Florida PIP reform law stays in place as 1st District Court of Appeals denies motion for rehearing

November 26th, 2013

The Florida Personal Injury Protection (PIP) reform law enacted in 2012 has withstood another legal challenge as the 1st District Court of Appeals denied a motion for rehearing on its reversal of an injunction that prevented a significant part of the law from taking effect.

In March, a coalition of acupuncturists, chiropractors and licensed massage therapists persuaded a Leon County circuit court judge to grant a temporary injunction that blocked the portion of the law banning payments to them and requiring that injured person seek treatment within 14 days of an accident from a physician or hospital except under certain conditions.

Those provisions were put in place because of widespread PIP fraud in Florida. Much of that fraud was generated through falsified claims for medical need and treatment.

The victory for those business groups was short-lived, as the 1st District Court of Appeals reversed the circuit court on Oct. 23. The appeals court said the business groups failed to show a specific instance that supported their claim of denial of access to the courts. The court also said that the claim of economic harm was insufficient to assert the potential access-to-courts claims of other parties.

“The real parties in interest—injured motorists whose ability to sue tortfeasors has been impermissibly limited—are absent from this case,” the court wrote in a unanimous decision. “The Provider Plaintiffs’ attempt to bootstrap the standing requirement by joining the fictional ‘Jane Doe,’ purporting to represent all Florida citizens that were, are, or will be injured as a result of a motor vehicle collision, must likewise fail. The instant record does not provide a factual context or legal basis to support this hypothetical claim.”

The business groups were denied a rehearing in late November, which means those provisions of the PIP reform law will remain in effect unless the business groups file a successful appeal with the Florida Supreme Court.

“In order for Florida to no longer be the No. 1 state in the nation for questionable auto claims, and stop the $1 billion fraud tax on Florida consumers, the PIP reforms passed by the Legislature must have time to be fully implemented,” Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America, told the website Property Casualty 360.

“We are cautiously optimistic that once these reforms are fully implemented and have been given time to work, the fraud and abuse in Florida’s no-fault auto insurance system that so adversely impacts Floridians will subside, and Florida consumers may be provided with much needed relief once and for all,” he said.

Operation Sledgehammer results in two more prison sentences

November 25th, 2013

The well of PIP criminals drawn out by Operation Sledgehammer never seems to end. Maykel Marquez, 32, of Jupiter, and Noelia Marichal, 52, of West Palm Beach, have been sentenced to more than four years in federal prison for their part in staged auto accidents that resulted in fraudulent Personal Injury Protection (PIP) claims.

They recruited and paid people to pretend they were injured in planned vehicle accidents. Medical clinics submitted phony bills to auto insurance companies and pocketed the money. Federal investigators said that 21 clinics participated in the scheme, which lasted from October 2006 to December 2012.

Marquez cashed checks worth $568,517 and Marichal checks worth $101,344 in laundered proceeds, according to a press release from the FBI. A federal judge ordered Marquezto pay $1.18 million in restitution and Marichal $1.36 million.

Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida, thanked federal investigators, the Florida Department of Insurance Fraud, the Palm Beach County state attorney’s office, and the Greater Palm Beach County Health Care Fraud Task Force for their work. He also recognized the National Insurance Crime Bureau (NICB) for its collaboration and assistance.





Auto insurer, Florida DIF partner to bust clinics on PIP fraud

November 18th, 2013

NBC-2.com WBBH News for Fort Myers, Cape Coral

It took a year, but undercover investigators have taken down two medical clinics in southwest Florida that filed fraudulent Personal Injury Protection (PIP) claims. The staged-accident scam was a lot like others in Florida that push up drivers’ insurance rates.

Nationwide Insurance worked with state investigators to learn who was organizing fake car crashes in which uninjured passengers would claim that they needed medical treatment.

Participants would sign documents at Evans Rehab Center on Evans Avenue in Fort Myers, but receive no treatment, according to a witness. The clinic then sent PIP claims to auto insurers.

“Insurance company investigators came to us and reported that they had suspicions that Evans Rehab was billing for services not rendered,” Lt. Mark Fritz with the Florida Department of Financial Service’s Fraud Division  told WINK News. “There was a recruiter that was referring patients to that clinic. We had a traffic accident report with their names on it and that’s what got us in the doors.”

The investigation then extended to Charlotte Wellness and Rehab on Kings Highway in Port Charlotte.

