Posts Tagged ‘Division of Insurance Fraud’

Chiropractor participates in PIP ‘fraud factory’ and is convicted for it

Tuesday, March 11th, 2014

The assembly line began at the site of staged accidents and ended in the wallet of a Naples chiropractor. The factory churned out more than $100,000 of fraudulent billings for Personal Injury Protection (PIP) claims for four years until authorities shut down the operation. The ringmaster is scheduled for trial this month.

A Collier County jury has found chiropractor Esmaeel Samaliazad, 49, guilty of guilty of organized scheme to defraud, insurance fraud involving more than $20,000 and insurance fraud involving less than $20,000.

“It basically was a fraud factory and they paid people to actually be patients,” prosecutor Michael Anthony Pica was quoted by the Naples Daily News as telling jurors during his summation. “(Patients) were paid, they staged an accident and then they didn’t receive treatments. This was a very corrupt clinic.”

As in some cases involving PIP fraud, Samaliazad wasn’t the mastermind. Prosecutors say Feghen Delva, 44, a chiropractic assistant, set up Cardinal Chiropractic Center in July 2008 and paid Samaliazad and another chiropractor a monthly fee to be straw owners to avoid state licensing requirements. Samaliazad worked in Naples two days a week, while also working at Delva’s clinic in Fort Myers.

The deal was a good one for Samaliazad. He earned more than $100,000 for basically looking the other way while the clinic committed fraud, Pica told jurors. They agreed and found him guilty on multiple accounts; he faces up to 15 years in a state prison on the top offense and five years each for the others.

Here’s how the fraud worked, according to published reports:

Delva hired recruiters to find Hispanic drivers to crash into vehicles in which Haitians were passengers. Delva paid the Haitians $2,000 each for agreeing to undergo 40 treatments, only some of which they received. Chiropractors and massage therapists, including James Greenhut, sometimes double-billed for treatments. Patient recruiter Guerold Dolcine acted as a lookout outside the clinic, watching for insurance and government inspectors.

After being alerted by a receptionist, the Florida’s Division of Insurance Fraud, the Office of the Attorney General, the National Insurance Crime Bureau, Geico and Direct General began investigating. They arrested five people in May 2012. Greenhut, 54, pleaded guilty. Dolcine, 38, pleaded guilty in November to obtaining more than $50,000 by fraud and was sentenced to time served in county jail.

Delva and office manager Marie Stephania Zamy, 28, face grand theft charges; Delva faces a money laundering charge in their joint trial scheduled for March.

Double the auto insurance fraud for Jacksonville resident?

Sunday, March 2nd, 2014

Stacy Lasondo Jackson has been charged in North Carolina with 10 counts of insurance fraud. But is it the first time she has committed this kind of crime?

Investigators with the N.C. Dept. of Insurance say that while she was living in Fayetteville, N.C., she obtained several thousand dollars from multiple insurance companies by filing fraudulent insurance claims for damage to her automobile and motorcycle between January and May 2013. They say that Jackson claimed the same vehicle was damaged more than once. Sometimes, there was no damage.

However, this may not be her first offense of this type. Jackson, 39, is from Jacksonville, Fla. According to North Carolina’s department of insurance, she was arrested on similar charges in Florida on Dec. 20, 2013. She lived in Jacksonville until she was extradited to North Carolina with the cooperation of Florida Dept. of Financial Services Division of Insurance Fraud and the Jacksonville Sheriff’s Office.

On Feb. 25, Jackson was arrested by N.C. Dept. of Insurance criminal investigators and placed under a $10,000 bond.

South Florida drivers should thank PIP prosecutor Ann Marie Villafana

Monday, February 24th, 2014

One of the biggest Personal Injury Protection (PIP) fraud rings is no more, thanks to the hard work of a person who does a great job without making headlines.

Ann Marie Villafana, assistant U.S. attorney for the Southern District of Florida, has been the lead prosecutor in Operation Sledgehammer, a multi-year effort to break up a criminal ring that staged auto accidents and then worked with others to collect fraudulent PIP claims.

