Archive for the ‘Uncategorized’ Category

« Older Entries
Newer Entries »

PIP fraud starts at young age when parents are involved

Friday, March 1st, 2013

It takes a very wrong kind of mom to put a child in an auto accident, just to make money from Personal Injury Protection (PIP) fraud. Yet that’s what happened. Ana Ovando of West Palm Beach subjected her five children – ages 3 to 17 – to faked crashes so that she could file phony PIP claims.

Now, Ovando is headed to federal prison for six-and-one-half years for mail fraud conspiracy and mail fraud. There’s no criminal penalty for being a reprehensible parent; if there were, she might not ever be released.

“These children were exposed to physical danger,” a federal prosecutor wrote to the judge in asking for a longer term than federal sentencing guidelines dictate.

“Ovando put them in a vehicle with the full knowledge that they would be in an automobile accident on a city street. Having the children present in the vehicle made the accident look more ‘real,’ and Ovando hoped that it would keep the insurance companies from suspecting fraud.”

To all the people who say that auto insurance companies have overstated the PIP fraud problem, we say look at Ovando. Prosecutors taped her calling home from jail, asking her children to lie to the court about her fraud, according to a Sun-Sentinel article. The same tapes revealed that her older children begged her not to include them in her crimes because they feared that the police would come after them.

Yes, the money to be made from PIP fraud can be a stronger motivator than a mother’s love. Janice Velez, who was convicted with Ovando, used her two children in one staged accident.

Ovando took her children to New York Medical and Rehab Center and Velez took her children to Karow Chiropractic Center. Both are in West Palm Beach. Massage therapists admitted in court that both mothers signed blank treatment sheets that the massage therapists later completed and submitted to the insurance company for reimbursement.

In that way, it was a typical PIP scheme: Each staged accident results in faked injuries that lead to fraudulent PIP claims. Velez was sentenced to two years in prison.

Both women were caught as a result of an investigation by the FBI, IRS, and Florida Department of Insurance Fraud. They were assisted by National Insurance Crime Bureau and the Greater Palm Beach Health Care Fraud Task Force.

We feel sorry for the children. While they were unwilling participants and therefore not charged or jailed, they were forced to live like criminals. Now they have lost their mothers. Where is the justice for them?

Tags: , , , , , , ,
Posted in Uncategorized | No Comments »

Wonder why PIP rates don’t go down? Look at how that money gets paid out in court

Thursday, February 28th, 2013

What would happen if you put on your time sheet hours that other employees worked and your boss caught you? Would you be punished? For sure. Would you be fired? Probably.

What if you’re attorney suing an insurance company for Personal Injury Protection (PIP) claims and you get caught padding your legal bill? Nothing. No penalty, no warning, no report to the Florida Bar.

That’s what attorney Rita Baez of Coral Gables got away with in not one, but two lawsuits against our company in Miami-Dade County. She claimed that she did all the legal work on behalf of General Health Medical Inc. while working at the law firm of Neil Gonzalez & Associates and, later, at her own firm.

At a fee hearing on the first lawsuit, Baez repeatedly testified under oath that she personally performed all of the tasks listed on her timesheet. However, on cross-examination, UAIC’s attorneys confronted Baez and proved that other, less-experienced attorneys had actually prepared and signed the documents.

Baez said she was entitled to be paid at her higher hourly rate because she supervised them. Just so you know, a judge considers an attorney’s skill, experience and reputation in calculating attorneys’ fees.

Our company wanted all the attorneys’ fees tossed because Baez had committed a fraud upon the court. Did she admonish Baez for faking her time sheets? Did he penalize her in any way? No, he awarded attorneys’ fees that included the lower hourly rates paid to Baez’s underlings.

In the second lawsuit, Baez quickly revised her time sheets to reveal all of the other attorneys at the Gonzalez firm who performed the work. However, when the two sides arrived at the fee hearing, her old boss, Neil Gonzalez, made a surprise appearance seeking payment of his fees as well as the fees of his less-experienced associates.

