Miami-Dade county judge faces ethics questions over ties to rehab center

February 10th, 2012


WSVN investigator reporter Carmel Cafiero digs into allegations of misdeeds in South Florida. She reported Feb. 7, 2012, that Miami-Dade County Court Judge Ana Maria Pando is being asked to recuse herself from some cases following charges of ethics violations.

Five attorneys have filed 16 motions charging Judge Pando violated the Code of Judicial Conduct after the judge “lent the prestige of her judicial office to advance the private interests of Florida Wellness & Rehabilitation Center Inc.,” Cafiero reports.

An accountant for Florida Wellness accidentally sent the state paperwork the company was closing, Cafiero reports. Judge Pando wrote to the state on her judicial letterhead to help the company be reinstated. State records show the company was then reactivated by “court order.”

Cafiero reports that Judge Pando has raised close to $70,000 for her re-election. Her campaign received $2,000 from four Florida Wellness & Rehabilitation Centers, reported the month after she sent the letter.

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PIP fraud update: Clinics fake car accidents and records to collect insurance claims

February 8th, 2012

PIP fraud is a big-time money crime, as three recent arrests make clear. Perpetrators collected more than $700,000 from insurance companies before investigators shut down their operations.

Those expenses show up in the insurance bills of Florida drivers. In 2008, a 40-year-old driver in Miami with an unblemished driving record was paying $582 in PIP premiums. That figured climbed 80 percent in two years to nearly $1,050 for the same coverage.

Anyone can fight PIP fraud by calling state investigators at 800-378-0445 to report suspected insurance fraud. Individuals who provide tips can remain anonymous and are eligible for a reward of up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

The Department of Financial Services to date has awarded almost $250,000 to approximately 40 citizens as part of its Anti-Fraud Reward Program.

Here are three of the latest examples of criminal enterprise:

Case #1: Unlicensed clinic in Orlando area collects $500,000 from insurance companies

Investigators with the Florida Department of Financial Services have arrested Jean Colin, 43, and charged him with operating an unlicensed clinic, fraud, and filing false insurance claims.

Colin and Marc Maxis are accused of staging car accidents after which passengers filed claims for faked injuries and never received treatment. The clinic, Silver Star Health and Rehab in Orange County, pocketed $500,000, according to court records.

Investigators also discovered that chiropractor Judith McKenzie put her name on the clinic’s license, but that Colin and Maxis owned and operated the business. Neither is a physician.

Case #2: Car-crash mastermind in Miramar pockets more than $200,000 in PIP claims

Yasser Vega-Martinez, 34, has been arrested and charged with faking three car crashes that resulted in more than $200,000 in fraudulent insurance claims.

“These staged accidents are at the heart of the PIP fraud epidemic that is casting a shadow over Florida’s roads,” Florida CFO Jeff Atwater said in statement. “Every Florida family is affected by these fake crashes in the form of high auto insurance premiums. My office is determined to work toward policy reforms to curb this costly crime.”

Vega-Martinez set up three accidents between late November 2009 and June 2010, and sent people who had no real injuries to several Miami-Dade clinics: including GMC Rehabilitation Center, AB Diagnostic Center, The Osteomuscular Rehab Center Corp, Y & H Imaging, Grand Canal Rehab, Justin Medical Services, Florida Health Professionals Group Corp, Angels Diagnostic Group and C & C Therapy Center Corp.

Geico and State Farm paid out more than $200,000 in benefits related to the three faked accidents. Vega-Martinez, of Miramar, faces up to 120 years in prison if convicted on all charges.

Case #3: Operator of unlicensed Miami-Dade clinic submits fraudulent PIP claims

Juan M. Dieguez, aka Jorge R. Gonzalez, was arrested and charged with operating a health care clinic without a license, grand theft and insurance fraud, including making fraudulent PIP claims.

The Florida  Department of Financial Services’ Division of Insurance Fraud says that Dieguez has owned and operated Venetian Rehab Center in Miami-Dade County since October 2010. He was arrested while working at another clinic, Therapy-Diagnostic, Tech Medical.

Division investigators found that Dieguez absconded from probation following a conviction for Medicaid fraud in 1999. They also discovered that Dieguez’s brother opened Venetian Rehab in 2003 and Dieguez added his false identity as an officer in 2010. Dieguez faces up to 15 years in prison if convicted.