Villafana has charged 101 suspects and obtained convictions that have resulted in 714 years in prison for the defendants and the repayment of more than $18 million. And she is not yet done going after the bad guys.

Her tireless effort has won her the Prosecutor of the Year award from the Coalition Against Insurance Fraud.

“Drivers in South Florida should be relieved. Breaking up a significant no-fault crash ring has made the roads of Palm Beach County safer. Villafana has stemmed a large-scale insurance theft that helped make no-fault premiums among the highest in America,” Dennis Jay, executive director of the Coalition, said in a statement.

Villafana received her award in a ceremony at the coalition’s annual member meeting in Washington. She collaborated with the FBI, IRS, Secret Service, Florida’s Division of Insurance Fraud and Palm Beach County state attorney’s office in building cases that led to 92 people being charged in federal and state court.

Villafana was a newcomer to fighting PIP fraud. She had to learn about no-fault and insurance fraud; she prepared so well that dozens of defendants plead guilty rather than go to trial.

They were part of a group that staged low-speed auto crashes in which no one was injured. Sometimes, the accident organizers made the damage look worse by striking cars with sledgehammers, which is the how the investigation got its name.

Accident participants filed false police reports and injury claims. Criminal organizers directed the individuals to medical providers that were part of the PIP fraud conspiracy. Chiropractors and other medical providers filed millions of dollars worth of PIP claims for treatments that were either not needed or not given. Attorneys who were part of the criminal ring sued auto insurers to ensure payment.

After ‘examinations,’ investigators produce PIP-related arrests

Wednesday, February 5th, 2014

The Miami man was not properly licensed and the clinic owner never performed medical services. But that didn’t stop the two from trying to collect on Personal Injury Protection (PIP) claims.

An investigation by the Division of Insurance Fraud of the Florida Department of Financial Services led to the arrests of Leonardo F. Marquez Garcia and Dayleann Marie Vallejo-Ruiz on charges of insurance fraud.

The DIF found that Garcia, of Miami conducted what was called ‘initial examinations” on auto accident victims. He then sent them to Injury Rehabilitation Center, which Vallejo-Ruiz owns, for physical therapy treatments that qualified for PIP claims.

Vallejo-Ruiz, who is a licensed massage therapist from Orlando, arranged for patients to sign blank treatment forms. Those were sent to the insurance company requesting PIP payments for services never provided, investigators say.

“This kind of deceit and abuse hurts all Floridians in the form of higher premiums,” said CFO Jeff Atwater in a news release. “I am proud of my team for putting a stop to this fraud and for their continuing success keeping other fraudsters off our streets.”

Investigators became aware of irregularities after Allstate Insurance Co. received bills for alleged medical treatments between Feb. 3 and March 16, 2012. Marquez Garcia filed PIP claims for his initial examinations made on behalf of Global Rehabilitation Center in Miami Lakes.

However, the center is not an Area of Critical Need facility, which can be a county health department, VA clinic, community health center, or a facility in a federally designated Health Professional Shortage Area.

Marquez Garcia, while an Area of Critical Needs doctor, is not licensed to practice medicine. So, Garcia was also charged with the unlicensed practice of medicine for operating outside the scope of his license, according to the DIF.

Additional arrests are expected. Each defendant faces up to 15 to 20 years in prison.

PIP fraud crackdown results in arrest of Fort Myers chiropractor

Friday, December 20th, 2013

An investigation by the Florida Division of Insurance Fraud has resulted in the arrest of a Fort Myers chiropractor at Gate Parkway Diagnostics Center on charges of Personal Injury Protection (PIP) fraud.

Harold John Pompey, 68, was charged with defrauding auto insurance companies by filing false and fraudulent insurance claims for PIP benefits, according to an official account. Investigators discovered that Pompey and the center prepared forms to support PIP claims to be paid to the center.

“PIP fraud impacts all Floridians by driving up auto insurance rates,” Florida CFO Jeff Atwater said in a statement. “I am proud of our dedicated fraud investigators who work to protect honest and hardworking Floridians by getting these fraudsters off our streets and out of our wallets.”

Tim Shaw, president of Tim Shaw Insurance-Acentria, based in Fort Myers, said the arrest was just of many instances of PIP fraud in Florida.

