Posts Tagged ‘insurance claim’

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.

One-armed man behind PIP fraud: Really

Thursday, December 19th, 2013

Three people have been arrested and charged with Personal Injury Protection (PIP) fraud, and one of them says a one-armed man was to blame.

The Sun-Sentinel reports that Donicio Ruiz, 34, told investigators that a one-armed man recruited him to be the other driver in a staged accident in West Palm Beach. Two women, driver Marilu Rodriguez, 26, and passenger, Monica Riveron, 34, also told police that they were injured. They went to a clinic where false insurance claims for PIP benefits were filed.

Ruiz told investigators that the one-armed man paid him $1,500 a week after the accident. Rodriguez said she was paid $1,000, but didn’t identify the person.

The staged accident was reported on May 5, 2010. Rodriguez confessed to an FBI agent in October 2011 that she was paid to set up the accident and file false claims. The trio was arrested in early December 2013.


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

Tuesday, 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.

Who is preying on drivers? Looks like PIP fraudsters

Monday, September 16th, 2013

The masterminds of Personal Injury Protection (PIP) fraud rarely put themselves in danger. They hire people to crash cars and file false police reports. Those average folk take big risks for a few bucks, while PIP fraud organizers collect the lion’s share of the money from insurance companies.

So, when we hear that auto insurance companies are taking advantage of consumers, we point to Faika Khader, who was short on cash and ideas how to get it. She told police that she needed $900 and signed on to a PIP fraud scheme to earn the money.

In August 2011, Khader crashed her Dodge minivan into a car at an intersection in Boynton Beach. She filed a PIP claim with Farmers Insurance at Apex Chiropractic & Rehab Center in West Palm Beach.

She later admitted to a Farmers Insurance investigator that a man she did not previously know gave her $900 to buy an auto insurance policy. On the night of the crash, he gave her instructions on what to do after the accident, and urged her to add passengers to her van. In return, he promised her several thousand dollars.

When the Florida Department of Financial Service’s Fraud Division became involved, Khader slightly changed her story, but the essentials were the same: Cause a crash, file a PIP claim, go to the clinic, and receive $2,000.

Khader was arrested, but the two strangers who rode in her minivan were not found. She’s in the most trouble, while the scammers – including the mystery man who recruited her – have moved on. We expect that they will resurface: clinic operators that police shut down often re-open in other counties, sometimes hiding their true identities.

We might not sympathize with Khader, but we can understand why she committed the crime: She needed the money. The real victims are the driver of the car she hit and all of us, who pay higher auto insurance premiums because the laws aren’t tough enough on PIP fraud.

New PIP law clamps down on fraud by requiring truthful statements

Friday, July 12th, 2013

Hypothetical: A person who claims to be injured in an auto accident is asked to state under oath what happened. On some auto insurance policies, such sworn statements are required as a condition of approving Personal Injury Protection (PIP) claims.

Why? To fight PIP fraud, which is rampant in Florida. Auto insurers want to know that a claim is legitimate before writing a check.

Real world: The Florida Supreme Court says that insurance companies can no longer require people who made claims before Jan. 1 to sit for a legal examination. The court said that the requirement delays and denies benefits, contrary to the intent of an old PIP law to pay benefits as quickly as possible.

The likely result? Higher PIP premiums for a while. Stripped of that legal tool, auto insurers cannot scrutinize claims as closely. More PIP fraud means more insurance payouts, which means higher auto insurance rates.

Some Florida Supreme Court justices thought that legal examinations were reasonable. In a dissenting opinion issued June 27, Justice Charles Canady wrote: “The right to a ‘swift and virtually automatic’ recovery of benefits is a right properly enjoyed by those who in fact meet the legal requirements for the receipt of benefits and comply with the legal obligations of an insured. The EUO [examination under oath] provision of the policy is simply designed to ensure that the ‘swift and virtually automatic’ payment of benefits is made only to those who are entitled to those benefits under the law.”

The PIP reform law that took effect this year corrects the situation. It enables auto insurance companies to include examinations under oath in an insurance policy. Once the backlog of PIP claims clears – a process that could take years – a more balanced approach will be restored.

Pain clinic defrauds Miami-Dade County with fake insurance claims

Tuesday, May 7th, 2013

The bus drivers weren’t hurt in accidents, but you couldn’t tell that from the hundreds of insurance claims. The scam is over, halted by authorities who say they busted the scheme to defraud Miami-Dade County’s health insurance plan of tens of thousands of dollars.

The Miami-Dade public corruption bureau arrested six top executives of AZJ Medical Center in Miami and put out an arrest warrant for company president Elvis Garcia, who had left the building. The alleged perpetrators were charged with filing false insurance claims, grand theft, organized scheme to defraud, and patient-brokering.

This is standard stuff at the clinics that rip off insurance companies and drivers on Personal Injury Protection (PIP) claims. Organizers fabricate records of injuries and treatments and bill the insurer for the maximum amount. Sometimes, crews stage accidents to generate more claims.