Based on this last-minute surprise and that false statement Baez made at the first fee hearing, UAIC asked the court for a delay. However, the trial court denied that request and ultimately entered a fee judgment against UAIC, ordering it to pay Baez, Gonzalez and his associates.

Think about it. What if your boss put in hours for work you did? Would you think he was cheating the company? Would you expect him to be escorted out of the building?

The trial court did nothing. When we challenged the ruling, an appeals court said that the corrections to the time sheets made everything OK.

However, the appeals court added the following to its opinion: “Although this Court affirms the judgments on appeal, this ruling should not be construed as an approval of Ms. Baez’s actions and misguided rationale in the court below. We caution attorneys who may attempt to pad their billing with misleading time records. The practice is an affront to the solemn oath of attorney and will result in dire consequences for the practitioner.”

Tags: , , , , , , , ,
Posted in Uncategorized | No Comments »

Hillsborough County detectives bust medical therapy clinic for PIP fraud

Friday, January 25th, 2013

The sheriff’s department detectives went undercover in August. When they emerged five months later, they had arrest warrants for employees of Heisha Medical & Therapy Center in Tampa on charges of personal injury protection (PIP) insurance fraud.

Among those arrested was Ana Belen Valdes of Tampa, a legal assistant to attorney Jose Dapena, who practices personal injury law and has offices in Tampa and Miami. Valdes was charged with soliciting motor vehicle tort claims. Dapena was not charged.

It takes months of painstaking work to catch the people who rip off Florida’s auto insurance system. Police and insurance companies work from suspicious insurance claims. Sometimes they get a tip about PIP fraud, as they did this time.

“Two of our undercover detectives came to the clinic and received, filled out all the paperwork, and received massages — received treatment as if they had been in an accident,” Hillsborough County Sheriff’s Office spokesperson Cristal Bermudez Nunez told Fox 13 News.

“At other times, maybe they received a 5-minute massage and still were signing paperwork saying it was an hour-and-a-half long,” Bermudez Nunez told ABC Action News.

On one visit, the detectives witnessed a staged crash, which is a faked auto accident that leads to a false police report and phony insurance claims for treatment. Usually, the participants enter the vehicles after they have collided and pretend they were passengers.

Detectives said that the crash organizer paid the participants between $500 and $1,500 to lie about the incident and injuries.

“If you get three jump-ins in a staged accident, or four, you’re talking $40,000 easy, just out of one vehicle,” Jorge Santa Maria, an investigator with Infinity Insurance, told Fox. “The amount of money is astronomical if you think about it. It’s going to be somewhere between half-million and million dollars per clinic that’s operating in this fraudulent way.”

Police arrested the office manager and several employees, along with the person who detectives say organized the staged accident. Several warrants were outstanding as of Jan. 16.

 

Tags: , , , , , , , ,
Posted in Uncategorized | No Comments »

Operation Whiplash in Florida produces first two PIP fraud convictions

Friday, January 4th, 2013

It was an illegal Florida business that generated more than $22.5 million in phony Personal Injury Protection (PIP) claims. However, an intensive police undercover operation has helped produce the first two guilty verdicts against the operators of an auto accident fraud ring that stretched from Cape Coral to Miami.

Francisco Huici Fernandez, 40, and Adrian Perez, 22, were found guilty of multiple federal counts of mail and healthcare fraud in mid-December 2012. They face decades behind bars.

The two men operated out of C&A Family Rehab Center in Cape Coral, according to the U.S. Attorney’s Office, Middle District of Florida. Fernandez sent participants from staged auto accidents to the clinic. They were paid to report fake injuriesand medical treatments.Perez fraudulently billed auto insurance companies.

Undercover investigators infiltrated C&A and a larger ring that Operation Whiplash, a joint law enforcement operation, had targeted for 13 months. The group staged crashes and operated in Cape Coral, Miami and Hialeah. A number of Cape Coral residents were indicted in mid-March, along with Karen Carmona Jackson of Lake Wales and Stephen M. Lovell, D.C. of Windermere, according to press reports.

