investigation involved clinics and their owners who allegedly staged accidents to obtain patients to send to their clinics and submit fraudulent billings to insurance companies The fraudulent exposure in this case is estimated at $10 million The clinics include Florida Mango Massage Therapy Karow Chiropractic Center Healthcare R Us and Chiropractic Office of South Florida
The cases are being prosecuted by Assistant US Attorney A Marie Villafantildea Several defendants have already pled guilty For more information see the press release from the US Attorneyrsquos office at httpwwwjusticegovusaofls
PressReleases120111-02html
The insurance companies defrauded in this case were Allstate Direct General Farmers Geico GMAC Hallmark Hartford Infinity Kingsway Amigo Liberty Mutual Mercury Metropolitan Nationwide Progressive Sentry State Farm Travelers and United Auto
Two subjects Vladimir Lopez and Lazaro Vigoa Mauri are fugitives and believed to be hiding in Cuba
INSIDE THIS ISSUE
1 Op SledgeHammer
2 Unlicensed Clinics
3 AHCA Clinic Sweep
4 PIP Fraud in the News
5 NICB Turns 100
7 Statewide Arrests
9 Statewide Contacts
HEADER HERE Fifteen Fraudsters Charged in WPB Operation SledgeHammer
Page 2 February 2012
Florida Chief Financial Officer Jeff Atwater announced today the arrest of a Miami clinic owner for submitting fraudulent Personal Injury Protection (PIP) claims from his unlicensed clinic
Juan M Dieguez who also used the false identity Jorge R Gonzalez is charged with operating a health care clinic without a license grand theft and insurance fraud following an investigation by the Department of Financial Servicesrsquo
Division of Insurance Fraud (DIF) Dieguez has owned and operated Venetian Rehab Center located at 434 SW 12th Ave since October 2010 but was arrested while working at another clinic Therapy-Diagnostic Tech Medical Dieguez was booked into the Miami-Dade County Jail on 012712 and is being held on $65000 bond If convicted he faces up to 15 years in prison
ldquoInsurance fraudsters have learned how to game Floridarsquos PIP system and every honest Floridian with a car in the driveway ends up payingrdquo Atwater said ldquoWe must put policies in place to stop those who make a career out of stealing our fellow Floridiansrsquo hard-earned dollarsrdquo
To demonstrate the increase of insurance fraud in Florida consider the fact that in 2008 a 40-year-old driver in Miami with an unblemished driving record was paying $582 in PIP premium and in 2010 this same driver paid nearly $1050 for the same coverage This is an 80 percent increase
A fingerprint check of Dieguez after his arrest showed that he was using a false identity under the name Gonzalez He had obtained a driverrsquos license in 2009 using a fictitious birth certificate from Puerto Rico DIFrsquos investigation further revealed that Dieguez absconded from his probation following a conviction for Medicaid fraud in 1999 Further investigation showed that Venetian Rehab was originally opened by Dieguezrsquos brother in 2003 and Dieguez added his false identity as an officer in 2010
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida Farmers Insurance Kingsway Amigo State Farm and United Auto provided assistance in this investigation
DIF Arrests Medicaid Fugitive For Operating Unlicensed Clinic in Miami
The Division of Insurance Fraud arrested Yasser Vega-Martinez 34 for planning and orchestrating three staged accidents resulting in more than $200000 in fraudulent claims submitted to Geico and State Farm
ldquoThese staged accidents are at the heart of the PIP fraud epidemic that is casting a shadow over Floridarsquos highwaysrdquo said CFO Atwater ldquoEvery Florida family is affected by these fake crashes in the form of the high auto insurance premiums My office is determined to work toward policy reforms to curb this costly crimerdquo
Vega-Martinez allegedly participated in two of three accidents he organized and staged between November 2009 and June 2010 The participants were referred to several clinics in the Miami-Dade area including GMC Rehabilitation Center AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging Grand Canal Rehab Justin Medical Services Florida Health Professionals Group Corp Angels Diagnostic Group and C amp C Therapy Center Corp
None of the clinics in this case were licensed by the Florida Agency for Health Care Administration (AHCA) however several of the clinics were issued exemptions
Vega-Martinez is believed to have organized other staged accidents and additional charges are anticipated
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle ldquoIn the battle against insurance scam artists who dip into all of our pockets I am proud to have the full support of Floridarsquos Chief Financial Officer Jeff Atwater and his elite force of Insurance Fraud investigatorsrdquo commented Fernandez Rundle ldquoWhen my prosecutors bring these insurance fraud criminals into court to face justice we know that we have the facts and the evidence on hand to convict With this effective team of fraud fighters on their trail these scammers need to recognize that they should be looking for a new and honest way to earn their livingrdquo
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Staged Accident Organizer Charged with $200000 in Fraudulent Claims
Page 3 The PIP Source
A report by the Agency for Health Care Administration (AHCA) revealed irregularities were discovered during a recent three-day sweep by investigators in 43 of 49 Miami-Dade County clinics In one case an insurance company providing personal injury protection coverage also known as PIP was charged $19000 for massage therapy
During those checks investigators witnessed only 17 patients while employees at some clinics reported they had never seen a patient At one clinic staff said they had not seen the owner or medical director in six months
The investigation found that most of the Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture
Many clinics also displayed advertisements for law firms and attorneys who specialized in traffic accident litigation while in numerous instances medical professionals at the clinics were employed without the required background screening And one man kept his job despite being deemed ineligible on his background check
AHCA referred information to the Division of Insurance Fraud (DIF) for potential criminal investigation
Read more in this article at - httpwwwocalacomarticle20120106WIRE120109810
AHCA Targets Health Care Clinics
Florida Bar Panel Looks at Limiting Lawyer Referral Services Membership A Bar committee is considering several proposals that would restrict lawyers from participating in a referral service that also handles referrals for nonlegal services including medical treatment ldquoI frankly think what we are looking at is a systemic problemrdquo committee Chair Grier Wells said
The four proposals are
bull A lawyer referral service shall not have [any relationship with] [any financial contractual or ownership interest in] a medical referral service or any person group of persons association organization or entity that specifically advertises in this state to accident victims or other prospective clients primarily for the purpose of a healthcare provider filing a claim of payment of treatment of an accident or injury victim and that uses a common phone number universal resource locator (URL) or other form of shared contact
bull A lawyer shall not accept client referrals from any person entity or service that also refers or attempts to refer clients to any type of medical provider
bull A lawyer shall not accept client referrals from any person entity or service that refers or attempts to refer clients to any other type of professional service
bull A lawyer shall not participate in or accept referrals from a referral service unless the participants in such referral service are members of The Florida Bar or otherwise subject to the Rules Regulating The Florida Bar
Read the entire article by Gary Blankenship at
httpwwwfloridabarorgDIVCOMJNjnnews01nsfcb53c80c8fabd49d85256b5900678f6c986ff5924518ad0d8525798e0047c971OpenDocumentampHighlight=0referral
Page 4 February 2012
CFO Atwater Attends lsquoPut the Brakes on Accident Fraud amp Abusersquo Event On January 25 CFO Jeff Atwater joined Gov Rick Scott and a broad coalition of Florida consumers business leaders law enforcement officials and concerned citizens to urge the legislature to take immediate action this session to Put the Brakes on Accident Fraud and Abuse in the personal injury protection (PIP) system
Tampa Clinic Owner Arrested on Structuring Charges The Division of Insurance Fraud arrested Norge Romero for structuring cash withdrawals in excess of $574000 Romero owned and operated Global Diagnostic Center a PIP clinic located in Tampa Global Diagnostic Center opened in 2008 and was issued a clinic exemption by the Agency for Health Care Administration (AHCA) involving medical doctor Sara Vizcay
Romero was the sole signatory on his personal account and the account for Global Diagnostic Center and intentionally structured cash withdrawals to avoid currency reporting requirements in violation of Florida statutes Romero allegedly intentionally structured cash withdrawals causing his bank to fail to file an applicable report and in doing so avoided the currency reporting requirements Between 12152009 and 04132011 Romero structured cash withdrawals 86 times at or below $10000 from both accounts cash withdrawals from these accounts totaled $574500
Romero was arrested on first degree felony charges of structuring transactions to evade reporting or registration requirements prohibited
State Targets PIP Fraud Efforts to reform Floridarsquos no-fault auto insurance system mdash which critics say is rife with fraud and soaring attorney fees mdash are expected to dominate insurance-related issues when the legislative session begins Tuesday
Gov Rick Scott and Chief Financial Officer Jeff Atwater have said reforms to mandatory no-fault coverage are critical and legislators are committed to the effort said Sen Garrett Richter R-Naples chairman of the Committee on Banking and Insurance
ldquoItrsquos important that the legislature address the fraud and runaway legal fees that have become a part of this systemrdquo Richter said ldquoAt the end of the day the fraud amounts to a huge tax or assessment on Florida motoristsrdquo
Randy Duncan an agent with the Insurance Depot of Lee County in Cape Coral said the mandatory coverage can account for up to 60 percent of the average auto insurance premium and that percentage is growing
Even efforts to clamp down on fraud may be difficult as groups like the Florida Medical Association fight to limit restrictions to truly fraudulent clinics and providers
ldquoThe FMA believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo said association spokeswoman Rebecca OrsquoHara
Read the full article by Tim Engstrom at httpwwwnews-presscomarticle20120109NEWS01073010900211121MOMSState-targets-PIP-fraudodyssey=nav|head
PIP FRAUD ndash In The News
Page 5 The PIP Source
In 2012 the National Insurance Crime Bureau (NICB) will celebrate its Centennial A Century of Service A Century of Trust
In 1912 when it was started under the leadership of Fred J Sauter and called the Automobile Protective and Information Bureau (APIB) Woodrow Wilson was president Jim Thorpe won Olympic gold at Stockholm and the HMS Titanic came to rest on the floor of the Atlantic Ocean
In 1927 the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB) It operated under that name for 65 years until 1992 when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB) The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company
When NICB questionable claims analysis showed a dramatic increase in medical fraud associated with auto policies NICB established in 2002 its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City Consisting of dedicated NICB special agents and analytical resources these task forces also work closely with law enforcement and insurance company special investigation unit personnel
The MMFTF model has been so successful that it has been replicated in Houston Los Angeles Washington DC Edison New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Floridas no-fault law enables auto policy medical fraud to thrive
The NICB is supported by more than 1100 property and casualty insurance companies and self-insured organizations NICB member companies wrote over $319 billion in insurance premiums in 2010 or approximately 80 percent of the nations propertycasualty insurance That includes more than 94 percent ($152 billion) of the nations personal auto insurance
Read the full press release at httpswwwnicborgnewsroomnews-releasesnicb-celebrates-its-centennial
NICB Celebrates 100 Years
NICBrsquos Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5 the National Insurance Crime Bureaursquos Ron Poindexter is retiring
During his tenure Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud
Poindexter was featured in the June 2011 issue of The PIP Source
Prior to joining the NICB Poindexter served as Director of the Florida Department of Insurancersquos Division of Insurance Fraud (DIF) from May 1996 until June 2001 At that time the Fraud Division had a staff of 171 of which 121 were sworn law enforcement investigators located throughout Florida During his tenure the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB
Ron served 27 years with the Hillsborough County Sheriffrsquos Office in Tampa Florida He rose to the rank of Colonel Chief of Law Enforcement Operations and retired in March 1996 He served three years in the United States Army as an Intelligence Analyst and is a graduate of the FBI National Academy
The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud and his many years of dedicated law enforcement service to the State of Florida We wish him well in his retirement
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 2 February 2012
Florida Chief Financial Officer Jeff Atwater announced today the arrest of a Miami clinic owner for submitting fraudulent Personal Injury Protection (PIP) claims from his unlicensed clinic
Juan M Dieguez who also used the false identity Jorge R Gonzalez is charged with operating a health care clinic without a license grand theft and insurance fraud following an investigation by the Department of Financial Servicesrsquo
Division of Insurance Fraud (DIF) Dieguez has owned and operated Venetian Rehab Center located at 434 SW 12th Ave since October 2010 but was arrested while working at another clinic Therapy-Diagnostic Tech Medical Dieguez was booked into the Miami-Dade County Jail on 012712 and is being held on $65000 bond If convicted he faces up to 15 years in prison
ldquoInsurance fraudsters have learned how to game Floridarsquos PIP system and every honest Floridian with a car in the driveway ends up payingrdquo Atwater said ldquoWe must put policies in place to stop those who make a career out of stealing our fellow Floridiansrsquo hard-earned dollarsrdquo
To demonstrate the increase of insurance fraud in Florida consider the fact that in 2008 a 40-year-old driver in Miami with an unblemished driving record was paying $582 in PIP premium and in 2010 this same driver paid nearly $1050 for the same coverage This is an 80 percent increase
A fingerprint check of Dieguez after his arrest showed that he was using a false identity under the name Gonzalez He had obtained a driverrsquos license in 2009 using a fictitious birth certificate from Puerto Rico DIFrsquos investigation further revealed that Dieguez absconded from his probation following a conviction for Medicaid fraud in 1999 Further investigation showed that Venetian Rehab was originally opened by Dieguezrsquos brother in 2003 and Dieguez added his false identity as an officer in 2010