At AZJ, operators recruited transit workers so the medical center could file phony claims with the insurance company administering the self-funded county plan. One bus driver generated billings for 135 visits and 758 treatments. But police say that the individual received only a handful of massages. Another worker signed blank medical forms that were turned into invoices.

One informant told investigators that she was paid more than $6,000 in cash to provide her name and insurance policy for fake claims and to recruit others to the scam. A clinic employee told police that he received $45 from the bosses each time he signed off on progress forms for patients he never treated.  Another employee signed off on forms for patients seen by a massage therapist who pretended to be an occupational therapist.

Those are common practices at clinics that engage in PIP fraud. Injuries and treatments are invented and become insurance bills. At the AZJ clinic, authorities first arrested seven transit workers on charges they were part of an insurance swindle. A year later, police had enough evidence to go after the ringleaders.

Sometimes, victim of PIP fraud is not just the insurance company, but the patient

Tuesday, April 23rd, 2013

A patient of Polo Medical Center in Delray Beach was more than a little surprised when she saw the number of Personal Injury Protection (PIP) insurance claims for her auto accident. She had gone to the chiropractic clinic for treatment and stopped two weeks later; however, her insurance company was billed for another 10 weeks of appointments.

When the patient notified her insurance company, it found that the clinic had billed $9,468, which is just under the $10,000 PIP limit. The clinic’s chiropractor, Barbara Ann Turkell-White, initially said the amount was a clerical error and made a partial refund. Further review found 24 false therapy notes.

The Florida Division of Insurance Fraud investigated and arrested Turkell-White in February on charges of insurance fraud and grand theft.

The lesson: You could be a victim of PIP fraud and not know it. Check your insurance claim statements for accuracy. Otherwise, a clinic could charge your insurer for services never provided and no one would be the wiser. However, you would be poorer because everyone pays for PIP fraud.

Last member of ‘Operation Whiplash’ ring convicted of PIP fraud

Monday, April 22nd, 2013

We reported that Stephen M. Lovell of Windmere was among those arrested on federal charges of Personal Injury Protection (PIP) fraud. Now, we can tell you that he was convicted.

Lovell was found guilty of conspiracy to commit health care fraud and could go to federal prison for up to 20 years. He is scheduled to be sentenced June 10.

Lovell, a chiropractor, had claimed that was president and sole officer of Xtreme Care Rehabilitation Center Inc. in Cape Coral. In fact, he was acting as a front for the real owners so that they could avoid government regulation as a health clinic.

The clinic was a sham in other ways. Lovell and the 11 others, all of whom have pleaded guilty, recruited people to stage auto accidents and filed fraudulent PIP claims on their behalf. Once paid by insurance companies, the conspirators laundered the proceeds through corporate bank accounts.

A number of agencies played important roles in uncovering the fraud in what they code-named “Operation Whiplash.” They were the Cape Coral police department, Secret Service, IRS criminal investigation, city of Miami police, Hialeah police department, Florida Dept. of Financial Services and National Insurance Crime Bureau.

The numbers are in, and they’re bad for PIP fraud in South Florida

Friday, March 22nd, 2013

Maybe the word “rampant” isn’t strong enough to describe Personal Injury Protection (PIP) fraud in South Florida. Maybe “unbridled” or “raging” best describes a situation that is completely out of control.

The National Insurance Crime Bureau says that Miami-Dade, Broward and Palm Beach counties accounted for almost half of all questionable insurance claims referred to investigators in 2012. The most common: PIP-related claims.

“Based upon this analysis, medical fraud in South Florida is still a significant problem facing NICB member companies,” says the report issued in late March 2013.

Here are the numbers:

• Miami-Dade had 3,530 questionable claims in 2012; that’s almost 10 a day. Broward had 929 questionable claims and Palm Beach 755.
• PIP was the most common kind of questionable claim, totaling almost half in South Florida.
• Not surprisingly, the overwhelming number of questionable claims involved personal cars, versus commercial vehicles or homes.

The top reasons for referring a questionable claim for investigation read like a list of postings on this website of what’s wrong with PIP in Florida. From highest to lowest, they are:

• Faked or exaggerated injury
• Medical provider
• Excessive treatment
• Billing for services not rendered
• Lack of cooperation from insured
• Staged or caused accident
• Prior injuries
• Inflated billing
• Organized group or ring activity
• Extensive loss history

PIP fraud costs drivers millions and millions of dollars in higher premiums. Florida insurance companies lose money, too, an average of $1.15 for each dollar in premium collected.

The solution? First, reform the courts and make sure judges follow the law. Fraudsters sue when they think they can win, not when they know they’ll lose or risk being exposed. We have an alarming number of PIP lawsuits in our court system today because the clinics know they have the judges on their side.

Second, more support for law enforcement. The statistics show that the problem is so widespread that hard-working investigators cannot keep up. The NICB provides assistance to police.

Last, PIP reforms passed by the legislature in the last session need time to work. Many of them took effect at the start of 2013 and can have an impact as the year goes on.

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?