 

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CBS reports: Scammers cash in on car “accidents”

January 29th, 2012

CBS News dispatched chief investigative correspondent Armen Keteyian to Florida to tell a national audience about “scam artists who stage car crashes in order to cash in.” Keteyan reports that Personal Injury Protection (PIP) has “set the stage for massive fraud.”

“Investigators say crooked clinic owners can rake in as much as $2 million a year in phony billings. Unethical doctors, lawyers and even massage therapists are involved and all get a cut,” according to the CBS News report.

It’s just one more sign that PIP reform is desperately needed in Florida.

 

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Could Judge Manno-Schurr have saved the Barahona children?

January 25th, 2012

Nubia Barahona was found dead on Valentine’s Day 2011 in the back of a pick-up truck parked off of I-95 in Palm Beach County. Her nude body was drenched in chemicals. Her 10-year-old twin brother, Victor, was found in the cab with acid burns and taken to the hospital.

Their adoptive parents, Jorge and Carmen Barahona, have been charged with Nubia’s murder and multiple counts of aggravated child abuse and neglect. Who could have prevented this tragedy?

An independent investigation commissioned by the Florida Department of Children and Family Services found that the “collective wisdom of all professionals who played a role in making decisions about the physical and emotional well-being of Victor and Nubia never coalesced into an effective focus.” In other words, everyone failed in their duties.

Among those in charge of the children’s care was Miami-Dade Circuit Court Judge Valerie Manno-Schurr. She approved the children’s 2009 adoption by the Barahonas, who are now behind bars for the heinous crimes they allegedly committed.

Judge Manno-Schurr denied the children a chance at a safe, normal life when she turned away pleas in 2007 to adopt the twins from their biological uncle and aunt, Isidro and Ana Reyes. Ana is the sister of the father of the twins. They told Judge Manno-Schurr that they could take care of the children, and provided references and financial statements to prove their worthiness.

Yet, Judge Manno-Schurr said no, preferring to keep the siblings in the foster care of the Barahonas. The DCF says that decision was “based on an incorrect assumption by all professionals involved in the case that it would be harmful for children of this age to experience a change in parents.”

When asked why Judge Manno-Schurr didn’t listen to the Reyes couple, their attorney, Steven Grossbard, said, “That is a piece of the puzzle that is not clear to me to this day, and I find it somewhat troubling.”

Miami-Dade voters should feel troubled when they consider whether to re-elect Judge Manno-Schurr. She has a spotty record marked by appeals court reversals and documented mishandling of cases. Can she exercise the kind of judicial wisdom and common sense needed to serve Miami-Dade residents? Do voters want other children’s lives in her hands?

The failure to approve the adoption by loving relatives in Texas wasn’t Judge Manno-Schurr’s only mistake. She also mishandled a 2007 evaluation of the children’s mental health. According to the DCF report, “The delay of more than five months to perform the psychological evaluation ordered by Judge Valerie Manno-Schurr appears inexcusable in light of the fact that it was compelled by the very serious concerns raised by the principal and teacher at the children’s schools about the safety of Nubia and Victor in their foster home.”

Why didn’t Judge Manno-Schurr push for quicker psychological evaluations of the twins? The results could have altered their fates. An evaluation in June 2007 – many years before Nubia was killed and Victor was burned — found that Nubia exhibited signs of depression and suicide. More troubling: She had a “premonition that something terrible was going to happen to her,” according to the DCF report.

Where was Judge Manno-Schurr? Why didn’t she consider the report when evaluating whether the Barahonas were qualified to be foster parents and later adoptive parents?

Given an apparent lack of judgment, does she deserve to continue to handle important cases like this? Is Manno-Schurr the kind of judge Miami-Dade County wants?

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Corruption at Miami-Dade auto accident clinics creates huge financial burden on drivers

January 15th, 2012

Personal Injury Protection (PIP) fraud is widespread in Miami-Dade County, say state investigators. They found regulatory violations at 90 percent of the pain clinics that primarily or exclusively treat automobile accident victims.

The rampant abuse is the biggest reason that many Miami-Dade drivers pay upwards of $2,000 a year for their PIP coverage.

Investigators at the Agency for Health Care Administration found irregularities at 43 of 49 clinics during a three-day period. Some of the problems were egregious:

  • Medical staff  were hired without required background screening.
  • Many clinic owners had no prior health care experience.
  • One employee was retained even after a background check showed he should be fired.
  • One insurer was charged $19,000 for massage therapy for one patient.
  • Employees at some clinics said they had never seen a patient.
  • Staff at one clinic said they had not seen the owner or medical director in six months.
  • Many clinics had advertisements for law firms and attorneys who handle traffic accident cases.

