Posts Tagged ‘Division of Insurance Fraud’

Vehicle hit when you’re not in it? No problem, file a PIP claim

Sunday, July 20th, 2014

Something strange happened to Frank Assouman one day. His parked truck was hit while he wasn’t in it, yet he filed Personal Injury Protection (PIP) claims totaling more than $25,000.

The Florida Division of Insurance thought it was odd, too, and arrested him. The state agency charged the 51-year-old West Palm Beach man with PIP fraud.

Assouman said he was eating lunch in his truck in Boca Raton when a vehicle struck his vehicle. The crash report and a witness statement disputed that.

He said that later  felt pain while on a trip to Haiti, according to an article in the Palm Beach Post. Assouman went to Delray Diagnostics for an MRI and Modern Medicine, Inc. for other treatment.

Those visits generated PIP claims of $21,815 to the other driver’s insurance company and $3,035 to his insurer. Both companies refused to pay, according to the Post article.

 

Operation No-Med Services produces another PIP fraud arrest

Saturday, May 31st, 2014

Operation No-Med Services has put the cuffs another person charged with committing Personal Injury Protection (PIP) fraud. Authorities hauled in 16 people a year ago, when the investigation was in full swing.

Aurora Hernandez
(from Local 10)

Aurora Hernandez was accused in late May of this year of organizing a staged accident and billing for faked injuries, according to a statement from Florida CFO Jeff Atwater.  She operated Magic Hands Medical Services, one of four clinics that participated in a scheme to defraud auto insurance companies.

Investigators found that individuals were recruited to participate in coreographed auto accidents in Miami-County between August 2010 and September 2012. The drivers and passengers falsely told police that they were injured. They were referred to clinics for treatment never provided. The clinics submitted to insurers falsified PIP bills totaling more than $408,000.

Investigators think that Magic Hands and the other clinics — Clarke Medical Services, Emoge Medical Services and New Life Rehab Services –  were involved in other staged accidents.

Last year, authorities arrested a medical doctor, two clinic owners, five medical licensees, six staged accident organizers and six others. Two massage therapists caught in Operation No-Med Services had been arrested in 2012 on charges of PIP fraud in related cases. Hernandez faces up to 235 years in prison for her involvement in PIP fraud.

“I am proud of our investigators for their commitment to keeping fraudsters off the streets and out of the pockets of hard-working Floridians,” said Atwater. “Every act of fraud drives up the cost of insurance and we refuse to allow those selfish acts to continue.”
 The investigation continues. The Florida Department of Financial Services Division of Insurance Fraud is pursuing Ricardo Jimenez, who owns two clinics that closed.

Tampa business owner sentenced to 2 years for PIP fraud

Friday, May 16th, 2014

To the opponents of the PIP reform law, we offer exhibit A, Dailin Rojas Perez, who perpetrated Personal Injury Protection (PIP) fraud through almost every means possible. The 2012 law was aimed at stopping people like her from ripping off the system and raising Florida auto insurance premiums.

The 30-year-old pleaded guilty in mid-May and was sentenced to 24 months of house arrest, according to an announcement from Florida CFO Jeff Atwater. Perez must pay $350,000 in restitution to insurance carriers and nearly $40,000 in investigative costs.

Her company, Today’s Medical Marketing, worked with  and Global Solutions Plus and accident clinic Medical Therapy Practitioners to fraudulently bill insurance carriers, swindling them out of $340,000. How did they do it? The clinic billed for services not rendered, participating in a staged auto accident scheme, and claimed that patients who had no injuries needed treatment.

The rampant fraud was evident in an admission by the clinic’s massage therapist Devin Sweet. He told investigators that in six weeks of working at the clinic, he had filled out approximately 5,000 fraudulent therapy forms for patients he never treated. According to one report, “Sweet stated he was surprised he didn’t have carpal tunnel after signing so many fraudulent forms. He sat at his desk and falsified medical treatment forms all day long, Monday through Friday, 9 a.m. through 6 p.m.”

A key part of the reform law — one that clinics are fighting in court — requires accident victims to visit a doctor before being referred to a clinic in order to collect PIP benefits. That extra step is proving to cut down on PIP fraud.

Doctors are more likely to play by the rules. Medical Therapy Practitioners did not. It fraudulently obtained an exemption from the Agency for Health Care Administration when chiropractor Anthony Esposito fraudulently claimed to be the 100 percent owner. Esposito told detectives from the Florida Division of Insurance fraud that he was recruited to be the straw owner of the clinic by Daysi Rojas, sister of Dailin.

Medical Therapy Practitioners tried to circumvent insurance carrier inspections by requiring them to make an appointment, which allowed the owner time to remove pre-signed treatment forms from the patient’s folder. The clinic also tried to avoid billing for undercover law enforcement officers by checking  potential patients against a list that contained suspected undercover officers.

Legitimate clinics have nothing to fear from the PIP reform law. In fact, business should be better for them once the PIP fraudsters are shut down.

South Florida chiropractors involved in PIP fraud convicted

Monday, April 28th, 2014

Federal prosecutors have won another set of convictions in Operation Sledgehammer, a joint effort of federal, state and private investigators to rid South Florida of Personal Injury Protection (PIP) fraud.

A jury found guilty three chiropractors — Hermann J. Diehl, 44, of Miami; Kenneth Karow, 54, of West Palm Beach; and Hal Mark Kreitman, 50, of Miami Beach — on charges that they organized fake auto accidents, filed phony medical claims and pocketed the money.

It was your classic PIP fraud scheme, with assistance from Joel Antonio Simon Ramirez, 29, of West Palm Beach, was found guilty for helping stage the accidents. People would be recruited and paid a small sum to tell police who arrived at the accident scene that they had injuries. The individuals were directed to clinics of the three chiropractors, signed forms that they needed and had received treatment, and went on their way.

The chiropractors filed PIP claims for treatments not needed and never given and, when insurance payments came, cashed the checks to  pay themselves, recruiters, the phony patients, and other participants.

As part of the scheme, the three men allegedly recruited individuals with medical or chiropractic licenses required by the state to open a clinic to pretend that they owned the clinics, when in fact, Diehl, Karow and Kreitman did.

Diehl was found guilty on three counts of money laundering and two counts of mail fraud. Karow was found guilty on 11 counts of money laundering and 48 counts of mail fraud.

Kreitman was found guilty on two counts of money laundering and 21 counts of mail fraud. Simon Ramirez was found guilty on one count of money laundering and eight counts of mail fraud.

They each face a maximum sentence of 20 years in prison and are scheduled for sentencing in July.

Operation Sledgehammer has produced federal and state charges against 93 defendants, resulting in court-ordered restitution of more than $11 million to the defrauded insurance companies, according to the United States Attorney’s Office for the Southern District of Florida.

With the latest verdicts, 51 of 57 defendants in federal court have been convicted by jury or by guilty plea. The arrests were produced through the collaboration of the FBI, IRS, Florida Division of Insurance Fraud, Palm Beach County State Attorney’s Office, Greater Palm Beach County Health Care Fraud Task Force and the National Insurance Crime Bureau (NICB).

 

 

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.