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida Farmers Insurance Kingsway Amigo State Farm and United Auto provided assistance in this investigation
DIF Arrests Medicaid Fugitive For Operating Unlicensed Clinic in Miami
The Division of Insurance Fraud arrested Yasser Vega-Martinez 34 for planning and orchestrating three staged accidents resulting in more than $200000 in fraudulent claims submitted to Geico and State Farm
ldquoThese staged accidents are at the heart of the PIP fraud epidemic that is casting a shadow over Floridarsquos highwaysrdquo said CFO Atwater ldquoEvery Florida family is affected by these fake crashes in the form of the high auto insurance premiums My office is determined to work toward policy reforms to curb this costly crimerdquo
Vega-Martinez allegedly participated in two of three accidents he organized and staged between November 2009 and June 2010 The participants were referred to several clinics in the Miami-Dade area including GMC Rehabilitation Center AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging Grand Canal Rehab Justin Medical Services Florida Health Professionals Group Corp Angels Diagnostic Group and C amp C Therapy Center Corp
None of the clinics in this case were licensed by the Florida Agency for Health Care Administration (AHCA) however several of the clinics were issued exemptions
Vega-Martinez is believed to have organized other staged accidents and additional charges are anticipated
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle ldquoIn the battle against insurance scam artists who dip into all of our pockets I am proud to have the full support of Floridarsquos Chief Financial Officer Jeff Atwater and his elite force of Insurance Fraud investigatorsrdquo commented Fernandez Rundle ldquoWhen my prosecutors bring these insurance fraud criminals into court to face justice we know that we have the facts and the evidence on hand to convict With this effective team of fraud fighters on their trail these scammers need to recognize that they should be looking for a new and honest way to earn their livingrdquo
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Staged Accident Organizer Charged with $200000 in Fraudulent Claims
Page 3 The PIP Source
A report by the Agency for Health Care Administration (AHCA) revealed irregularities were discovered during a recent three-day sweep by investigators in 43 of 49 Miami-Dade County clinics In one case an insurance company providing personal injury protection coverage also known as PIP was charged $19000 for massage therapy
During those checks investigators witnessed only 17 patients while employees at some clinics reported they had never seen a patient At one clinic staff said they had not seen the owner or medical director in six months
The investigation found that most of the Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture
Many clinics also displayed advertisements for law firms and attorneys who specialized in traffic accident litigation while in numerous instances medical professionals at the clinics were employed without the required background screening And one man kept his job despite being deemed ineligible on his background check
AHCA referred information to the Division of Insurance Fraud (DIF) for potential criminal investigation
Read more in this article at - httpwwwocalacomarticle20120106WIRE120109810
AHCA Targets Health Care Clinics
Florida Bar Panel Looks at Limiting Lawyer Referral Services Membership A Bar committee is considering several proposals that would restrict lawyers from participating in a referral service that also handles referrals for nonlegal services including medical treatment ldquoI frankly think what we are looking at is a systemic problemrdquo committee Chair Grier Wells said
The four proposals are
bull A lawyer referral service shall not have [any relationship with] [any financial contractual or ownership interest in] a medical referral service or any person group of persons association organization or entity that specifically advertises in this state to accident victims or other prospective clients primarily for the purpose of a healthcare provider filing a claim of payment of treatment of an accident or injury victim and that uses a common phone number universal resource locator (URL) or other form of shared contact
bull A lawyer shall not accept client referrals from any person entity or service that also refers or attempts to refer clients to any type of medical provider
bull A lawyer shall not accept client referrals from any person entity or service that refers or attempts to refer clients to any other type of professional service
bull A lawyer shall not participate in or accept referrals from a referral service unless the participants in such referral service are members of The Florida Bar or otherwise subject to the Rules Regulating The Florida Bar
Read the entire article by Gary Blankenship at
httpwwwfloridabarorgDIVCOMJNjnnews01nsfcb53c80c8fabd49d85256b5900678f6c986ff5924518ad0d8525798e0047c971OpenDocumentampHighlight=0referral
Page 4 February 2012
CFO Atwater Attends lsquoPut the Brakes on Accident Fraud amp Abusersquo Event On January 25 CFO Jeff Atwater joined Gov Rick Scott and a broad coalition of Florida consumers business leaders law enforcement officials and concerned citizens to urge the legislature to take immediate action this session to Put the Brakes on Accident Fraud and Abuse in the personal injury protection (PIP) system
Tampa Clinic Owner Arrested on Structuring Charges The Division of Insurance Fraud arrested Norge Romero for structuring cash withdrawals in excess of $574000 Romero owned and operated Global Diagnostic Center a PIP clinic located in Tampa Global Diagnostic Center opened in 2008 and was issued a clinic exemption by the Agency for Health Care Administration (AHCA) involving medical doctor Sara Vizcay
Romero was the sole signatory on his personal account and the account for Global Diagnostic Center and intentionally structured cash withdrawals to avoid currency reporting requirements in violation of Florida statutes Romero allegedly intentionally structured cash withdrawals causing his bank to fail to file an applicable report and in doing so avoided the currency reporting requirements Between 12152009 and 04132011 Romero structured cash withdrawals 86 times at or below $10000 from both accounts cash withdrawals from these accounts totaled $574500
Romero was arrested on first degree felony charges of structuring transactions to evade reporting or registration requirements prohibited
State Targets PIP Fraud Efforts to reform Floridarsquos no-fault auto insurance system mdash which critics say is rife with fraud and soaring attorney fees mdash are expected to dominate insurance-related issues when the legislative session begins Tuesday
Gov Rick Scott and Chief Financial Officer Jeff Atwater have said reforms to mandatory no-fault coverage are critical and legislators are committed to the effort said Sen Garrett Richter R-Naples chairman of the Committee on Banking and Insurance
ldquoItrsquos important that the legislature address the fraud and runaway legal fees that have become a part of this systemrdquo Richter said ldquoAt the end of the day the fraud amounts to a huge tax or assessment on Florida motoristsrdquo
Randy Duncan an agent with the Insurance Depot of Lee County in Cape Coral said the mandatory coverage can account for up to 60 percent of the average auto insurance premium and that percentage is growing
Even efforts to clamp down on fraud may be difficult as groups like the Florida Medical Association fight to limit restrictions to truly fraudulent clinics and providers
ldquoThe FMA believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo said association spokeswoman Rebecca OrsquoHara
Read the full article by Tim Engstrom at httpwwwnews-presscomarticle20120109NEWS01073010900211121MOMSState-targets-PIP-fraudodyssey=nav|head
PIP FRAUD ndash In The News
Page 5 The PIP Source
In 2012 the National Insurance Crime Bureau (NICB) will celebrate its Centennial A Century of Service A Century of Trust
In 1912 when it was started under the leadership of Fred J Sauter and called the Automobile Protective and Information Bureau (APIB) Woodrow Wilson was president Jim Thorpe won Olympic gold at Stockholm and the HMS Titanic came to rest on the floor of the Atlantic Ocean
In 1927 the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB) It operated under that name for 65 years until 1992 when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB) The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company
When NICB questionable claims analysis showed a dramatic increase in medical fraud associated with auto policies NICB established in 2002 its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City Consisting of dedicated NICB special agents and analytical resources these task forces also work closely with law enforcement and insurance company special investigation unit personnel
The MMFTF model has been so successful that it has been replicated in Houston Los Angeles Washington DC Edison New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Floridas no-fault law enables auto policy medical fraud to thrive
The NICB is supported by more than 1100 property and casualty insurance companies and self-insured organizations NICB member companies wrote over $319 billion in insurance premiums in 2010 or approximately 80 percent of the nations propertycasualty insurance That includes more than 94 percent ($152 billion) of the nations personal auto insurance
Read the full press release at httpswwwnicborgnewsroomnews-releasesnicb-celebrates-its-centennial
NICB Celebrates 100 Years
NICBrsquos Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5 the National Insurance Crime Bureaursquos Ron Poindexter is retiring
During his tenure Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud
Poindexter was featured in the June 2011 issue of The PIP Source
Prior to joining the NICB Poindexter served as Director of the Florida Department of Insurancersquos Division of Insurance Fraud (DIF) from May 1996 until June 2001 At that time the Fraud Division had a staff of 171 of which 121 were sworn law enforcement investigators located throughout Florida During his tenure the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB
Ron served 27 years with the Hillsborough County Sheriffrsquos Office in Tampa Florida He rose to the rank of Colonel Chief of Law Enforcement Operations and retired in March 1996 He served three years in the United States Army as an Intelligence Analyst and is a graduate of the FBI National Academy
The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud and his many years of dedicated law enforcement service to the State of Florida We wish him well in his retirement
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 3 The PIP Source
A report by the Agency for Health Care Administration (AHCA) revealed irregularities were discovered during a recent three-day sweep by investigators in 43 of 49 Miami-Dade County clinics In one case an insurance company providing personal injury protection coverage also known as PIP was charged $19000 for massage therapy
During those checks investigators witnessed only 17 patients while employees at some clinics reported they had never seen a patient At one clinic staff said they had not seen the owner or medical director in six months
The investigation found that most of the Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture
Many clinics also displayed advertisements for law firms and attorneys who specialized in traffic accident litigation while in numerous instances medical professionals at the clinics were employed without the required background screening And one man kept his job despite being deemed ineligible on his background check
AHCA referred information to the Division of Insurance Fraud (DIF) for potential criminal investigation
Read more in this article at - httpwwwocalacomarticle20120106WIRE120109810
AHCA Targets Health Care Clinics
Florida Bar Panel Looks at Limiting Lawyer Referral Services Membership A Bar committee is considering several proposals that would restrict lawyers from participating in a referral service that also handles referrals for nonlegal services including medical treatment ldquoI frankly think what we are looking at is a systemic problemrdquo committee Chair Grier Wells said
The four proposals are
bull A lawyer referral service shall not have [any relationship with] [any financial contractual or ownership interest in] a medical referral service or any person group of persons association organization or entity that specifically advertises in this state to accident victims or other prospective clients primarily for the purpose of a healthcare provider filing a claim of payment of treatment of an accident or injury victim and that uses a common phone number universal resource locator (URL) or other form of shared contact
bull A lawyer shall not accept client referrals from any person entity or service that also refers or attempts to refer clients to any type of medical provider
bull A lawyer shall not accept client referrals from any person entity or service that refers or attempts to refer clients to any other type of professional service
bull A lawyer shall not participate in or accept referrals from a referral service unless the participants in such referral service are members of The Florida Bar or otherwise subject to the Rules Regulating The Florida Bar
Read the entire article by Gary Blankenship at
httpwwwfloridabarorgDIVCOMJNjnnews01nsfcb53c80c8fabd49d85256b5900678f6c986ff5924518ad0d8525798e0047c971OpenDocumentampHighlight=0referral
Page 4 February 2012
CFO Atwater Attends lsquoPut the Brakes on Accident Fraud amp Abusersquo Event On January 25 CFO Jeff Atwater joined Gov Rick Scott and a broad coalition of Florida consumers business leaders law enforcement officials and concerned citizens to urge the legislature to take immediate action this session to Put the Brakes on Accident Fraud and Abuse in the personal injury protection (PIP) system
Tampa Clinic Owner Arrested on Structuring Charges The Division of Insurance Fraud arrested Norge Romero for structuring cash withdrawals in excess of $574000 Romero owned and operated Global Diagnostic Center a PIP clinic located in Tampa Global Diagnostic Center opened in 2008 and was issued a clinic exemption by the Agency for Health Care Administration (AHCA) involving medical doctor Sara Vizcay
Romero was the sole signatory on his personal account and the account for Global Diagnostic Center and intentionally structured cash withdrawals to avoid currency reporting requirements in violation of Florida statutes Romero allegedly intentionally structured cash withdrawals causing his bank to fail to file an applicable report and in doing so avoided the currency reporting requirements Between 12152009 and 04132011 Romero structured cash withdrawals 86 times at or below $10000 from both accounts cash withdrawals from these accounts totaled $574500
Romero was arrested on first degree felony charges of structuring transactions to evade reporting or registration requirements prohibited
State Targets PIP Fraud Efforts to reform Floridarsquos no-fault auto insurance system mdash which critics say is rife with fraud and soaring attorney fees mdash are expected to dominate insurance-related issues when the legislative session begins Tuesday