“I think the cleaning up of fraud and PIP is a long, drawn-out process,” he told the Fort Myers News-Press.

Investigators said that diagnostic tests performed at the center enabled Pompey and others to collect up to $10,000 in PIP coverage for every patient. Recruiters connected to treatment clinics in Florida would tell participants what to say about their supposed injuries in a way that would not create suspicion at insurance companies.

Following a search of the center, investigators found that between October 2011 and December 2012 the center filed claims for 514 patients. Pompey was listed at the chiropractor on more than 300 of those files.

Pompey was arrested in Fort Myers on a Duval County warrant and charged with one count of a first degree scheme to defraud and six counts of false and fraudulent insurance claims.

 

In a PIP fraud hotspot, more arrests for falsified billings

Monday, 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.

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

Thursday, 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.

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.

Investigators nab owners of North Miami Beach center, charge PIP fraud

Tuesday, August 28th, 2012

A joint investigation by the Florida Department of Financial Services, Division of Insurance Fraud, and the National Insurance Crime Bureau has resulted in the arrest of two clinic owner-operators in North Miami Beach on charges of Personal Injury Protection (PIP) fraud.

Authorities charged Nazih Boulos Chamoun, 74, and Robbie N. Chamoun, 30, with operating an unlicensed accident clinic and grand theft. Investigators say that over a period of 15 months, the two owned and managed Sky Imaging without the appropriate license from Florida’s Agency of Health Care Administration.

To get around the law, the Chamouns hired a licensed medical professional to sign paperwork and pretend he was the clinic’s owner. With that person in place, Sky Imaging was able to defraud the agency and hide the truth about who really owned the clinic.

“It never ceases to amaze me the great lengths fraudsters will go to circumvent the law and steal the hard-earned money of honest Floridians,” Florida CFO Jeff Atwater stated in a release. “My office will continue to crack down on these unlicensed clinics that set up shop for the sole purpose of committing fraud.”

Atwater and others continue to fight an epidemic of PIP fraud in Florida that has resulted in a skyrocketing number of phony medical claims and higher auto insurance premiums. Florida now has a law that began to take effect in July 2012 that makes it more difficult to commit PIP fraud. The law places limits on the time and places allowed in treating accident injuries and requires police investigating auto accidents to collect more information at the scene.

The law also mandates that auto insurers reduce their PIP rates by 10 percent this October or tell state regulators why they cannon. PIP rates are supposed to fall again by 25 percent by January 2014.

Florida CFO Atwater says new law sets up fresh challenges in fight against PIP fraud

Friday, July 6th, 2012

Florida CFO Jeff Atwater, whose office enforces the personal injury protection (PIP) law that took effect on July 1, says that provisions to reduce fraud will take time to take effect. Drivers should see some benefit. Just how soon and what to degree will become known over time.

The new law prohibits payments for massage or acupuncture treatments and restricts the payout for non-emergency treatment of accident-related injuries to $2,500. That should make a dent in the rampant PIP fraud perpetrated by unscrupulous clinics.

The law also requires more details in accident reports, which could reduce the number of staged accidents that are designed to generate fake PIP claims.

Will the provisions of the PIP law work? “We will know the answer to that in the next 12 to 24 months,” Atwater told the Orlando Sentinel.

As part of the new law, Atwater is creating a group to fight PIP fraud that self-funds investigations.  The money could come from the insurance and medical companies, and Atwater said fundraising details are still being worked out. He wants the group to pay for and share technology or data rather than fund prosecutions.

“That’s a bit of a pressure issue,” he said. “You don’t buy justice.”

Auto insurance companies are waiting to see how much the new law and new group can accomplish. The new law has an Oct. 1 deadline by which auto insurers must cut premiums 10 percent or give reasons why that’s not possible.  On Jan. 1, 2014, insurers must cut 25 percent or explain to the state why not.

“I really believe that the expectation that a 10 percent reduction and to follow with a 25 percent reduction is achievable,” Atwater told the Sentinel. “And even if it falls slightly short of those benchmarks, the people of Florida deserve that relief.”