“We were able to track the money and were able to see what they were doing with it, see how they operated, and were able to federally seize vehicles, airplanes, and bank accounts,” Det. Josh Silko of the Cape Coral Police Department told WZVN of Fort Myers when indictments were handed down.

More than 200 acts of mail and health care fraud were documented by the investigating agencies: Cape Coral Police Department, Secret Service, IRS, National Insurance Crime Bureau, and the Florida Department of Financial Services Division of Insurance Fraud.

Posted in Uncategorized | No Comments »

Investigators shut down two clinics in crackdown on PIP fraud and staged accidents

Tuesday, December 18th, 2012

View more videos at: http://nbcmiami.com.

 

Investigators have the right name for their effort to stop PIP fraud: Operation Never Ends. There is no end of bad guys who rip off the auto insurance companies for Personal Injury Protection (PIP) money.

The problem has become so bad that now the Secret Service is involved. The federal agency, along with Miami police, local and state agencies, and private insurance companies have broken up a ring of 11 individuals that authorities say staged auto accidents and filed phony PIP claims.

Police went undercover for more than a year at two medical clinics in Miami-Dade County to infiltrate the operation. In a typical scheme, clinic operators hire an individual to recruit and pay people to pretend to be in auto accidents. The people are coached on what to tell police and afterward go to a clinic where injury reports, treatment records and PIP claims are falsified.

“In one clinic that we had, I can tell you that one investigation we did in the beginning, they were up to $80,000 before we shut them down in just one crash,”Sgt. Luis Tabordaof the West Miami police department told news media.

Among those arrested were Jorge Felix Felipe Pupo, 49 and Yanaris Ramirez Paneque, 36, police said. Authorities closed two clinics, Miami Medical Care Center and Caribe Rehab.

“The State Attorney’s Office takes these cases very seriously and takes these crimes — staged accidents and insurance fraud — very seriously,” Scott Holtz of the Miami-Dade state attorney’s office told the news media. “That’s why we are committed to fighting them through our specialized fraud unit.”

The Secret Service, police departments of West Miami and Hialeah, Miami-Dade County State Attorney’s Office, Florida Department of Health, National Insurance Crime Bureau (NICB), worked in cooperation with State Farm, United Auto, Direct General and Nationwide insurance companies to break up the ring.

Tags: , , , , , , ,
Posted in Uncategorized | No Comments »

What’s pushing up your auto insurance premium? Check the hospital bill

Sunday, December 16th, 2012

Maybe it was bound to happen: Hospital, clinic and doctor charges for accident insurance claims are going up, up, up.  While the number of nationwide claims for personal injury protection and bodily injury are falling, the costs are rising, according to the Insurance Research Council.

That shouldn’t be happening. Motor vehicle deaths are at their lowest level since 1949, due in part to greater car safety.

But auto insurance premiums are going up everywhere, not just in Florida where PIP fraud is a leading cause. James Ruotolo, an insurance fraud technologist at the software company SAS, blames an increase in medical treatment costs. Caregivers are ordering more sophisticated tests and more treatments.

While better testing is leading to improved patient treatment, “there is little evidence to suggest that the dramatic rise in diagnostics is fully warranted,” he writes for the publication Insurance Technology.

“Not only do the costs of the diagnostic treatment itself increase the claim costs, the fact that several diagnostic tests were ordered serves to establish a position that an injury is more severe.”

Statistics show that the inflation for auto and work-related accidents is going up twice as fast as general medical inflation. Ruotolo says doctors, clinics and hospitals are looking for new places to make money, so they’re ordering more expensive tests and treatments.

Sometimes those tests and treatments are needed, but not always. After looking at a lot of big bills, some insurance companies are looking more closely at the charges. They suspect what’s now being called “soft fraud,” in which needless tests are conducted just for the revenue.

“This ‘soft fraud’ has occurred in Florida PIP claims for years,” says Richard Parrillo Sr., CEO of United Automobile Insurance Company.