Gov Rick Scott and Chief Financial Officer Jeff Atwater have said reforms to mandatory no-fault coverage are critical and legislators are committed to the effort said Sen Garrett Richter R-Naples chairman of the Committee on Banking and Insurance
ldquoItrsquos important that the legislature address the fraud and runaway legal fees that have become a part of this systemrdquo Richter said ldquoAt the end of the day the fraud amounts to a huge tax or assessment on Florida motoristsrdquo
Randy Duncan an agent with the Insurance Depot of Lee County in Cape Coral said the mandatory coverage can account for up to 60 percent of the average auto insurance premium and that percentage is growing
Even efforts to clamp down on fraud may be difficult as groups like the Florida Medical Association fight to limit restrictions to truly fraudulent clinics and providers
ldquoThe FMA believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo said association spokeswoman Rebecca OrsquoHara
Read the full article by Tim Engstrom at httpwwwnews-presscomarticle20120109NEWS01073010900211121MOMSState-targets-PIP-fraudodyssey=nav|head
PIP FRAUD ndash In The News
Page 5 The PIP Source
In 2012 the National Insurance Crime Bureau (NICB) will celebrate its Centennial A Century of Service A Century of Trust
In 1912 when it was started under the leadership of Fred J Sauter and called the Automobile Protective and Information Bureau (APIB) Woodrow Wilson was president Jim Thorpe won Olympic gold at Stockholm and the HMS Titanic came to rest on the floor of the Atlantic Ocean
In 1927 the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB) It operated under that name for 65 years until 1992 when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB) The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company
When NICB questionable claims analysis showed a dramatic increase in medical fraud associated with auto policies NICB established in 2002 its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City Consisting of dedicated NICB special agents and analytical resources these task forces also work closely with law enforcement and insurance company special investigation unit personnel
The MMFTF model has been so successful that it has been replicated in Houston Los Angeles Washington DC Edison New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Floridas no-fault law enables auto policy medical fraud to thrive
The NICB is supported by more than 1100 property and casualty insurance companies and self-insured organizations NICB member companies wrote over $319 billion in insurance premiums in 2010 or approximately 80 percent of the nations propertycasualty insurance That includes more than 94 percent ($152 billion) of the nations personal auto insurance
Read the full press release at httpswwwnicborgnewsroomnews-releasesnicb-celebrates-its-centennial
NICB Celebrates 100 Years
NICBrsquos Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5 the National Insurance Crime Bureaursquos Ron Poindexter is retiring
During his tenure Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud
Poindexter was featured in the June 2011 issue of The PIP Source
Prior to joining the NICB Poindexter served as Director of the Florida Department of Insurancersquos Division of Insurance Fraud (DIF) from May 1996 until June 2001 At that time the Fraud Division had a staff of 171 of which 121 were sworn law enforcement investigators located throughout Florida During his tenure the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB
Ron served 27 years with the Hillsborough County Sheriffrsquos Office in Tampa Florida He rose to the rank of Colonel Chief of Law Enforcement Operations and retired in March 1996 He served three years in the United States Army as an Intelligence Analyst and is a graduate of the FBI National Academy
The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud and his many years of dedicated law enforcement service to the State of Florida We wish him well in his retirement
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 4 February 2012
CFO Atwater Attends lsquoPut the Brakes on Accident Fraud amp Abusersquo Event On January 25 CFO Jeff Atwater joined Gov Rick Scott and a broad coalition of Florida consumers business leaders law enforcement officials and concerned citizens to urge the legislature to take immediate action this session to Put the Brakes on Accident Fraud and Abuse in the personal injury protection (PIP) system
Tampa Clinic Owner Arrested on Structuring Charges The Division of Insurance Fraud arrested Norge Romero for structuring cash withdrawals in excess of $574000 Romero owned and operated Global Diagnostic Center a PIP clinic located in Tampa Global Diagnostic Center opened in 2008 and was issued a clinic exemption by the Agency for Health Care Administration (AHCA) involving medical doctor Sara Vizcay
Romero was the sole signatory on his personal account and the account for Global Diagnostic Center and intentionally structured cash withdrawals to avoid currency reporting requirements in violation of Florida statutes Romero allegedly intentionally structured cash withdrawals causing his bank to fail to file an applicable report and in doing so avoided the currency reporting requirements Between 12152009 and 04132011 Romero structured cash withdrawals 86 times at or below $10000 from both accounts cash withdrawals from these accounts totaled $574500
Romero was arrested on first degree felony charges of structuring transactions to evade reporting or registration requirements prohibited
State Targets PIP Fraud Efforts to reform Floridarsquos no-fault auto insurance system mdash which critics say is rife with fraud and soaring attorney fees mdash are expected to dominate insurance-related issues when the legislative session begins Tuesday
Gov Rick Scott and Chief Financial Officer Jeff Atwater have said reforms to mandatory no-fault coverage are critical and legislators are committed to the effort said Sen Garrett Richter R-Naples chairman of the Committee on Banking and Insurance
ldquoItrsquos important that the legislature address the fraud and runaway legal fees that have become a part of this systemrdquo Richter said ldquoAt the end of the day the fraud amounts to a huge tax or assessment on Florida motoristsrdquo
Randy Duncan an agent with the Insurance Depot of Lee County in Cape Coral said the mandatory coverage can account for up to 60 percent of the average auto insurance premium and that percentage is growing
Even efforts to clamp down on fraud may be difficult as groups like the Florida Medical Association fight to limit restrictions to truly fraudulent clinics and providers
ldquoThe FMA believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo said association spokeswoman Rebecca OrsquoHara
Read the full article by Tim Engstrom at httpwwwnews-presscomarticle20120109NEWS01073010900211121MOMSState-targets-PIP-fraudodyssey=nav|head
PIP FRAUD ndash In The News
Page 5 The PIP Source
In 2012 the National Insurance Crime Bureau (NICB) will celebrate its Centennial A Century of Service A Century of Trust
In 1912 when it was started under the leadership of Fred J Sauter and called the Automobile Protective and Information Bureau (APIB) Woodrow Wilson was president Jim Thorpe won Olympic gold at Stockholm and the HMS Titanic came to rest on the floor of the Atlantic Ocean
In 1927 the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB) It operated under that name for 65 years until 1992 when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB) The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company
When NICB questionable claims analysis showed a dramatic increase in medical fraud associated with auto policies NICB established in 2002 its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City Consisting of dedicated NICB special agents and analytical resources these task forces also work closely with law enforcement and insurance company special investigation unit personnel
The MMFTF model has been so successful that it has been replicated in Houston Los Angeles Washington DC Edison New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Floridas no-fault law enables auto policy medical fraud to thrive
The NICB is supported by more than 1100 property and casualty insurance companies and self-insured organizations NICB member companies wrote over $319 billion in insurance premiums in 2010 or approximately 80 percent of the nations propertycasualty insurance That includes more than 94 percent ($152 billion) of the nations personal auto insurance
Read the full press release at httpswwwnicborgnewsroomnews-releasesnicb-celebrates-its-centennial
NICB Celebrates 100 Years
NICBrsquos Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5 the National Insurance Crime Bureaursquos Ron Poindexter is retiring
During his tenure Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud
Poindexter was featured in the June 2011 issue of The PIP Source
Prior to joining the NICB Poindexter served as Director of the Florida Department of Insurancersquos Division of Insurance Fraud (DIF) from May 1996 until June 2001 At that time the Fraud Division had a staff of 171 of which 121 were sworn law enforcement investigators located throughout Florida During his tenure the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB
Ron served 27 years with the Hillsborough County Sheriffrsquos Office in Tampa Florida He rose to the rank of Colonel Chief of Law Enforcement Operations and retired in March 1996 He served three years in the United States Army as an Intelligence Analyst and is a graduate of the FBI National Academy
The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud and his many years of dedicated law enforcement service to the State of Florida We wish him well in his retirement
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 5 The PIP Source
In 2012 the National Insurance Crime Bureau (NICB) will celebrate its Centennial A Century of Service A Century of Trust
In 1912 when it was started under the leadership of Fred J Sauter and called the Automobile Protective and Information Bureau (APIB) Woodrow Wilson was president Jim Thorpe won Olympic gold at Stockholm and the HMS Titanic came to rest on the floor of the Atlantic Ocean
In 1927 the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB) It operated under that name for 65 years until 1992 when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB) The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company
When NICB questionable claims analysis showed a dramatic increase in medical fraud associated with auto policies NICB established in 2002 its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City Consisting of dedicated NICB special agents and analytical resources these task forces also work closely with law enforcement and insurance company special investigation unit personnel
The MMFTF model has been so successful that it has been replicated in Houston Los Angeles Washington DC Edison New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Floridas no-fault law enables auto policy medical fraud to thrive
The NICB is supported by more than 1100 property and casualty insurance companies and self-insured organizations NICB member companies wrote over $319 billion in insurance premiums in 2010 or approximately 80 percent of the nations propertycasualty insurance That includes more than 94 percent ($152 billion) of the nations personal auto insurance
Read the full press release at httpswwwnicborgnewsroomnews-releasesnicb-celebrates-its-centennial
NICB Celebrates 100 Years
NICBrsquos Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5 the National Insurance Crime Bureaursquos Ron Poindexter is retiring
During his tenure Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud
Poindexter was featured in the June 2011 issue of The PIP Source
Prior to joining the NICB Poindexter served as Director of the Florida Department of Insurancersquos Division of Insurance Fraud (DIF) from May 1996 until June 2001 At that time the Fraud Division had a staff of 171 of which 121 were sworn law enforcement investigators located throughout Florida During his tenure the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB
Ron served 27 years with the Hillsborough County Sheriffrsquos Office in Tampa Florida He rose to the rank of Colonel Chief of Law Enforcement Operations and retired in March 1996 He served three years in the United States Army as an Intelligence Analyst and is a graduate of the FBI National Academy
The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud and his many years of dedicated law enforcement service to the State of Florida We wish him well in his retirement
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 6 February 2012
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Arrested
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 7 The PIP Source
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Daniel Martinez 41 ndash massage therapist - $6555 - LOP Rehabilitation Center (Allstate) W
Alex Arnoldo Flores 30 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Julio Fernandez Delgado 42 ndash runner - mail fraud conspiracy to commit mail fraud () W
Ernesto Miralles 39 ndash runner - mail fraud conspiracy to commit mail fraud () W
Josue Santiago Montanez 35 ndash staged acct 111609 (passenger) $1941 - Advance Pain Management (First Acceptance) T
Roberto Santiago 40 ndash staged acct 120811 (recruiter) $0 - (unk) M
Hashley Mocombe 22 ndash staged acct 050111 (driver) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Yvio Lesperance 23 ndash staged acct 050111 (passenger) $21871 - KJ Chiropractic Clinic Wellness Pain amp Rehab (Farmers Geico) O
Brenda Magaly Vasquez 25 ndash fake ins card (MGA Insurance) W
Jacquana Lucas 30 ndash staged acct 053010 (driver) $802+ - Massage amp Healing Center (Hallmark) T
Amy Wava McEver 31 ndash paper acct 100510 (driver) $0 - Personal Medical Center (Farmers) T
Diane Gibson 52 ndash false police report (Geico) J
Francina Gonzalez 31 ndash staged acct 053010 (driver) $unk - Massage amp Healing Center (unk) T
Marcella Jean Clemmons 52 ndash false police report (Geico) J
Armando G Espinosa 38 ndash PIP patient - $1930 - LOP Rehabilitation Center (Allstate) W
Zachary Keith Stuhler 28 ndash PIP patient - mail fraud conspiracy to commit mail fraud ndash () W
Aida Artiles Rodriguez 51 ndash staged acct 051810 (passenger) $78941 ndash Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
David Dewilton Thomas 56 ndash staged acct 062411 (driver) $15146 - Orthopedic Center of Okeechobee (Repwest State Farm) F
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 8 February 2012
Statewide PIP Arrests ndash January 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Captain Smith
Juan C Romero 46 ndash PIP patient - $555 - LOP Rehabilitation Center (Allstate) W
Ketty Gonzalez 39 ndash massage therapist - mail fraud conspiracy to commit mail fraud () W
Roberto Martinez 28 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Norge Romero 40 ndash clinic owner structuring money laundering - $574500 - Global Diagnostic Center (unk) T
Manuel Madrigal Perez 49 ndash staged acct 051810 (passenger) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Raul Torres Oliva 29 ndash staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Ac-tive Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Juan Torres Garcia 54 - staged acct 051810 (recruiter) $78941 - Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic J amp C Imaging Lianet Rehab Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Viva X-Ray Diagnostic Center (21st Century State Farm) M
Alvin Edward Blocker 58 ndash application fraud (Esurance) P
Jorge Gonzalez aka Juan Dieguez 41 ndash unlicensed clinic - $55646 ndash Venetian Rehab Center (Farmers Kingsway Amigo State Farm United Auto) M