The state agency may revoke licenses and file criminal charges. The Florida Division of Insurance Fraud, which has been highly active in rooting out PIP fraud, is conducting its own investigation.

These findings are typical of most PIP clinics now operating.  They all know how easy it is to rip off the PIP system. Florida needs PIP reform now to reduce the fraud tax that honest drivers and insurance companies have to pay. Legislators should pass PIP legislation to bring the problem under control.

PIP fraud in Florida could reach $1 billion this year, according to the Insurance Information Institute. Florida has the highest rate of PIP fraud in the nation, and Miami-Dade is a leading metropolitan market for the crime. The expense is absorbed by insurance companies and passed along to drivers.

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Florida Division of Insurance Fraud gets new leader: Daniel S. Anderson

December 23rd, 2011

The Florida Division of Insurance Fraud has a new leader in the fight against Personal Injury Protection (PIP) fraud. Daniel S. Anderson, who has extensive experience in global criminal investigations and coordinating work among law enforcement agencies, starts work at the DIF in January 2012.

He knows criminal elements well. In 1982, he was hired as a Broward County police officer. He joined the Drug Enforcement Administration in 1986 as a special agent and worked there until his appointment to the DIF.

Among his top priorities: fighting PIP fraud. It costs drivers and insurers more than $1 billion a year, according to studies. The average person with two cars per household pays at least an extra $100 a year in insurance premiums because the problem is so bad.

Anderson was unit chief of operations management at DEA headquarters during his 25 years with the DEA. His most recent post was as associate special agent in charge of the DEA’s New York Field Division, where he supervised more than 800 employees.

At DIF, Anderson will lead nearly 155 sworn law enforcement officers who made more than 1,000 insurance fraud-related arrests last fiscal year. His staff includes administrators and civilian support staff members.

“I know he will be a tremendous asset in our continuing fight to crackdown on fraudsters in Florida,” Florida Chief Financial Officer Jeff Atwater said in a press release.

“With auto insurance and workers’ compensation fraud schemes increasing the cost of living for our fellow Floridians, there is no more capable person to confront these challenges head-on, dismantle these schemes and put the criminals behind bars,” Atwater said.

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PIP fraud connected to organized crime, detectives testify

December 23rd, 2011

Bad guys — organized ones — are behind much of the personal injury (PIP) fraud that forces up drivers’ insurance premiums, say two Hillsborough County undercover detectives.

“Myself and my partner, we’ve been investigating the PIP fraud for approximately two years now and in that time period we’ve arrested 123 people, closed down 11 clinics,” Hillsborough County special investigator Ronnie Cooper said. “We’ve gained a lot of intel [intelligence] on how these organized crime groups work and how they perpetuate the fraud.”

The detectives testified before legislative committees in Tallahassee in early December 2011. You can hear the details on what they uncovered in a radio report from WFSU.

The clinics are the hub of PIP fraud, said Det. Cooper. It starts with an unscrupulous doctor who sells, or rents, the state-authorized exemption to open a clinic, so that it is not subject to state oversight by the Agency for Healthcare Administration.

Other people operate the clinic and the PIP fraud that involves faked injuries and treatments never given, the detectives say. When a real injured person comes in, that individual is turned away with an excuse, such as the doctor is unavailable.

The money comes in through phony billings and “it’s been documented through investigations of this money leaving the county, leaving the state of Florida, whether it be back to Cuba, Mexico, the Cayman Islands, Costa Rica,” said Det. Cooper. “So it’s a lot bigger than what a lot of people understand, and the fact is that it’s not just a staged crash and it’s not just insurance fraud.”

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Injured people would know what lawyers, clinics pay each other under Florida bill

December 1st, 2011

Here’s the scenario: You get injured in an auto accident. Your attorney sends you to a treatment clinic or the clinic sends to you to the attorney. Ever wonder if they’re sending people only to certain care providers? Ever think that 1-800 service that sent you to a specific doctor or lawyer might be kicked back money for the referral?

If a bill filed by Rep. Rick Kriseman, D-St. Petersburg, becomes law, you’ll know. He wants to force lawyers, clinics and referral services to make public the financial arrangements that they can now hide from clients and patients. The proposed law would also prohibit arrangements that limit consumer freedoms to choose an attorney or doctor.