“Each clinic, they were required to visit 40 times,” Fritz told the TV station. “With the 40 times, it maxed out the PIP payment. A lot of times, they’d go there and sign a form multiple times for five visits, but they really didn’t have to go all those 40 times.”

The investigation also found that Charlotte Wellness did not have the proper licensure requirements, according to an announcement from the Florida Division of Insurance Fraud.

In late October, investigators arrested:

  • Clinic owner Gerard Jean Stephen Valere, 51, for patient brokering and attempt to solicit, conspire
  • Facilitator Joe Gevans, 51, on criminal solicitation and patient brokering
  • Chiropractor Ronald Woodley, 63, for filing a false health clinic application
  • Jordany Estimond, 44, on charges of patient brokering and attempt to solicit, conspire
  • Massage therapist Andres Bravo, 52, on a charge of grand theft
  • Receptionist Gloria Feliz, 31, on seven counts of insurance fraud and one count of fraud

If convicted, each faces up to five years in prison. The state is looking for additional suspects connected to the clinics.

“These arrests are another great win in the ongoing fight against PIP fraud in Florida,” Florida CFO Jeff Atwater said in a statement. “I applaud the hard work of our investigators who are able to identify and shut down these destructive crime rings, which hurt Florida families by driving up insurance rates for everyone.”

PIP fraud arrests at southwest Florida clinic



Operation Sledgehammer claims more criminals, millions of dollars in restitution

November 13th, 2013

One of the furthest-reaching federal investigations of Personal Injury Protection (PIP) fraud has produced more prison sentences.

U.S. District Judge Kenneth Marra has sentenced Maria Testa Baceiro to six years in prison and ordered her to pay $4.2 million in restitution, the amount she collected from from Febre’s Medical Center in West Palm Beach and Universal Rehab Med Group in Miami

Testa Baceiro is the ninth person to be sentenced in Operation Sledgehammer. She had pleaded guilty to almost 50 crimes, mainly money-laundering and fraud. She has agreed to testify against others. About 40 people have been arrested; some of those indicted in June fled to Cuba.

Her boyfriend, Luis Ivan Hernandez, pleaded guilty to similar charges; he was sentenced to nine years and ordered to pay $4.2 million in restitution. He had owned six clinics in Miami-Dade and Palm Beach counties, including one with Testa Baceiro.

Two other defendants, Daviel Castro of West Palm Beach and  Aaron Freedlander of Weston, were sentenced after pleading guilty to charges of conspiring to commit mail fraud. Castro participated in staged auto accidents, recruited others to participate in fake crashes, and cashed checks. Judge Marra sentenced him to four years and 10 months in jail and ordered him to pay $1.3 million in restitution. The judged Freedlander to three years and four months in prison and ordered him pay about $900,000.




In a PIP fraud hotspot, more arrests for falsified billings

November 11th, 2013

Hillsborough County is the third-worst in Florida for Personal Injury Protection (PIP) fraud, after Miami-Dade and Broward counties. So it’s no surprise that the Division of Insurance Fraud arrested a Tampa clinic owner and put the office manager on its most-wanted list.

Clinic owner Dailin Rojas Perez, 30, was charged with racketeering and money laundering involving more than $340,000 in fraudulent proceeds. Massage therapist Devin Sweet, 27, was charged with insurance fraud for helping to  falsify records at Medical Therapy Practitioners.

That clinic worked with two other companies to bill insurance companies for services: that were either not provided or not needed; that were related to staged auto accidents; and were not eligible for payment because business licenses were fraudulently obtained. The DIF said the companies were Global Solutions Plus, owned by Yanely Campillo Hernandez, and Today’s Medical Marketing, LLC, owned by Rojas Perez.

Chiropractor Anthony Esposito told DIF detectives that he pretended to own the clinic after the real owner’s sister recruited him.

DIF detectives conducted a sweep of the clinic and found predated therapy sheets. Few patients were ever seen. Sweet admitted that he spent most of his day filling out falsified forms.

Arrest warrants for racketeering conspiracy and money laundering were issued for clinic manager Armando Diaz Tomas, 34, and his wife, billing clerk Yanely Campillo Hernandez, 31. Campillo Hernandez is believed to be in Cuba. The DIF has placed Diaz Tomas on its most-wanted list.  He had been arrested in Jacksonville earlier in the year.