Hirain Valle Delgado 37 ndash probation violation M
Donna Sue Joseph 28 ndash staged acct 110808 (passenger) $21001 -East Colonial Chiropractic amp Rehab (AvisBudget) O
Yasser Vega Martinez 34 ndash staged acct 111109 (recruiter) $85420 ndash GMC Rehabilitation AB Diagnostic Center The Osteomuscular Rehab Center Corp Y amp H Imaging (Geico State Farm) M
Yasser Vega Martinez 34 ndash staged acct 041510 (recruiter) $25365 ndash Grand Canal Rehab Angels Diagnostic Group (State Farm) M
Yasser Vega Martinez 34 ndash staged acct 061610 (recruiter) $93553 ndash Justin Medical Services CampC Therapy Center Corp Y amp H Imaging Angels Diagnostic Group Florida Health Professionals Group Corp (Geico) M
Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Copy goes her Editorrsquos Corner On page one we highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer
We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two
On page three we cover the Agency for Health Care Administrationrsquos (AHCA) sweep of Miami-Dade County clinics
We join in the celebration of NICBrsquos 100th Birthday and announce the retirement of Area 5 Director Ron Poindexter
Happy Valentinersquos Day
Page 9 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Captain Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Captain Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Captain Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Captain Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Captain Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Charges have been filed against an
Orlando chiropractor and
two clinic operators for allegedly conspiring
to create a ldquostrawrdquo ownership
arrangement
Volume 2 - Issue 9 March 2012
Florida Chief Financial Officer Jeff Atwater announced that charges have been filed against an Orlando chiropractor and two clinic operators for allegedly conspiring to create a ldquostrawrdquo ownership arrangement to thwart Floridarsquos clinic licensing laws
Judith Christina McKenzie a chiropractic physician allegedly fronted ownership of Silver Star Health and Rehab an accident clinic in Orlando However an investigation by the Department of Financial Servicesrsquo Division of Insurance Fraud (DIF) determined that Silver Star was really owned operated and managed by non-physicians Jean Ely Colin and Marc Arthur Maxis Arrest warrants were issued for all three McKenzie and Colin surrendered and were booked into the Orange County Jail Maxis was located and arrested in Palm Beach County
ldquoThis kind of fraud costs every honest Floridian with a car in the driveway and we canrsquot throw the crooks in jail fast enoughrdquo Atwater said ldquoMy department is committed to finding the perpetrators and bringing them to justice but we also must put more barriers in place to stop this fraud and the skyrocketing cost of auto insurance in Floridardquo
McKenzie purported to be the sole owner of Silver Star so the clinic operated with a self-proclaimed exemption since its inception in May 2008 Because McKenzie held a license with the Department of Health (DOH) she was automatically exempt from clinic licensing requirements regulated by the Agency for Health Care Administration under the Health Care Clinic Act
Florida Statute 4009935 (3) states ndash ldquoAll charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part but that is not so licensed or that is otherwise operating in violation of this part are unlawful charges and therefore are noncompensable and unenforceablerdquo
As a result of the clinicrsquos fraudulent business arrangement insurance claims filed by the clinic were fraudulent The DIF found more than $525000 in fraudulent PIP claims filed with five different insurance companies
Detectives said Silver Starrsquos banking records proved the ldquostraw ownerrdquo arrangement Furthermore McKenzie admitted she did not run the clinic and had no financial obligations to the operation
The three co-conspirators are charged with organized scheme to defraud operating an unlicensed health care clinic filing false and fraudulent insurance claims and grand theft If convicted on all charges each could face up to 125 years in prison in addition to fines and restitution
The case is being prosecuted by the Orange County State Attorneyrsquos Office
INSIDE THIS ISSUE
1 Chiropractor Arrest
2 Tampa Takedown
3 PIP Fraud News
5 FIFEC - 20 Years
6 PIPrsquos Dark Side
8 Statewide Arrests
10 Statewide Contacts
HEADER HERE Chiropractor 2 Others Charged in Unlicensed Clinic Fraud in Orlando
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 2 March 2012
Florida Chief Financial Officer Jeff Atwater announced the arrests of ten accident clinic employees for soliciting undercover agents posing as accident victims
A long-term investigation by the Florida Department of Financial Servicesrsquo Division of Insurance Fraud and the Tampa Police Department revealed that employees at multiple accident clinics including Tampa Rehab Center Auto Injury Doctors of Tampa and PVC Medical Center paid fraud investigators posing as accident victims to sign fraudulent treatment forms attesting to medical services they never received The clinics subsequently submitted fraudulent claims to insurance companies including Nationwide Farmers Progressive and 21st Century Insurance
ldquoFloridarsquos auto insurance system has become a feeding frenzy for those who are looking to make money off the backs of consumersrdquo CFO Atwater said ldquoMy office will continue to partner with state and local law enforcement agencies to dismantle these organized crime rings and put the crooks behind barsrdquo
The individuals arrested during the sweep include Tavares Castillo 37 Jose Luis Avila Robles 30 Jorge Luis Gutierrez 33 Jose Miguel Alvarado Jr 29 Yankiel Cordero 21 Yankiel Borrego 31 Blanca M Acosta 53 Evelisse Acosta 42 Alfredo Rodriguez 41 and Aileen Lynn Cazanas 18 The individuals were arrested on third-degree felony charges for patient brokering and filing fraudulent insurance claims If convicted they could face up to 15 years in prison
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida
Ten Arrested in Tampa Clinic Takedown
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 3 The PIP Source
Massage Therapist Arrested in WPB Fraud Case Massage therapist Diosniley Acanda Crespo 38 was arrested for insurance fraud and grand theft for allegedly fabricating records for treatment he did not provide to three patients Crespo worked at Coral Therapy and Medical Center a clinic in West Palm Beach The clinic allegedly owned by chiropractor Laz Rodriguez opened in 2010
Crespo who was first licensed as a massage therapist in November 2009 was charged with more than $2330 in fraudulent billings that were discovered by Allstate after conducting surveillance of the patients A total of $41520 was billed by Coral Therapy and Medical Center for the three patients in this case One of the patients told detectives she was offered $3000 to be treated at the clinic but never got paid
Coral Therapy and Medical Center was issued an exemption with the Agency for Health Care Administration (AHCA)
Investigation of the clinic continues and additional arrests are anticipated
Clinic Owner Arrested Again for More Staged Accidents Clinic owner Daysi Puigros 43 was arrested again last month and charged with allegedly organizing two more staged accidents Puigros owner of Better Life Medical Center was first arrested in August 2011 after an investigation by the Division of Insurance Fraud found that she had operated an unlicensed clinic and used the name and license of a deceased doctor to fraudulently bill insurance companies Subsequent to the original charges it was discovered that Puigros was the organizer of multiple staged accidents to obtain patients to be treated at her clinic and she was arrested again in October 2011
The latest charges involve a staged accident in 2009 where participants were sent to Better Life Medical Center and a staged accident in 2010 where some participants were sent to one of Puigrosrsquo clinics Quality Life Rehabilitation Center LLC while others were sent to Centinel Medical Center As a result of these two staged accidents more than $110000 in fraudulent claims were submitted to Affirmative Allstate Progressive RAC State Farm and United Auto The National Insurance Crime Bureau (NICB) assisted in this case
Five Arrested in Miami Staged Accident Case Five subjects were arrested for a staged accident that occurred in May 2011 Rafael La-Rosa 32 allegedly organized the staged accident offering participants up to $2000 to go to a clinic afterwards Participants were sent to accident clinics in Miami including Benefica Health Center and La Maison Medical Practice More than $88000 in fraudulent bills were submitted to Allstate and Ocean Harbor
Four participants including Jose Angel Abreu Hernandez 25 Odalys Olomo Hernandez 42 Leslie Simo 19 and Arturo Varela Jr 22 were each charged with staged accident insurance fraud and grand theft The National Insurance Crime Bureau (NICB) assisted in this case
Dennis Russo Named to Lead NICB in Florida Dennis Russo was named as Director of Operations for the Southeast Region replacing the retired Ron Poindexter and will lead the National Insurance Crime Bureaursquos (NICB) fight against fraud in Florida Russo had been supervising NICBrsquos Central Florida Major Medical Fraud Task Force since May 2011
Russo started his law enforcement career with the Polk County Sheriffrsquos Office in 1978 rising to the rank of detective before moving to the Florida Department of Law Enforcement (FDLE) as a Special Agent in 1988 There Russo was responsible for investigating major multiple jurisdictional crimes to include narcotics homicides and fraud and was a member of the Special Operations Team and a high liability instructor
Russo joined NICB in April 2008 assigned to the greater Orlando area investigating medical fraud auto fraud and running the Orlando Mini Medical Fraud Task Force In July 2010 Russo was assigned to the Central Florida Major Medical Fraud Task Force
We congratulate Director Russo in his new position and look forward to continuing our working relationship with NICB
PIP FRAUD ndash In The News
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 4 March 2012
Staged Accident Demonstration Held for Florida Government Leaders Cars collided in full view of Floridarsquos highest ranking officials today at the Pat Thomas Law Enforcement Academy showcasing the dangerous crimes of insurance fraud through staged accidents Florida continues to lead the nation in staged accidents and abuse of the Personal Injury Protection (PIP) system
ldquoViewing how easy it is to fake an auto accident is sickeningrdquo Governor Rick Scott said at a news conference after the demonstrations ldquoIf there was any shred of doubt left in any legislatorrsquos mind this exercise has surely demonstrated beyond a doubt that PIP reform is critical to protect Florida drivers from these dangerous staged car accidents and from rate increases caused by fraudrdquo
The Florida Highway Patrol and the Coalition to Put the Brakes on Accident Fraud hosted the event
ldquoIt defies logic that as automobile accidents have decreased by eight percent over the past five years auto insurance rates have skyrocketed for Florida families - from 80 percent in Tampa and Miami to nearly 50 percent in Jacksonville and Destinrdquo Chief Financial Officer Jeff Atwater said ldquoOne thing is clear Floridarsquos personal injury protection system is surrounded by sharks looking to make their money off the backs of consumers and by taking decisive action this session to drive down costs we can protect Florida insurance consumers from being preyed uponrdquo
Florida Highway Patrol Colonel David Brierton also vowed to provide training to his troopers across the state in an effort to reduce or eliminate traffic crash fraud
ldquoThis is a new generation of organized crime and we need to work together to develop a solutionrdquo Col Brierton said ldquoEvery day that passes is another day law enforcement officers across the state will have to handle fraudulent accident reports and another day the wallets of Floridians are hit with the ever-increasing costs of abuse from accident fraudrdquo
Visit the Coalition to Put the Brakes on Accident Fraud website at wwwputthebrakesonaccidentfraudcom
Read this article at httpwwwprnewswirecomnews-releasesgovernor-rick-scott-witnesses-examples-of-insurance-fraud-139461253html
Miami Police Department Leads Crackdown on Fake Insurance Cards On Wednesday February 29 2012 the Miami Police Department conducted a county-wide Fraudulent Proof of Motor Vehicle Insurance Operation which was the largest of its kind in Floridarsquos law enforcement history A total of 17 arrests were made including 4 for fake insurance cards and a total of 542 citations were issued
Drivers that were stopped by police officers for traffic violations or involved in motor vehicle crashes were asked to show proof of insurance The goal of this operation was to identify and apprehend any drivers with fake insurance cards Drivers caught with forged paperwork were charged with a third-degree felony for carrying fraudulent proof of motor vehicle insurance The Miami Police Department the National Insurance Crime Bureau (NICB) 19 insurance companies and 22 law enforcement agencies cooperated in this joint effort During the operation officers were able to radio in the driverrsquos insurance card information to a command center where the insurance representatives were standing by to verify the insurance coverage
Drivers with fake insurance cards affect all drivers on the road because in the event of a crash with an uninsured motorist the cost acquired can eventually be passed on to those with valid insurance Insurance rates keep escalating every year to recover losses due to uninsured drivers It is illegal to drive in the state of Florida without insurance or with a fake insurance card
The law enforcement agencies that participated in this operation included Aventura Bal Harbour Bay Harbor Biscayne Park Coral Gables Florida Highway Patrol Hialeah Homestead Key Biscayne Medley Miami Miami Beach Miami-Dade Miami-Dade School Police Miami Gardens Miccosukee North Bay Village North Miami Opa-Locka Sunny Isles Beach Surfside and West Miami
The insurance companies that participated included 21st Century Allstate Direct General Farmers Gainsco Geico GMAC Infinity Kingsway Amigo Mercury MetLife Nationwide Sentry Star Casualty State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 5 The PIP Source
This year the Florida Insurance Fraud Education Committee (FIFEC) will celebrate the 20th Anniversary of their Annual Conference which will take place June 13-15 2012 in Orlando The conference is attended by law enforcement insurance investigators and professionals members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators)
The Florida Insurance Fraud Education Committee began its existence as the DIFSIU Annual Training Seminar representing the Florida Department of Insurancersquos Division of Insurance Fraud and the Special Investigations Unit (SIU) community in 1992 DIF hosted this first seminar which was actually a one-day open forum-type workshop held in Altamonte Springs with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud To register or for more info go to wwwfifecorg Expected to return this year is Floridarsquos Chief Financial Officer Jeff Atwater and new Division of Insurance Fraud Director Dan Anderson will make his first appearance at the conference
This years conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center located at 8101 World Center Drive in Orlando where it has been since 2004