“It is a major factor in the huge increase in auto insurance premiums. It’s unfortunate because it is Florida’s citizens that have to pay for all of this unnecessary treatment.”

Auto insurers are serious about fighting the problem. Their insurance fraud departments are working with government and private health insurance investigators to learn more about how to detect and fight overbilling.

It’s a start in the battle against a new kind of insurance fraud, but Ruotolo writes that auto insurers are far behind others in detecting what’s legitimate and what’s not. Until the insurers get a handle on the problem, they will be passing along the higher costs to drivers.

“It is not the insurers that are far behind in detecting the fraudulent treatment,” Parrillo says. “It is the courts that have failed to crack down on medical providers that are ordering and performing all these unnecessary services. These medical providers do it because they know they can get away with it.”

Tags: , , , ,
Posted in Uncategorized | No Comments »

Feds put Florida chiropractor behind bars for staged-accident scheme

Wednesday, November 21st, 2012

The case was so strong it didn’t go to trial. Jennifer Adams of Boca Raton has pleaded guilty to a federal charge that she worked with others to rip off insurance companies through staged auto accidents. The chiropractor could go to jail for up to 20 years, pay a $250,000 fine and return $1.9 million stolen from the insurance companies.

Cases like hers are among the reasons why the Florida legislature pushed through Personal Injury Protection (PIP) reform in the 2012 session. Under a law that took effect in July, people injured in a car accident can receive the full $10,000 in PIP benefits if they to go to a doctor, but no more than $2,500 if they see a chiropractor or visit a non-medical care outlet.

Why? PIP fraud stems in part from medical clinics and chiropractors that predominantly treat auto accident-related injuries. The 39-year-old Adams is one example. Federal prosecutors say recruiters found people who would fake car collisions. The participants in both vehicles were coached on what to tell police when they arrived at the scene of the staged accident, and organizers would then file false injury claims with insurance companies.

The organizers sent the participants to two chiropractic clinics to which Adams loaned her license and she claimed she owned, prosecutors said. They were Ovy Rehabilitation Medical Center, Inc. in West Palm Beach and Chiropractic Office of South Florida in Palm Springs.

However, the organizers ran the clinics and filed falsified paperwork for PIP claims even though the participants were not injured and received little or no treatment. Prosecutors say Adams knew what was going on and collected a salary from the organizers; they kept most of the $1.9 million collected from 10 insurance companies.

The fraud was uncovered through the hard work of the FBI, IRS and Florida Department of Insurance Fraud. Prosecutors gave a special thanks to the National Insurance Crime Bureau for its assistance. The NICB is a nonprofit organization funded by insurance companies that works with law enforcement agencies to find and prosecute insurance criminals.

Tags: , , , , , , , , , , , , , ,
Posted in Uncategorized | No Comments »

Insurance company pays fraudulent PIP claims, you foot the bill

Tuesday, November 20th, 2012

The office of Richard Parrillo Sr., president of United Auto Insurance Company (UAIC), recently received an email that tells a tale all too common in Florida. The names of the person facing the Personal Injury Protection (PIP) claim and the insurer — which is not our company — are not being disclosed to protect their privacy.

Mr. Parrillo:

I am a victim of a “play by play” PIP fraud. Against my plea to investigate before tendering the $10,000 [PIP benefit], the insurance company has decided to give them the money because, the company says, “even though it might be true,it’s too hard to collect sufficient support or prove that is a fake PIP claim.” I am liable for a possible $40,000, according to them. What to do?

Here’s how Mr. Parrillo might answer that letter:

We feel for you. Every day we see hundreds of PIP claims that we suspect are falsified. Our investigations have exposed people who faked accidents, injuries, medical evaluations and treatment. PIP fraud is a huge problem in Florida and you are one of its many victims.

What should you do? It’s hard to fight a system where the criminals know how to play the insurance game, where PIP attorneys wantonly abuse the justice system to line their pockets, and where the judges won’t follow the law or rules of evidence.