ABC News investigates PIP fraud: A Nightline report

November 4th, 2013

ABC News reports on PIP fraud in Florida

Want to see just how bad PIP fraud is in Florida? Read an ABC News investigative report into the problem.

“Authorities said insurance fraud is very lucrative and suspects can potentially rake in millions. It’s estimated that personal injury fraud costs the state of Florida alone $1 billion a year, a loss that is passed along to consumers in the form of rising insurance premiums,” according to the Nightline report.

Learn more at the ABC News website.


Clinic owner in Jacksonville faces sentence of up to 75 years for PIP and staged-accident convictions

November 1st, 2013

Justice comes this month to a clinic owner involved in a scheme to fraudulently obtain PIP payments. David Rodriguez Lopez will be sentenced in November after being convicted of Lopez on charges of schemes to defraud, insurance fraud, and participation in a staged accident. He faces up to 75 years in prison.

Prosecutors said Lopez was involved in more than 26 staged accidents that sent 60 people to his Jacksonville-based Indian Rehabilitation Center Inc. Investigators found that Lopez billed for treatment never given or involving equipment the clinic did not possess. Insurers were cheated out of $240,000 in PIP benefits.

Lopez recruited an individual to put his name on the clinic’s ownership papers, even while Lopez controlled bank accounts and directed fraudulent clinic operations.

Investigators arrested 60 other people involved in staged accidents, recruiters and the clinic’s office staff. Investigators said the participants participated in staged accidents dating back to March 2012.

New Division of Insurance Fraud director Simon J. Blank pledges strong enforcement action

October 31st, 2013

Simon J. Blank officially started as director of the Division of Insurance Fraud on Sept. 3, but had made his feelings about fighting fraud well-known before then.

“The Division is fully committed and our enforcement actions have never been bolder or more unrelenting,” he said before taking office. “I believe the DIF is poised to accomplish even greater things in the years to come and I feel honored to have been named its director.”

Blank started with Division of Insurance Fraud in 1996 when he joined the workers compensation squad in Palm Beach County. He worked in all areas of the division and rose to Bureau Chief of Workers Compensation Fraud and Major of Law Enforcement Operations. Blank is well-respected by both law enforcement and the insurance industry.

“I have seen many changes since joining the division but one thing has remained constant throughout that time: the dedication and commitment of all our members to safeguard the citizens of this state against all acts of insurance fraud,” he told The PIP Source.

“Effective partnerships have been formed, the number of dedicated prosecutors has significantly increased, technological advances have been made, and the working relationship with the insurance industry as well as regulatory and enforcement agencies has never been better.”

Blank served Air Force from 1982 through 1986. He received the rank of sergeant and completed his service with an honorable discharge. He joined the Royal Palm Beach police department in 1988, starting as a patrol officer and was promoted over time to a supervisor of criminal investigations before joining the Division of Insurance Fraud.

Appeals court ruling hinders efforts to fight PIP fraud in Hillsborough County

October 30th, 2013

An ordinance that helped Hillsborough County fight PIP fraud by regulating operations of certain healthcare clinics has been suspended and probably won’t be reinstated. The law drastically curtailed staged auto accidents and attempts by clinics to file the false insurance claims that were generated from that fraud.

The Tampa Bay Times reports that the Second District Court of Appeal has upheld a temporary injunction against county enforcement of the ordinance.

“Obviously, we’re disappointed with the decision,” Rob Brazel, chief assistant county attorney for litigation told the newspaper. “We’ve got to determine whether or not there is something we can amend in the ordinance to make it enforceable.”

For more on the story visit, here.

PCI commends conviction of Tampa clinic owner on charges related to PIP fraud

October 29th, 2013

The Property Casualty Insurers Association of America has commended CFO Jeff Atwater, police and state prosecutors following the recent announcement of a conviction of a clinic owner in large-scale PIP fraud ring.

“Curbing fraud and abuse within Florida’s no-fault auto insurance system is a top priority for Florida’s consumers,” said Donovan Brown, state government relations counsel for the association.

“Today’s action by Chief Financial Officer Jeff Atwater, Jacksonville investigators and the state attorney’s office of convicting the Tampa clinic owner who was involved in a large PIP fraud scheme should be commended.”

“Bringing this fraud ring leader to justice is a step in the right direction for the overall effort to provide relief to Florida consumers who continue to be plagued by a $1 billion auto insurance fraud tax,” he said.