Scheduled among this yearrsquos offerings are the following PIP related courses
Clinic Capers Chiropractic Trends Covert Clinic Operations Lawyer Referral Services The State of Fraud in the State of Florida Forget the Treatment - Just Send the Bill Handling EUOs A ldquoLiterallyrdquo Hands On Approach Anatomy of a Clinic - Organized Crime in SW Florida The Web Fee Splits Kickbacks and Clinic Ownership Issues Vehicle Accident Reconstruction for Adjusters and Attorneys Staged Accident Investigations Deputy Detective amp SIU Perspectives Fraud Referrals to DIF The Road to Prosecution Begins With DIF amp NICB Basic Automobile Accident Reconstruction for the Insurance Investigator Out of the MIST - Some New Trends amp Some Old Trends in Soft Tissue Claims Hot Topics amp Trends in Personal Injury Protection (PIP) Case Law amp Legislative Update Fraud Cases and EUOs in a Post-Custer World Real Time Examples and Audience Participation Discussion of Recent Florida Case Law Developments Regarding EUO Methodology and Limitations
FIFEC Set to Celebrate 20 Years
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 6 March 2012
The Division of Insurance Fraud (DIF) arrested seven defendants in January and February 2012 for a staged accident that occurred on May 18 2011 in Miami that resulted in more than $78000 in fraudulent claims Typical story right
But there is an interesting twist to this story and it reveals a dark side to this widespread crime
Organizer Roberto Martinez 28 has staged many fake accidents in his young life DIF has previously arrested him for three other staged accidents Martinez was first arrested in April 2011 for a staged accident and $17950 in fraudulent claims While out on bond in that case Martinez staged an accident in June 2011 resulting in $77438 in fraudulent claims Martinez was arrested and his bond was revoked While Martinez sat in jail awaiting trial he was charged with a paper accident that he arranged in August 2010 resulting in $18671 in fraudulent charges
For these four staged accidents Martinez is responsible for more than $192000 in fraudulent claims filed against three different insurance companies
Most staged accident organizers like Martinez have a relationship with the clinics to which they provide patients many of the clinics know the ldquopatientsrdquo are participants from fake crashes Martinez operated his ring with the purpose of optimizing his profit he would ldquosellrdquo his participants to as many clinics as he could collecting multiple payoffs This causes a problem for the clinics when the insurance companies receive multiple claims for the same patient treating at different providers and the clinics are often not paid for their claims causing them to be upset with the runner In this case ndash Martinez
One of the participants in an accident staged by Martinez decided to end his involvement and refused to go to any more clinics Someone believed to be associated with one of the clinics allegedly attempted to take this participant to the clinic by force and when the participant resisted he was pepper-sprayed
But what happened in this new case is even more alarming In this case one of the participants in the May 18 2011 staged accident was taken to a clinic where he was allegedly threatened and accosted about money owed to the clinic by Martinez When the participant was unable to help the clinic get their money he was removed from the clinic put into a car and was under the belief that the driver and accomplice were go-ing to kill him Instead the participant pulled out his own handgun and shot the two other persons in the car and escaped Miami-Dade Police Department charged those two persons with kidnapping and they face trial in March
Among the clinics that billed insurance companies for treating patients from staged accidents organized by Martinez were Absolute Health Center Corp Ache Free Body Active Wellness Center Atlantic Mobile Services B amp A Diagnostic C amp C Rehabilitation Center Dade Wellness Center First Care Solution J amp C Imaging Lianet Rehab Center Lorena de Jesus Rehabilitation Matanzas System Corp MCJ Medical Center Corp MG Therapeutic Rehabilitation Corp Ocean Medical amp Diagnostic Services Omega Medical Diagnostic ORD Medical Center and Viva X-Ray Medical Diagnostic Center
Under arrest in this case are the organizer Martinez recruiters Raul Torres Oliva 29 and Juan Torres Garcia 54 and participants Aida Artiles Rodriguez 51 Manuel Madrigal Perez 49 Juan Manuel Diez 26 and Julio Gutierrez 55 One suspect remains at large
This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle
The insurance companies defrauded by Martinez in these staged accidents include 21St Century Geico and State Farm This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
The Dark Side of PIP Fraud
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 7 The PIP Source
At least 47 clinics have closed as a result of law enforcement investigations by the Division of Insurance Fraud and other state local and federal agencies over the last year These clinics include the following
1st Open MRI LLC - Miami AB Diagnostic Center ndash Opa Locka Aesthetic amp Rehabilitation Center - Tampa Alhambra Health amp Rehab - Orlando American Relax Center - Tampa Auto Injury Doctors of Tampa LLC - Tampa Bayshore Chiropractic Center - Naples Best Care Medical Center - Tampa Coral Therapy and Medical Center ndash West Palm Beach Coral Way Rehabilitation Services - Miami D amp A Rehabilitation Center Corp ndash West Palm Beach Elite Rehabilitation Services Center ndash Lake Worth Family Chiropractic Center ndash North Miami Beach Family Health Care Solutions - Miami Florida Rehabilitation Practice - Tampa Ft Myers Chiropractic Center ndash Ft Myers Hallandale Medical Associates - Hallandale Health Park Chiropractic (aka Fils Chiropractic and Rehab Center LLC) - Naples Injury Mid-Florida Rehab LLC dba Physical Medicine Group - Orlando La-Salle Comprehensive - Miami MAA Diagnostic Solution ndash Coral Gables Marbella Medical Center - Tampa Medical Therapy Practitioners - Tampa Medico de la Familia Corp - Hialeah Mendez Rehab Center LLC - Tampa New Horizon Practice - Miami New Oasis Practice - Miami Oasis Medical and Rehabilitation Center - Miami Pain Solution LLC - Tampa Personal Outreach Rehabilitation - Tampa Physical Rehab Center - Tampa Preferred Diagnostic Solution - Tampa Progressive Rehab Treatments Corp ndash Lake Worth PVC Medical Center - Tampa Relief All Pain Rehab Center - Tampa Relief Pain Rehab Center - Tampa Tampa Rehab Center LLC - Tampa Therapeutic Health Center - Tamarac Therapium Health Corporation - Miami Therapy Diagnostic Tech Medical ndash Miami Jacksonville and Tampa Universal Rehab Med Group ndash Lake Worth Venetian Rehab Center - Miami Wagner Chiropractic amp Acupuncture ndash Daytona Beach Wellness Center of Tampa ndash Winter Haven West Coast Chiropractic amp Medical Center - Tampa Westchester Professional Health Services - Miami Whitfield Chiropractic and Massage Clinic PLLC ndash Winter Haven
PIP Clinic Closings
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 8 March 2012
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Jose Manuel Diez 26 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medi-cal amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Jean Ely Colin 43 - clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Judith McKenzie 68 - chiropractor unlicensed clinic - $523590 - Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Julio Gutierrez 55 ndash staged acct 051810 (driver) $78941 - J amp C Imaging Active Wellness Center Ocean Medical amp Diagnostic Services Omega Medical Diagnostic Lianet Rehab Center Viva X-Ray Diagnostic Center Atlantic Mobile Services Absolute Health Center Corp Ache Free Body B amp A Diagnostic (21st Century State Farm) M
Luis Sergio Pileta Echeverria 38 ndash staged acct 062110 (passenger) $69608 ndash Quality Life Medical Center Centinel Medical Center (Allstate Progressive RAC United Auto) M
Kelvin Enrique Escalante 23 ndash false statement in support of jump-in 011711 - $3977 (Direct General) F
Amalia Soto Escalante 43 ndash jump-in 011711 - $3977 ndash Dr Russell Turner (Direct General) F
Sherley Lussage 23 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Vanessa St Marc 24 ndash staged acct 102909 (passenger) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash staged acct 102909 (recruiter) $30000 - R amp H Clinic (Liberty Mutual) O
Marc Maxis 42 ndash clinic owner unlicensed clinic - $523590 ndash Silver Star Health and Rehab (Allstate Farmers Liberty Mutual Safeco State Farm) O
Luis Mendez Rubalcaba 55 ndash PIP patient false injury - $14624 (Sentry) T
Mladen Antolic 56 ndash doctor ndash insurance fraud patient brokering racketeering - Physical Medicine Group dba Injury Mid Florida Rehab () O
Terry Thackeray 45 ndash false claim - $10898 (State Farm) W
Fernando Taveras Castillo 37 ndash clinic employee - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Blanca Rojas 44 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Alfredo Rodriguez 40 ndash clinic manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Blanca M Acosta 53 ndash clinic employee ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Jose Miguel Alvarado Jr 28 ndash runner - $8362 ndash Tampa Rehab Center (Farmers Nationwide) T
Kenzi Sanchez 17 ndash staged acct 060910 (jump-in) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Michael John Santos 24 ndash staged acct 060910 (driver) $44900 ndash Advance Quality Medical Center GA Therapy Service (Allstate Progressive) M
Orisel Guerra 39 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Mariset Orihuela Guerra 19 ndash staged acct 111110 (jump-in) $30200 ndash Selem Medical Center Corp (State Farm) M
Evelisse Acosta 41 ndash massage therapist ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Dorotea Mirella Perez Almeyda 62 ndash staged acct 111110 (jump-in) $30200 - Selem Medical Center Corp (State Farm) M
Kenia Peres 33 - staged acct 032009 (passenger) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 9 The PIP Source
Statewide PIP Arrests ndash February 2012 Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Giobel Moreira Navarro 47 ndash staged acct 070810 (recruiter) $45002 - CAC Medical Center Centinel Medical Center (Allstate Progressive) M
Rolando Soto 37 - staged acct 032009 (driver) $40792 - Better Life Medical Center LLC (Affirmative RAC State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 061910 (recruiter) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Giobel Moreira Navarro 47 ndash staged acct 020210 (recruiter) $101805 - Brilliant Medical Center L amp A Majestic Medical Center LLC ORD Medical Center (Progressive State Farm United) M
Yankiel Cordero 20 ndash massage therapist ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Ivan Zamora 38 ndash staged acct 061910 (driver) $87765 - Centinel Medical Center The Hope Rehabilitation (Progressive State Farm) M
Suramy Hernandez 42 ndash PIP patient - $370 - Better Life Medical Center (Mercury) W
Nelson Reinaldo Hernandez 47 ndash PIP patient - $720 - Better Life Medical Center (Mercury) W
Jesus Iluminado Guerrero 29 ndash staged acct 060709 (recruiter) $19414 (Allstate) M
Yankiel Borrego 30 ndash clinic manager ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jose Luis Avila Robles 30 ndash runner ndash $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Jorge Luis Gutierrez 33 ndash runner office manager ndash $7812 - PVC Medical Center (21st Century Nationwide) T
Leslie Simo 19 ndash staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Kriter Oliver Gutierrez 35 ndash staged acct 040309 (driver) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Jose Angel Abreu 25 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Arturo Varela Jr 22 - staged acct 052211 (passenger) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Aillen Lynn Cazanas 18 ndash clinic employee $22662 - Auto Injury Doctors of Tampa (Farmers Progressive) T
Odalys Oloma Hernandez 42 - staged acct 052211 (driver) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Rafael La-Rosa 32 - staged acct 052211 (recruiter) $88647 ndash All X-Ray Diagnostic Benefica Health Center La Maison Medical Practice Diagnostic amp Radiology (Allstate Ocean Harbor) M
Diosniley Acanda Crespo 38 ndash massage therapist - $2330 - Coral Therapy and Medical Center (Allstate) W
Daysi Puigros 43 - staged acct 032009 (recruiter) $40792 ndash Better Life Medical Center LLC (Affirmative RAC State Farm) M
Daysi Puigros 43 - staged acct 062110 (recruiter) $69608 ndash Centinel Medical Quality Life (Allstate Progressive RAC United Auto) M
Zaily Morera 39 ndash staged acct 040309 (passenger) $28375 - E amp B Rehabilitation Center Francos Medical Center (Progressive State Farm) M
Guillermo Alberto Chavez 56 ndash staged acct 022310 (passenger) $101805 ndash Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Kenneth Wayne Beasley 52 - staged acct 022310 (driver) $101805 - Brilliant Medical Center L amp A Majestic Medical Center Ord Medical Center (Progressive State Farm United) M
Office Code ndashB (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Copy goes her Editorrsquos Corner On Page one we spotlight the major arrest of two clinic owners and the chiropractor who helped them operate their accident clinic without a license
On page two we cover a major bust conducted by the Division of Insurance Fraud in Tampa involving three clinics
On page six in ldquoThe Dark Side of PIP Fraudrdquo we expose a disturbing new trend of violence in what has traditionally been a paper crime
FIFEC celebrates their 20th Anniversary this year
As always we cover PIP related news from around the state and report on those arrested for PIP related crimes
Page 10 March 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Dennis Russo 8639676904
Statewide PIP Contacts
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Massage therapists and acupuncturists
were both eliminated from eligibility for PIP
benefits
Volume 2 - Issue 10 April 2012
CFO Jeff Atwater and Gov Rick Scott worked tirelessly with legislative leaders this session to pass reforms to the statersquos personal injury protection (PIP) system and stop the estimated $1 billion fraud tax on Floridarsquos consumers Reforms championed by CFO Atwater and passed this session target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and provide rate relief for Floridarsquos consumers
A report released in November by Insurance Consumer Advocate (ICA) Robin Westcott appointed by CFO Atwater highlighted the need for reforms through concrete and meaningful data According to the ICArsquos report the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
ldquoWhen I took office as Floridarsquos CFO I made a commitment to do all I could to go after the fraudsters cheating Floridians out of their hard-earned dollarsrdquo CFO Atwater said ldquoWith the passage of this bill and the help of Floridarsquos Legislature I know we have gone a long way in fulfilling that promise Irsquom eager to start seeing the positive impacts of this bill in the form of rate relief for Floridarsquos consumersrdquo
In 1972 Florida passed the PIP law to make sure anyone injured in an auto accident would quickly get money to treat their injuries The legislation provided that a drivers insurance company pay up to $10000 to cover medical bills and lost wages after an accident no matter who is at fault There have been numerous attempts to tighten the law since then and it briefly sunset in 2007 for three months before being reenacted