Why is this law needed? In part, because Personal Injury Protection (PIP) insurance has become such a big moneymaker that businesses, some of them questionable, have grown around them. Clinics can bill for maximum insurance benefits and attorney can sue for tens of thousands in legal fees when they take on PIP cases.

Read more in an article on the Florida Bar News website.

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‘Four Pillars’ of Florida can bring PIP insurance relief to drivers

November 28th, 2011

Personal Injury Protection (PIP) insurance is in desperate need of reform, and Florida’s government leaders have outlined a plan to do just that. We should all show our support for changes that would that would reduce the PIP fraud premium that all Florida drivers pay.

Gov. Rick Scott, Chief Financial Officer Jeff Atwater and legislative leaders have pinpointed four areas where executive and legislative action can reduce PIP fraud and possibly auto insurance rates. The four pillars would attack the problem at its roots.

“Regrettably, our state’s auto insurance system has been taken over by a circling pool of pariah — fraud clinics, lawyer referral services and organized crime — that have been making their millions on the backs of every Floridian with a car in the driveway,” Florida CFO Atwater said in an official statement on Nov. 15, 2011.  “Today, we stop throwing consumers to the wolves and take action to drive down the cost of auto insurance for Florida’s consumers.”

The four areas of action:

  1. Fraud Prevention. Florida leads the nation in staged crashes and questionable claims, and often individuals not involved in the crash receive PIP benefits.
  2. Litigation Reform. From 2006 to 2010, PIP-related lawsuits pending at year-end increased by 387 percent. Attorney fees often far exceed the value of the $10,000 coverage and the damage amounts in dispute.
  3. Utilization and Provider Reform. Florida is above the national average in the amount of medical provider charges per claim and the number of procedures per claim. Florida must address fraud and abuse to reduce these occurrences.
  4. Accountability. Governor Scott and CFO Atwater called for a plan to gather the data needed to evaluate the legislation’s overall effectiveness to stop PIP fraud and abuse and drive down rates.

Florida drivers can help reform the PIP system by telling their state senators and representatives that reform is needed now. Drivers can also send statements of support to Gov. Scott and CFO Atwater.

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Look who’s making a fortune from PIP; it’s not insurance companies

November 17th, 2011

When you dial 1-800-ASK-GARY, you ring up big bucks for Gary Kompothecras, whom Bloomberg Businessweek exposes in a November 2011 article as “a chiropractor who has grown wealthy and gained prominence in Florida catering to car-accident victims.”

Is he on the side of accident victims? Based on the article, the answer would be a big NO. Ask Gary for help, Businessweek reports, and the people who are likely to benefit are Kompothecras, owners of so-called pain clinics, and personal injury lawyers. The injured person they claim to care about comes last, if that.

Kompothecras’s company, Physician’s Group, has plastered billboards with the toll-free number all over Tampa Bay, Orlando and Jacksonville in an effort to snare accident victims. A phone center sends people to a network of 50 or so treatment clinics that file PIP claims. Callers are also referred to attorneys, many of whom send people to clinics in Kompothecras’s network, even if those clinics are more expensive.

It’s a big-money game. The ASK-GARY network spends $12.6 million a year to advertise its toll-free number, according to Nielsen Holdings. In 2010, it paid $1.2 million for the naming rights to the amphitheater on the Florida State Fairgrounds in Tampa.

Kompothecras has done very well for a gone-bust stockbroker who became a chiropractor. Businessweek says that he lives in a $7.4 million mansion, owns a private jet, and in 2011 bought the Captiva Beach Resort.

He and his company have also attracted the attention of state and federal investigators. They are looking into allegations that some treatments weren’t needed and that people outside the clinic were directing care.

Businessweek found that “Physician’s Group patients were treated until their insurance benefits were gone, even when they felt no pain.” Ernestine Brantley, a former office manager for the company, told the magazine that “using up all the benefits was referred to internally as ‘milking the system.’”

Those allegations are nothing new to readers of this website. There are more claims in the article, all detailed with names, dates and horror stories of how patients were manipulated to make the most profit from them with little to no regard for their health.

Read the entire article and draw your own conclusions. Does Florida need PIP reform? Who stands to lose if clinics are more closely scrutinized and marketing companies like ASK-GARY are put out of business? And what about Florida drivers who are paying some of the highest insurance rates in the country because of PIP fraud? Who’s looking out for that person? You can bet it’s not Gary.

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