Don’t worry; you won’t have to pay the $40,000 out of your own pocket. But your insurance company will pay. And your insurance rates will go up, even though it’s not your fault. The new PIP reform law can help, but until we have enough investigators and a justice system that helps fight PIP fraud, it won’t be enough.

So, we’re going to help you by telling your story on our blog. Other people will read it. And maybe enough of them will tell Florida judges and legislators that enough is enough. Honest drivers are tired of footing the bill for people who rip off the PIP system. When that happens, then your insurance company won’t give in to criminals and you will be safer.

Tags: , , , ,
Posted in Uncategorized | No Comments »

Auto accident fraud happens in ways you do not expect

Monday, November 19th, 2012

Personal Injury Protection (PIP) fraud cases are common in Florida. Sadly, sometimes the police hide what truly happened in an accident. Kudos to the honest cops and one of our adjusters for uncovering the truth and correcting an injustice.

Three police officers in Medly, a town in Miami-Dade County, have been fired for covering up who was to blame in an auto accident. A Medley police officer crashed his unmarked car into a mini-van that was turning left at an intersection. To a video of the accident, click here.

The van’s driver, Leovigildo Bravo Fraga, was charged with failing to yield right of way and drunk driving, according to the Miami Herald. However, Hialeah police called in to assist in the case discovered that Fraga, 49, was completely sober.

Later, our UAIC insurance adjuster “noticed that Medley police reports and scene photos did not jibe with the evidence: The Medley cop, not Fraga, was at fault in the accident,” the Herald reported. A video from the scene also showed Fraga was not to blame.

The Medley police department has fired three officers, saying they wrote false police reports and committed other misconduct. They have responded with a lawsuit against the city.

The greatest victim in all of this is the innocent driver, just as it is when PIP fraud is committed. The Medley police released Fraga, but charged him with causing the crash. Fraga’s car was towed; he paid $151 to retrieve it. Fraga told the Herald that his driver’s license has been suspended, his car is damaged, and no has paid him anything.

As often happens with PIP fraud, false insurance claims helped authorities discover the lies. The investigation found that the acting police chief broke Medley rules by filing the report directly with the department’s insurance company, not with the town’s legal department.

The UAIC adjuster noticed that Romero’s claim did not match the accident report and photos. When our company denied the claim, the Medley police chief’s office asked the Hialeah police to investigate.

Tags: , , , , , ,
Posted in Uncategorized | No Comments »

Warning to massage therapists: No tolerance for fraud

Thursday, October 11th, 2012

Florida’s Surgeon General and Secretary of Health, Dr. John Armstrong, is cracking down on the licensing of massage therapists. He pulled the licenses of 81 people who apparently paid a massage school employee for the documents needed to obtain a license, Gov. Rick Scott said at a press conference in Tampa in late September.

“The investigation has revealed that some massage therapists paid between $10,000 and $15,000 for fraudulent college certificates and transcripts,” said Gov. Rick Scott at a press conference in Tampa.

The Tampa Bay Times reports that more than 200 therapists may have obtained their licenses using fraudulent transcripts from a Florida massage school. Officials did not name the school, saying their investigation was not complete.

The fraudulent licenses were discovered during an investigation of massage establishments that Gov. Scott said was part of the state’s fight against human trafficking. The Florida Dept. of Health and the Clearwater Human Trafficking Task Force led the crackdown, according to the Governor’s office.

“If you want to break the law, if you want to prey on the vulnerable, if you’re in anyway in the business of human trafficking, you don’t want to do it in Florida,” said Scott. “Our justice system here is thorough and swift.”

While many massage therapists earned their licenses and provide legitimate services, some have been arrested on Personal Injury Protection (PIP) fraud. In April, a licensed massage therapist was charged with sending $250,000 in fraudulent bills to insurance companies for injury-treatment claims related to auto accidents.

Fraud has become so widespread that the new PIP law which soon takes effect makes massage therapists ineligible to bill PIP for alleged services rendered to accident patients.

Tags: , , , ,
Posted in Uncategorized | No Comments »

« Older Entries
Newer Entries »