The new legislation requires an accident victim to obtain treatment within 14 days in an ambulance or hospital or from a physician osteopathic physician chiropractic physician or dentist The full $10000 PIP benefit can be used only if it is determined that the insured has an emergency medical condition If not the PIP benefit is limited to $2500 Massage therapists and acupuncturists were both eliminated from eligibility for PIP benefits
The legislation also includes that an insured must submit to an examination under oath This investigative tool had been in question since the Custer ruling by the Supreme Court in 2010
INSIDE THIS ISSUE
1 PIP Reform Passes
2 Operation Whiplash
3 Miami Tampa fraud
4 PIP Fraud News
6 New PIP Scheme
8 Statewide Arrests
11 Statewide Contacts
HEADER HERE
Florida Passes PIP Reform
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 2 April 2012
The Cape Coral Police Department wrapped up an undercover investigation into PIP fraud and staged crashes with 12 arrests last month The investigation was conducted by the Cape Coral Police Department US Secret Service the City of Miami Police Department Hialeah Police Department the Division of Insurance Fraud IRS US Attorneyrsquos Office and the National Insurance Crime Bureau (NICB) Also assisting the investigation were several insurance companies including State Farm Met Life Sentry Travelers Allstate Nationwide and Farmers
In the 13-month investigation detectives went undercover and infiltrated a sophisticated insurance fraud scheme Participants staged traffic crashes feigned injuries and sought medical treatment at a clinic which would bill the insurance company for thousands of dollars per crash The investigation discovered that two clinics Xtreme Care Rehabilitation Center and C amp A Family Rehab Center were allegedly operating in Cape Coral as unlicensed health care clinics since 2009
Xtreme Care Rehabilitation Center located at 2002 Del Prado Boulevard South Suite 100 in Cape Coral was incorporated in December 2009 and listed chiropractor Stephen Lovell as the President and sole officer Lovell has been licensed in Florida as a chiropractor since August 1986 and as a Physicianrsquos Assistant since February 2007
C amp A Family Rehab Center located at 1401 Viscaya Parkway Suite 4 in Cape Coral was incorporated in September 2009 and listed chiropractor William A Hall as the President and sole officer Hall has been licensed in Florida as a chiropractor since July 1994
Neither clinic was licensed by or been issued an exemption by the Agency for Health Care Administration (AHCA)
The investigation resulted in the federal indictments of 12 individuals at all levels of the criminal organization from staged crash recruiters to massage therapists clinic owners and a chiropractor Hundreds of thousands of dollars in assets were also seized The investigation continues and additional arrests are anticipated
In one indictment involving activity at Xtreme Care Rehabilitation Center chiropractor Stephen M Lovell 54 clinic owners Francisco Huici Fernandez 39 and Ernesto Diaz 30 staged accident recruiter Joanna Capote 23 office managers Karen Carmona Jackson 29 and Jeanine Lastres Huici 41 massage therapists Marylda Santana 21 and Sonia Arroyo 52 and receptionist Indra Lemus Castellanos 19 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering and money laundering
In a separate indictment involving activity at C amp A Family Rehab Center clinic owners Abel de Jesus Perez 43 and Francisco Huici Fernandez 39 massage therapists Victor Caballero Duarte 22 and Marylda Santana 21 and receptionist Adrian Perez 21 were charged with conspiracy to commit health care fraud and mail fraud health care fraud mail fraud and conspiracy to commit money laundering
Each of the counts in the two indictments carry a maximum penalty of 20 years in federal prison
The US Attorneyrsquos Office has called this investigation the largest most successful of its kind and the agency will recommend it as a ldquotemplaterdquo for other investigations to follow in the future
Read more on this operation at httpwwwnews-presscomarticle20120322CRIME303230014Cape-Coral-police-12-people-arrested-multi-million-dollar-insurance-fraud-investigation
12 Arrested in Lee Countyrsquos Operation Whiplash
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 3 The PIP Source
Following a two-year investigation by the Division of Insurance Fraud (DIF) 15 subjects were arrested for their roles in a Miami ring that used lunch trucks to stage more than a dozen accidents and file more than $800000 in fraudulent property damage and Personal Injury Protection (PIP) claims ldquoWhile many businesses are struggling to stay afloat during these difficult economic times turning to insurance fraud is never the answerrdquo said CFO Atwater ldquoI will not stand by and let these fraudsters go to lunch on your hard-earned dollarrdquo
The investigation revealed that a lunch truck company catering to construction sites found itself on tough financial times and created the scheme to improve cash flow The owners of the lunch trucks recruited participants to pose as the owners and stage auto accidents The real truck owners then filed fraudulent claims and paid the fake owners several thousand dollars for their roles Between 2008 and 2010 the ring staged more than a dozen accidents and also filed false stolen truck claims
Members of the ring were first arrested in 2010 for a staged accident in November 2009 In that case subjects Abdel Tome Luis Rivero Dominguez Angel Sotolongo Sierra Sergio Cordero Hilda Somodvilla-Licea and Jesus Iluminado Guerrero were charged for fraudulent claims in excess of $116000 for one staged accident
Those arrested in last monthrsquos sweep were Armando Alonso Yordan Martin Mata Yanet Soriano Dunaikis Roche April Caridad Sequinot Alberto Paz Hernandez Yoandris Benitez Eduardo Alonso Castellanos Lucia Amigot Alicia Iris Laurenco Cuesta Ivan Silva Robert Jabani Hinklein Abraham Alliegro Evelyn Yero Noy Yoandris Benitez and Jesus Iluminado Guerrero The latest arrests are a result of the follow-up investigation that identified eleven additional staged accidents and 3 false stolen vehicle claims which resulted in fraudulent claims in excess of $545000 filed against seven insurance companies Additional arrests are anticipated
The insurance companies defrauded by this scheme included Allstate National Indemnity Group Old Republic Progressive Republic Western State Farm and US Security Insurance Companies
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
15 Arrested in Lunch Truck Accident Ring
Three Clinic Employees Arrested in Tampa The Division of Insurance Fraud (DIF) arrested three Tampa clinic employees on charges of insurance fraud and patient brokering Clinic manager Danilo Ardian Gonzalez-Alfonso 37 massage therapist Lydia Merlo-Fernandez 23 and Yennier Gutierez Obregon 23 - all employees of CPS Medical Clinic - allegedly solicited a confidential source to participate in a scheme to file fraudulent claims for services never provided
ldquoThese fraud clinics have become an albatross around the neck of Floridarsquos consumersmdashdriving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridiansrdquo CFO Atwater said ldquoMy office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crimerdquo
During the investigation a confidential source went with Obregon to CPS Medical Center During multiple visits Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving any treatment If convicted each could face up to 10 years in prison
CFO Atwater has been advocating for reforms this legislative session that target staged accident fraud strengthen billing practices so appropriate services are provided to those who need care tighten requirements for clinic ownership and ultimately result in rate relief for Floridarsquos consumers Based on a report by the Insurance Consumer Advocate the number of Florida drivers has remained stable and the frequency of crashes declined between 2006 to 2010 while the number of PIP claims opened or recorded during the same time increased 28 percent In addition the payment on PIP claims increased 66 percent during the same period
This case is part of a continuing crackdown by CFO Atwaterrsquos Division of Insurance Fraud in the fight against auto insurance fraud in Florida Nationwide Insurance provided assistance in this investigation This case will be prosecuted in the 13th Judicial Circuit under the direction of Hillsborough State Attorney Mark Ober
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 4 April 2012
Clinic Owner Runner Charged in Tampa PIP Fraud Scheme The owner of Cypress Wellness Center massage therapist Nohora Patricia Triana 35 and her runner Jose Luis Avila Robles 30 were arrested by the Division of Insurance Fraud in Tampa last month for their involvement in a PIP fraud scheme Robles recruited and offered to pay a confidential source working for DIF to refer patients to the clinic which was located in Tampa at the time The source and an undercover officer went to the clinic and received treatment on four occasions but were asked by Triana to sign for treatments that they did not receive Triana then relocated her clinic to Pasco County as a result of the Hillsborough County ordinance passed to combat clinic fraud Triana told the source and the undercover officer that they could continue to sign for the treatments not received at the new location Cypress Wellness Center submitted claims to Nationwide Insurance for more than $24000
Former Police Officer Charged in Broward PIP Jump-In Case Pamela Murray-Laun 29 a former detention deputy with the Broward Sheriffrsquos Office and police officer with the Seminole Police Department was arrested last month and charged with insurance fraud A street sweeper struck Murray-Launrsquos unoccupied truck in the parking lot of the Broward County Jail Murray-Laun later claimed to have been in the truck and went to a clinic for treatment of alleged injuries An investigation by the Division of Insurance Fraud showed that Murray-Laun was not in her vehicle at the time it was struck
Three Doctors Surrender Medical Licenses in Fraud Conviction Pleas Three medical doctors have surrendered their licenses with the Department of Health through plea agreements with the Miami-Dade State Attorneyrsquos office
Gerald Amado 72 and Carlos Barrera 60 were arrested in March 2011 as part of the undercover operation known as Operation Dark Horizon for their role in a fraud scheme that resulted in 25 defendants being charged Amado worked at New Horizon Practice and Barrera worked at Therapium Health Corp Jose Gerardo Valiente 74 was arrested in May 2009 as part of an undercover operation at E amp B Rehabilitation Clinic involving staged accidents and false treatment
These pleas are part of a continuing process through which the Division of Insurance Fraud the Department of Health and the prosecuting State Attorneyrsquos offices prevent criminals from again using their licenses to participate in fraudulent activities in Florida A final resolution may still require action by the licensing board
CFO Jeff Atwater Announces $25000 in Fraud Rewards Florida Chief Financial Officer Jeff Atwater announced $25000 in rewards last month for three Floridians who provided key information that led to arrests and convictions in five major insurance fraud cases These citizens helped the Florida Department of Financial Services Division of Insurance Fraud uncover almost $560000 in fraudulent insurance billings leading to 10 arrests to date ldquoThese individuals had the courage to come forward and report suspected insurance fraud ultimately helping protect their fellow Floridians from this costly crimerdquo CFO Atwater said ldquoWithout their assistance these fraudsters would still be on the streets stealing your hard-earned dollarsrdquo
- $10000 was awarded to a citizen whose report of a solicitation to participate in a staged automobile accident led to the arrest of an accident clinic owner and recruiter and a massage therapist
- $10000 was awarded to a citizen who was able to obtain audio as well as video evidence demonstrating the daily operation of an illegal accident clinic The citizen provided invaluable time and effort by taking time from his job and personal life to assist fraud detectives
- $5000 was awarded to a citizen who provided detectives with assistance in apprehending a fraudster who told him he was planning to intentionally drive an SUV into a canal in Ft Lauderdale in order to assist a friend in making a fraudulent insurance claim
Anyone with information about suspected insurance fraud is asked to call 1-800-378-0455 You can remain anonymous
Two Charged in Staged Accident Case at Tampa Clinic Two defendants were arrested last month in Tampa by the Division of Insurance Fraud (DIF) for their roles in a staged accident Thais Scharenberg 19 and Karen Martinez 23 participated in a staged accident in June 2010 and then went to Relief All Pain Rehabilitation Center and signed for treatment they did not receive As a result of their actions nearly $24000 in fraudulent PIP claims were filed against Progressive and State Farm insurance companies Additional arrests are anticipated
PIP Fraud in the News
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 5 The PIP Source
Check out the latest Most Wanted at httpwwwmyfloridacfocomPressOfficeMostWanted
Most Wanted Fugitive
How You Can Help Fight Insurance Fraud in Florida This year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check)
The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 6 April 2012
New PIP Scheme A Tampa company has sent fliers to chiropractors suggesting ways to capitalize on potential loopholes in new legislation aimed at denting the runaway fraud plaguing Floridas mandatory motor vehicle no-fault law
The Tampa health care staffing agency is offering to send medical doctors or osteopathic physicians to chiropractorsrsquo offices to examine patients and fill out paperwork that could possibly qualify them as an emergency and eligible for the maximum $10000 personal injury protection benefit
Chiropractors Dont miss out on your $7500 the Medical on Demand Staffing solicitation promises We Have The Medical Doctors You Need
Darrell Stollings chief executive officer of the medical staffing and placement firm said Wednesday that hes not trying to skirt conditions of the new legislation although he agreed that his flier (shown below) was an eye-catcher
We have physicians who are available to look at the patient to make sure that patient is medically needing of that (chiropractic) service Stollings explained If not they dont get that service
The governor hasnt even signed the bill yet and some firm is sending this thing around asked Rep Jim Boyd a Bradenton Republican who sponsored the legislation Its very brazen and I think action will be taken if someone is trying to do something that is not acceptable
Boyd said he had already spoken to officials from the Department of Health and Division of Insurance Fraud about checking into the validity of the Tampa companys overture to chiropractors
Stollings solicitation was faxed last week to chiropractors and physicians with the companys phone number and email address less than three weeks after the Legislature narrowly agreed to pass the bill (HB 119) backed by Gov Rick Scott
Check out the full story by Brent Kallestad of the Associated Press at httpwwwinsurancejournalcomnews
southeast20120406242386htm and a related article at httpwwwbradentoncom201204083986927erosion-of-rep-boyds-pip-reformhtml
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 7 The PIP Source
ldquoRegrettably our states auto insurance system has been taken over by a circling pool of piranha - fraud clinics lawyer referral services and organized crimerdquo
- CFO Jeff Atwater St Pete Times 111511
The $10000 per individual PIP coverage with 11 million cars in Florida is ldquoa huge pot of moneyrdquo that unscrupulous individuals are using as their ldquopersonal slush fundrdquo
- Ron Poindexter then-Director of Operations for the Southeast with the National Insurance Crime Bureau Bests News Service 013111
ldquoA multiplier is supposed to be used in cases of complexity or scarcity when few attorneys may be willing to take on a case Anyone who has driven up and down I-95 or I-75 and who has seen all of the lsquo1-800-CallMersquo billboards knows that is not the caserdquo
- Sen Garrett Richter R-Naples newspresscom 1812
ldquoThe FMA (Florida Medical Association) believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud put those who break the law in jail and revoke the licenses of the health care providers who participate in schemes to defraud the PIP systemrdquo
- Association spokeswoman Rebecca OrsquoHara newspresscom 1812
ldquoWe are the No 1 state for staged auto accidents where people fake an accident If we dont fix this - its already $1 billion in fraud - it will go up 30 percent year after year after yearrdquo
- Governor Rick Scott Tampa Bay Times 22612
ldquoNo-fault insurers have been besieged with fake injury claims by crooked injury clinics They have been bleeding insurers for years PIP reform is good news for insurance companies because the bill has provisions that apply a great deal of heat on sham clinics that operate solely to make bogus injury claims against auto insurersrdquo
- James Quiggle Director of Communications for Coalition Against In-surance Fraud Insurance Networking News 31312
PIP QUOTES
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 8 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Blanca Lopez Santiestaben 49 - staged acct 020511 (recruiter) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Margot Ascano 77 ndash staged acct 041510 (jump-in passenger) $11615 ndash Angelrsquos Diagnostic Grand Canal Rehab (State Farm) M
Danilo Ardian Gonzalez-Alfonso 37 - clinic manager - $4017 - CPS Medical Clinic (Nationwide) T
Lydia Merlo-Fernandez 23 - massage therapist - $4017 - CPS Medical Clinic (Nationwide) T
Yennier Gutierez Obregon 23 ndash clinic employee - $4017 - CPS Medical Clinic (Nationwide) T
Mileidy Ortega Hernandez 33 ndash PIP patient - $14505 ndash Coral Therapy and Medical Center (Allstate) W
Nohora Patricia Triana 35 - clinic owner massage therapist - $24303 - Cypress Wellness Center (Nationwide) T
Jose Luis Avila Robles 30 - runner - Cypress Wellness Center (Nationwide) T
Ruben Froilan Reyes 54 - staged acct 051910 (jump-in) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Glenda Sanchez 29 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Barbara Doris Tenemas 25 - staged acct 051910 (passenger) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Jorge Nilo Bequer 60 - staged acct 020511 (passenger) $57279 ndash Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Teresa Rosario Tenemas 53 - staged acct 051910 (driver) $71162 - ORD Medical Center G amp O Rehabilitation Center (Geico State Farm) M
Pauline Jones Farmer 40 ndash jump-in 081811 - $0 ndash (Geico) TL
Aneiter de Dios Luis 46 ndash nurse assistant - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Indira Labadie 20 ndash massage therapist - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Gilson B Gilles 18 ndash fake ins card (Allstate) W
Tanya Maria Page 40 ndash staged acct 071210 (driver) $25638 - Injury Care Pine Hills Family Chiropractic Silver Hills Health amp Rehab (Allstate Geico Progressive State Farm) O
Pamela Murray-Laun 29 ndash jump-in - $18124 (Progressive) B
Thais Scharenberg 19 ndash staged acct 062510 (driver) $11080 - Relief All Pain Rehabilitation Center (Progressive) T
Catalina Caridad Valdes Avalos 50 ndash clinic employee - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Robert Jabani Hinklein 25 ndash staged acct 042509 (driver) $23232 ndash (State Farm) M
Hector Adolis Cutino Court 41 ndash staged acct 020511 (passenger) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Willie Frank Jackson 50 ndash fake ins card (Peak Property amp Casualty) W
Delilah Smith-Mallard 26 ndash application fraud (Progressive) T
Angela Denise Battle 41 ndash paper acct 072610 (driver) $6262 - Personal Medical Center (Farmers) T
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 9 The PIP Source
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Eduardo Gino Baroni 74 ndash fake ins card (Allstate) W
Katherine Martinez 23 ndash staged acct 062510 (passenger) $12826 ndash Park Place Therapy LLC (State Farm) T
Caridad Cordovi Ferrera 60 ndash jump-in - $0 (Allstate) B
Mario Collazo Sr 49 ndash PIP patient - $13143 - Performance Health amp Wellness (Allstate) W
Mario Collazo Jr 21 ndash PIP patient - $11883 - Performance Health amp Wellness (Allstate) W
Julio C Fernandez 44 ndash staged acct 110910 (passenger) $30670 ndash DampA Rehabilitation Progressive Rehab Treat-ment Corp (Assurance America Hallmark) W
Luis Ernesto Rodriguez 33 ndash staged 082709 (passenger) $3300 ndash West Therapy Institute (USAA) T
Kristopher Michael Exile 24 - staged acct 101310 (driver) $5168 ndash (Republic Western Security National) B
Stephen Mark Lovell 54 ndash chiropractor mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Francisco Huici Fernandez 39 ndash clinic owner mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Center C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Ernesto Diaz 30 ndash clinic owner mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Joanna Capote 23 ndash staged acct recruiter mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Cen-ter (Metropolitan Casualty Peak Property amp Casualty) F
Karen Carmona Jackson 29 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Jeanine Lastres Huici 41 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Marylda Santana 21 ndash massage therapist mail fraud money laundering - $169245 - Xtreme Care Rehabilitation Cen-ter C amp A Family Rehab Center (Metropolitan Casualty Peak Property amp Casualty State Farm) F
Sonia Arroyo 52 ndash massage therapist mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Indra Lemus Castellanos 19 ndash clinic employee mail fraud money laundering - $145895 - Xtreme Care Rehabilitation Center (Metropolitan Casualty Peak Property amp Casualty) F
Abel de Jesus Perez 43 ndash clinic owner mail fraud conspiracy money laundering - $23350 - C amp A Family Rehab Cen-ter (State Farm) F
Victor Caballero Duarte 22 ndash massage therapist fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Adrian Perez 21 ndash clinic employee fraud conspiracy money laundering - $23350 - C amp A Family Rehab Center (State Farm) F
Marlon Bryan Sadinas 23 ndash runner ndash patient brokering - $6704 - Aesthetic Rehabilitation amp Medical Center (Bristol West) T
Alberto Paz Hernandez 40 ndash staged acct 062609 (driver) $43758 (Allstate US Security) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 10 April 2012
Statewide PIP Arrests ndash March 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Abraham Alliegro 39 - staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Yordan Martin Mata 35 - staged acct 050209 (driver) $1109810 (Allstate) M
Yanet Soriano 39 ndash staged acct 060709 (driver) $1941426 (Allstate) M
Alicia Iris Laurenco Cuesta 41 ndash staged acct 091609 (driver) $6275219 (Old Republic Progressive State Farm) M
Ivan Silva 39 ndash false stolen truck report 052608 - $3005936 (Allstate) M
April Caridad Sequinot 23 ndash staged acct 120509 (driver) $7005297 (National Indemnity Old Republic Progressive) M
Armando Alonso 61 - staged acct 21409 (driver) $87041 ndash Florida Wellness amp Rehab Center (Republic Western State Farm) M
Lucia Amigot 50 ndash false stolen truck report 112608 - $1807670 (State Farm) M
Dunaikis Roche 30 - staged acct 060709 (driver) - $1941426 ndash (Allstate) M
Evelyn Yero Noy 35 ndash false stolen truck report 082609 - $1373450 (Progressive) M
Eduardo Alonso Castellanos 59 - staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Janeth Delgado 27 ndash paper acct 010511 (passenger) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Maria C Alejo 56 ndash paper acct 010511 (driver) $1589 - Health amp Well-Being Therapy Center II (Allstate) T
Roberto Alvarez 46 ndash clinic owner - $4650 - Robert Medical Center (State Farm) B
Juan Francisco Castro Sr 59 - staged acct 070409 (driver) $20802 - Theramed Place LLC (21st Century Victoria) T
Lisbeth Pimentel 22 ndash sale of fake ins card (Geico) B
Ernest James Walker 21 ndash application fraud (Direct General) B
Blas Manuel Beltran 52 ndash staged acct 040209 (driver) $25242 ndash E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Yoandris Benitez 25 - staged acct 062609 (driver) $43758 ndash (Allstate US Security) M
Jesus Iluminado Guerrero 29 ndash staged acct 091609 (recruiter) $6275219 ndash (Old Republic Progressive State Farm) M
Rosa Fernandez 29 ndash staged acct 110910 (driver) $26194 - Progressive Rehab Treatment Corp (Hallmark) W
Ana Pantoja Freites 47 ndash staged acct 020611 (recruiter) $57279 - Chirocorp Stat Diagnostic Imaging Dr M Feijoo (Geico United Auto) M
Juan Jose Arguelles 47 ndash false statement (State Farm) M
Michael Anthony Lowe 47 ndash PIP patient prescription fraud (State Farm) P
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Copy goes her Editorrsquos Corner On page one we report on the PIP reform passed by the Florida Legislature
On page two we cover Operation Whiplash a major PIP fraud investigation in Lee County by a multi-agency task force resulting in a dozen arrests
On page three we cover two major cases involving PIP fraud in Miami and Tampa
On page six we report on a flyer by one company in response to the new PIP law
And as always we provide information on all the PIP-related arrests around the state
Page 11 The PIP Source
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Pensacola Field Office - 8504537802 Capt Buddy HAND Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE
South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Dir of Field Ops SE Region Dennis Russo 8639676904
Statewide PIP Contacts
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
(Clinic owner) Delva allegedly paid two
licensed chiropractors a monthly fee to pose as
straw owners of the clinic to avoid the AHCA licensing requirements
Volume 2 - Issue 12 June 2012
In April 2009 the Division of Insurance Fraud (DIF) and the Office of the Attorney General - Statewide Prosecutor with the assistance of the National Insurance Crime Bureau (NICB) and insurance companies Direct General Geico and Nationwide began an investigation into criminal activities at a Naples accident clinic Cardinal Chiropractic Center The total amount of fraudulent billing discovered was in excess of $100000
The investigation uncovered a large organized scheme to defraud insurance companies by submitting false medical treatment forms for treatments that were either not administered or were administered by employees who did not possess a valid Florida Department of Health (DOH) license The fraudulent billings were related to motor vehicle accidents and the claims filed to the insurance companies for personal injury protection coverage
The investigation revealed that the true owner of Cardinal Chiropractic Center was Feghens Delva Delva allegedly paid two licensed chiropractors a monthly fee to pose as straw owners of the clinic to avoid the Florida Agency for Health Care Administration (AHCA) licensing requirements These licensed chiropractors enabled this criminal enterprise to flourish
The following defendants were arrested Clinic Owner Feghens Delva Chiropractor Esmaeel Samaliazad Massage Therapist James Greenhut Office Manager Marie Stephania Zamy and Patient Recruiter Guerold Dolcine
The case will be prosecuted by the Office of the Statewide Prosecutor
These arrests come on the heels of another major investigation in Ft Myers that resulted in federal indictments and a dozen arrests in March and is part of the continuing crackdown by CFO Atwaters Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida
Check this link from NBC2 in Ft Myers for more information - httpwwwnbc-2comstory1806614120120502insurance-fraud-bust-nets-3-arrests
INSIDE THIS ISSUE
1 Naples Clinic Bust
2 Sledgehammer
Update
3 PIP Fraud News
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner Chiropractor Charged in Naples PIP Fraud Takedown
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 2 June 2012
Wifredo A Ferrer United States Attorney for the Southern District of Florida Jose A Gonzalez Special Agent in Charge Internal Revenue Service Criminal Investigation Division (IRS-CID) John V Gillies Special Agent in Charge Federal Bureau of Investigation (FBI) Miami Field Office and Jeff Atwater Florida Chief Financial Officer announced that defendant Oscar Luis Franco Padron was sentenced in West Palm Beach Florida before US District Judge Kenneth A Marra on charges of conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure financial transactions for his role in a staged accident fraud scheme Franco Padron was the latest and highest-ranking member of the scheme to be sentenced
Padron who managed several clinics and recruited patients had pled guilty on January 11 2012 to conspiracy to commit mail fraud conspiracy to commit money laundering and conspiracy to structure transactions Padron was sentenced to 96 months in prison to be followed by three years of supervised release along with restitution in the amount of $435108213
US District Judge Marra has also imposed sentences on defendants Joaquin Ross Aureliano Diaz Lisbet Leon Yida Bello Gloria Cintron Veronica Riofrio Ketty Gonzalez Ernesto Miralles Julio Fernandez Delgado and Zachary Keith Stuhler for their roles in the same fraud scheme
US Attorney Wifredo A Ferrer stated ldquoThis massive ring orchestrated phony automobile accidents and made a living by defrauding insurance companies of millions of dollars Auto insurance fraud is not a victimless crime Not only were the insurance companies defrauded but this scheme also hurt consumers as our insurance costs continue to soar because of fraudrdquo
Jeff Atwater Florida Chief Financial Officer stated ldquoFraudsters and criminal enterprises have learned how to game Floridarsquos auto insurance system and every honest Floridian with a car on the road ends up paying Through partnerships with law enforcement and state attorneys we will go after these criminals put them in handcuffs and deliver them to justicerdquo
Check this link for details on this case involving all defendants - httpwwwfbigovmiamipress-releases2012leader-of-massive-staged-car-accident-ring-sentenced-on-mail-fraud-money-laundering-and-structuring-for-role-in-staged-accident-fraud-schemeutm_campaign=email-Immediateamputm_medium=emailamputm_source=miami-press-releasesamputm_content=101798
Operation Sledgehammer Defendants Sentenced by Federal Judge in Palm Beach
How You Can Help Fight Insurance Fraud in Florida Last year the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation gift or grant to the Insurance Regulatory Trust Fund The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives as well as fund anti-fraud programs around the state This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida
Payments should be made payable to The Department of Financial Services (Please write ldquoCode 1201Frdquo on the memo line of your check) The mailing address is
Department of Financial Services
Revenue Processing Section
PO Box 6100
Tallahassee FL 32314-6100
The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud The letter should include his her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts Also include a statement that if the donation is to be used for any other purpose the funding should be withdrawn
If you have any questions you can contact us at the PIP Source and we will get an answer Thank you for your help
Join the Fight Be a part of the Solution Make a Difference
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 3 The PIP Source
Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising Attorney General Pam Bondirsquos office has required the company 411-PAIN to change its advertising practices and to make a total charitable contribution of $550000 as part of a settlement agreement entered last month in Broward Circuit Court The Attorney Generalrsquos Office filed a lawsuit against Florida-based 411-PAIN for alleged misrepresentations to consumers ldquoWe are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practicesrdquo stated Attorney General Pam Bondi
The Broward Circuit Court simultaneously with the filing of the lawsuit entered a consent judgment barring the company from the following practices advertising any specific amount of monetary reward or lost wages using a dollar amount in any advertising that promises more than $10000 in PIP benefits and depicting a police officer in an advertisement that does not clearly state the individual is a ldquoPaid Actorrdquo
To view the settlement please click here httpmyfloridalegalcomwebfilesnsfWFJLUS-8UUQ5L$file411PainJune2012pdf
Daytona Beach Chiropractor arrested A Daytona Beach chiropractor was arrested on charges of illegally prescribing drugs to patients Federal investigators say Joseph Wagner accepted $100 monthly from uninsured patients to prescribe drugs including hydrocodone and Xanax He threw in a free back crack prosecutors say
Charging documents also accuse Joseph Wagner 62 of fraudulently billing Medicare and private insurance companies for patient examinations and physical therapy that was never performed The crimes occurred between January 2008 and August 2011 court documents state
The Personal Injury Protection squad of the Florida Department of Financial Services started an investigation into Wagner Chiropractic amp Acupuncture Clinic in 2009 Wagner relinquished his chiropractic license this past March
Read the article by Susan Jacobson of the Orlando Sentinel at httparticlesorlandosentinelcom2012-05-18newsos-daytona-chiropractor-joseph-wagner-20120518_1_joseph-wagner-chiropractic-license-chiropractor
FL Bar Panel Attorney Referral Services and Medical Providers Should Not Mix Lawyers should not be able to join referral services that also refer callers for medical help or other non-legal professional services according to the Special Committee on Lawyer Referral Services The committee voted unanimously to make that recommendation at its May 4 meeting as it begins to put the finishing touches on a report that could go to the Bar Board of Governors in July The committee is scheduled to meet again to possibly approve a final report during the Barrsquos Annual Convention later this month
If ultimately approved in rule form by the Bar Board of Governors and the Supreme Court the committeersquos action would mean ldquoA lawyer cannot accept a referral from any entity which also refers to other professionals for the same eventrdquo said committee Chair Grier Wells
Read the entire article by Florida Bar Senior Editor Gary Blankenship at httpwwwfloridabarorgDIVCOMJNjnnews01nsf8c9f13012b96736985256aa90062482938cf0208d1436b0785257a05004557eaOpenDocument
Palm Beach County Sheriffrsquos Office Conducts Fake Insurance Card Sweep Last month the Palm Beach County Sheriffrsquos Office conducted a county-wide lsquoFraudulent Proof of Motor Vehicle Insurance Operationrsquo It is illegal to drive in the state of Florida without insurance or with a fake insurance card In the event of a crash with an uninsured motorist the cost acquired can be eventually passed on to those with valid insurance A total of 837 citations were issued and 20 arrests made
The law enforcement agencies that participated in the operation included Atlantis Police Boynton Beach Police Florida Highway Patrol Greenacres Police Jupiter Police Lake Clarke Shores Police Lantana Police North Palm Beach Police Riviera Beach Police Tequesta Police and West Palm Beach Police
The following insurance companies had representatives on hand Allstate Direct Farmers Gainsco Geico GMAC Hartford Imperial Omni Infinity Mercury Nationwide Sentry State Farm Travelers United Auto USAA and Windhaven
PIP FRAUD ndash In The News
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 4 June 2012
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
James Greenhut 32 ndash massage therapist organized scheme to defraud money laundering - $100000 - Cardinal Chiroprac-tic Center (Direct General Geico Nationwide) F
Esmaeel Samaliazad 47 ndash chiropractor organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Feghens Delva 42 ndash clinic owner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Veronica Maria Aleman 22 ndash PIP patient - $14229 ndash Performance Health amp Wellness Center (Allstate) W
Manuel de Jesus Castellanos 50 ndash staged acct 032311 (driver) $29045 - New Life Therapy (State Farm United Auto) M
Marie Stephania Zamy 26 ndash clinic manager organized scheme to defraud money laundering - $100000 - Cardinal Chiro-practic Center (Direct General Geico Nationwide) F
Aracelis Gamboa Martinez 59 ndash staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Armando Alonso 61 ndash staged acct 121008 driver - $7020733 ndash (Allstate State Farm) M
David M Morris 45 ndash jump-in - $10226 ndash Therapeutic Health Center (Geico) B
Yolaine Santa Cruz Gamboa 29 - staged acct 021109 (passenger) $27374 - E amp B Rehabilitation Center (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 050209 (driver) $11098 (Allstate) M
Jesus Iluminado Guerrero 29 ndash staged acct 120509 (recruiter) $70052 (National Indemnity Old Republic Progressive) M
Rigaud Victor 29 ndash fake ins card (Liberty Mutual) W
Leando Mortimer Dexter Payne 39 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Pro-gressive Safeco) B
Ricardo Alfonso Miranda 46 ndash unlicensed practice of law (United Auto) M
Paul Edmundo Corrales 31 - unlicensed practice of law (United Auto) M
Istony Marcelon 42 ndash staged acct 040611 (driver) $58690 ndash Advanced Chiroprachtic Rehab and Medical Centers Appleton Chiropractic Center (Imperial Fire amp Casualty) B
Guerold Dolcine 36 ndash runner organized scheme to defraud money laundering - $100000 - Cardinal Chiropractic Center (Direct General Geico Nationwide) F
Lester T Curry 41 ndash staged acct 051910 (recruiter) $4587 ndash (Republic Western) W
Abdias Saintine 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Erika Milliken 58 ndash jump-in train wreck 071707 - $87000 (National Indemnity) T
Kim Thompson 32 ndash false claim (Progressive) T
Sharif Javone Parker 22 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shaquan Walik Parker 20 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Pedro R Ramirez 42 ndash jump-in 071911 - $9345 (Mendota) T
Mercedes Carlo 41 ndash false statement in support of jump-in 071911 - $9345 (Mendota) T
Sabrina Leigh Levine 24 ndash clinic employee - $4919 - Sunrise Medical Clinic (Progressive) B
Anton Marquis Merrick 40 ndash staged acct 072111 (recruiter) $6875 ndash Sunrise Medical Clinic (Hertz Progressive) B
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Page 5 The PIP Source
Statewide PIP Arrests ndash May 2012
Each issue will provide a list of PIP arrests made by the offices throughout the State Along with each defendantrsquos name and age we will include the type of scheme involved the fraud dollar amount clinic name(s) victim insurance company name(s) and the arresting office If you need additional details on any of these arrests please contact Capt Smith
Wender Monnely 22 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Shavett Deloris Irving 26 ndash staged acct 121210 (driver) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Monelu Casimir 20 ndash staged acct 121210 (recruiter) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Lanovel McCrone 35 ndash staged acct 062011 (recruiter) - Broward Rehab Sunrise Medical Clinic (Geico Progressive Safeco) B
Omar Alexander Perez Jr 23 - staged acct (recruiter) $40697 - Chiropractic amp Therapy Services Corp (Geico Mercury) W
Yoandris Benitez 25 ndash staged acct 080109 (driver) $46935 (Progressive) M
Egerio Vicente Vieira Fortes 46 ndash staged acct 051910 (driver) $4587 ndash (Republic Western) W
Makenson Mondesir 30 - staged acct 042810 (recruiter) $62632 - Marcus Chiropractic Center (Assurance America) B
Jorge Ocampo 32 ndash fake ins card (Nationwide) W
Deshaun Adekoya 34 ndash staged acct 121210 (passenger) $51836 - First Choice Care Chiropractic Immediate Health Care (Esurance Farmers Hallmark) O
Luis Ramon Arce 41 ndash staged acct 093010 (recruiter driver) $6259 - Advanced Orthopedics Pain Management Orthope-dic Clinic of Central FL (Republic Western Windhaven) O
Joseph Chiappa 21 ndash staged acct 072111 (driver) $6275 ndash Sunrise Medical Clinic (Hertz Progressive) B
Liban Valladares 19 ndash PIP patient - $910 ndash Blue Village Medical Center (Allstate) W
Joseph Burrell Wagner 62 ndash chiropractor - Wagner Chiropractic amp Acupuncture Clinic (Liberty Mutual) O
Mikael B LrsquoAndre 37 ndash false claim - $2481 (Geico) P
Joseph Burrell Wagner 62 ndash chiropractor ndash Wagner Chiropractic amp Acupuncture Clinic (multiple companies) O
Hema Sookhoo 32 ndash clinic employee - $38462 - Immediate Health Care (Hallmark) O
Edward S McNamara 46 ndash chiropractor - $38462 - Immediate Health Care (Hallmark) O
Joshua Kalil Saldana 24 ndash staged acct 093010 (driver) $6259 - Advanced Orthopedics Pain Management Orthopedic Clinic of Central FL (Republic Western Windhaven) O
Randi Dee Seltman 42 ndash false claim - $35000 (Allstate) W
Eddy Concepcio-Ruiz 30 ndash staged acct 051910 (recruiter) $57373 ndash G amp O Rehabilitation Center ORD Medical Center (Geico State Farm) M
Gabriel Cluzet 47 ndash staged acct 042711 (driver) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Tammy Ann Bidwell 43 ndash application fraud (USAA) J
Yissel Cardenas Honrubia 31 ndash PIP patient - $14146 - Light Rehabilitation Center (Allstate) W
Cecilio Juviel Gonzalez 71 ndash staged acct 042711 (passenger) $80584 - AZJ Medical La Maison YH Imaging (Allstate Geico State Farm) M
Wilfredo Rodriguez Martinez 47 ndash staged acct 040209 (recruiter) $45243 - E amp B Rehabilitation Center Sunshine Therapy amp Medical Center (Allstate Infinity) M
Code ndash B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (TampaSt Pete) W (West Palm Beach)
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-
Copy goes her Editorrsquos Corner On page one we cover the arrests in Naples of an accident clinic owner a chiropractor and other employees in a $100000 fraud scheme
On page two we update our February 2012 story on Operation Sledgehammer and cover the sentences handed down by the Federal Judge
As always we report on PIP Fraud in the News
And finally Hurricane Season has arrived CFO Atwater encourages all Floridians to ldquoProtect Your Home Baserdquo Be prepared and be safe
Page 6 June 2012
PANHANDLE REGION Counties Bay Calhoun Escambia Franklin Gadsden Gulf Holmes Jackson Jefferson Lafayette Leon Liberty Madison Okaloosa Santa Rosa Taylor Wakulla Walton Washington
Tallahassee Field Office - 8504133115 Capt Robert BRONGEL Pensacola Field Office - 8504537802 Lt Joseph HOLOKAN
NORTH REGION Counties Alachua Baker Bradford Citrus Clay Columbia Dixie Duval Flagler Gilchrist Hamilton Levy Marion Nassau Putnam St Johns Sumter Suwannee Union
Jacksonville Field Office - 9047985802 Capt Brian McCOY Lt Kevin JONES
WEST CENTRAL REGION Counties Charlotte Collier DeSoto Glades Hardee Hendry Hernando Highlands Hillsborough Lee Manatee Pasco Pinellas Polk Sarasota
Tampa Field Office - 8139728602 Capt Michael BYRNE Lt Carlos ROSARIO Lt Darrell WILSON
Fort Myers Field Office - 2392787527 Lt Mark FRITZ
EAST CENTRAL REGION Counties Brevard Indian River Lake Martin Okeechobee Orange Osceola Palm Beach Seminole St Lucie Volusia
West Palm Beach Field Office - 5618375601 Major Simon BLANK Capt Glen HUGHES Lt Evangelina BROOKS
Orlando Field Office - 4078354402 Lt Jewel CAMERON Lt Paul MEYERS
SOUTH REGION Counties Broward Dade Monroe
Miami Field Office - 3055360302 Capt Steven SMITH Lt Violeta SERRANO Lt John DYGON Lt Stanley JEAN-FELIX
Plantation Field Office - 9543212902 Lt Bill LEE South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 9543297427 Central Florida Major Medical Fraud Task Force Director Southeast Region Dennis Russo 8639676904
Disaster Preparedness Webinars scheduled for Wednesday June 27th at 10 am
Tuesday July 10th at 12 pm Wednesday July 18th at 2 pm Tuesday July 24th at 530 pm
Online registration and information can be found at wwwMyFloridaCFOcomYMM
Statewide PIP Contacts
- Volume 2 - Issue 813
- February 201213
- INSIDE THIS ISSUE13
- 1Op SledgeHammer13
- 2Unlicensed Clinics13
- 3AHCA Clinic Sweep13
- 4PIP Fraud in the News13
- 5NICB Turns 10013
- 7Statewide Arrests13
- 9Statewide Contacts13
- HEADER HERE13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Page 13
- February 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- Page 13
- February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash January 201213
- Page 13
- February 201213
- Statewide PIP Arrests ndash January 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
- PIPSource032012pdf
-
- Volume 2 - Issue 913
- March 201213
- INSIDE THIS ISSUE13
- 1Chiropractor Arrest13
- 2Tampa Takedown13
- 3PIP Fraud News13
- 5FIFEC - 20 Years13
- 6PIPrsquos Dark Side13
- 8Statewide Arrests13
- 10Statewide Contacts13
- HEADER HERE13
- Page 13
- March 201213
- Page 13
- The PIP Source13
- PIP FRAUD ndash In The News13
- Page 13
- March 201213
- PIP FRAUD ndash In The News13
- Page 13
- The PIP Source13
- FIFEC Set to Celebrate 20 Years13
- Page 13
- March 201213
- The Dark Side of PIP Fraud13
- Page 13
- The PIP Source13
- PIP Clinic Closings 13
- Page 13
- March 201213
- Statewide PIP Arrests ndash February 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash February 201213
- Page 13
- March 201213
- Statewide PIP Contacts13
-
- PIPSource042012pdf
-
- Volume 2 - Issue 1013
- April 201213
- INSIDE THIS ISSUE13
- 1PIP Reform Passes13
- 2Operation Whiplash13
- 3Miami Tampa fraud13
- 4PIP Fraud News13
- 6New PIP Scheme 13
- 8Statewide Arrests13
- 11Statewide Contacts13
- HEADER HERE13
- Page 13
- April 201213
- Page 13
- The PIP Source13
- Page 13
- April 201213
- PIP Fraud in the News13
- Page 13
- The PIP Source13
- Page 13
- April 201213
- New PIP Scheme13
- Page 13
- The PIP Source13
- PIP QUOTES13
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash March 201213
- Page 13
- April 201213
- Statewide PIP Arrests ndash March 201213
- Page 13
- The PIP Source13
- Statewide PIP Contacts13
-
- PIP Source June12pdf
-
- Volume 2 - Issue 1213
- June 201213
- INSIDE THIS ISSUE13
- 1Naples Clinic Bust 13
- 2Sledgehammer 13
- Update13
- 3PIP Fraud News13
- 4Statewide Arrests13
- 6Statewide Contacts13
- HEADER HERE13
- Page 13
- June 201213
- Page 13
- The PIP Source13
- Attorney Generalrsquos Office Requires 411-PAIN To Change Advertising13
- PIP FRAUD ndash In The News13
- Page 13
- June 201213
- Statewide PIP Arrests ndash May 201213
- Page 13
- The PIP Source13
- Statewide PIP Arrests ndash May 201213
- Page 13
- June 201213
- Statewide PIP Contacts13
-