Posts Tagged ‘South Florida’

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.

Operation Sledgehammer results in two more prison sentences

Monday, 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.





Operation Sledgehammer claims more criminals, millions of dollars in restitution

Wednesday, 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.




ABC News investigates PIP fraud: A Nightline report

Monday, 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.


A cause worth supporting: a non-profit for fighting PIP fraud

Monday, September 16th, 2013

Personal Injury Protection (PIP) fraud takes a financial toll on every Florida driver. Police investigations produce arrests and break up criminal rings operating out of medical clinics. Those efforts are limited, though, to the amount of time and money can be spent addressing the widespread problem.

There is a way to devote more resources: Create a strike force that raises money to defray the costs of undercover operations and other anti-crime efforts. We’re glad to report that such an effort is underway under the leadership of former Broward County Sheriff Al Lamberti, who has been named chairman of the Auto Insurance Fraud Strike Force.

Lamberti told a July meeting of the Strike Force board that a Florida fund created to fight prescription drug fraud raised $1 million. A similar corporation for fighting auto insurance fraud was formed in May and will be seeking not-for-profit status with the IRS.

Florida CFO Jeff Atwater, who sits on the Strike Force board, suggested the organization develop presentations to solicit the insurance industry and others for funds.

Lamberti also led a discussion on ways the Strike Force can coordinate efforts with Florida’s Agency for Health Care Administration and Department of Health and Florida law enforcement to crack down on doctors running clinics that commit PIP and other auto insurance fraud.

These initiatives, the Strike Force, more investigations, and better coordination across state agencies, will go a long way to reduce the amount of PIP fraud in Florida. These are efforts that we all can – and should – support.


Call it help-yourself PIP fraud

Friday, August 16th, 2013

What’s a quick way to make an illegal buck from Personal Injury Protection (PIP) in South Florida? Be part of an auto accident.

An average of 211 accidents take place every day in Miami-Dade, Broward and Palm Beach counties, based on the latest figures from the Florida Highway Safety and Motor Vehicles department. That’s a lot of chances, about one every 7 minutes. A lot of those produce injuries – real and fake.

A woman took advantage of an accident to rack up $14,000 in illegitimate auto insurance claims, according to police reports. On Oct. 9, 2012, Rodrigue Baptiste of Boynton Beach and his son were in an accident near the intersection of West Gateway Boulevard and State Road 807 in Boynton Beach. A woman driving a Ford Explorer pulled out of a driveway and struck their Ford Focus.

A few minutes later – before the police arrived –another woman arrived in her truck and told the man that she wanted to be listed as a passenger in his Focus. He agreed, which was a mistake.

The next day, the woman went to Delray Chiropractic and Wellness Center, where she filled out insurance claims for injuries supposedly suffered in the accident. The clinic billed her insurance company for $14,000 in PIP and other benefits and the company paid about $7,500 of that.

And you wonder why your PIP premiums keep going up.

A week later, Baptiste filed a PIP claim with his insurer, Liberty Mutual Insurance. He said that she was in the car at the time.

The story fell apart when investigators interviewed him. Baptiste admitted to police that the woman was never in the car. The driver of the Ford Explorer had already reported that she saw only the father and son in the car when the accident occurred.

Pressed a little harder, Baptiste said that he “did not want to disrespect her in front of the police.” Why didn’t he tell the truth upfront? No one asked him, he answered. Baptiste was charged with insurance fraud and released on bail.

Who is preying on drivers? Looks like PIP fraudsters

Thursday, August 15th, 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.

PIP investigation results in 21 arrests in Miami

Tuesday, May 14th, 2013


It’s not a record that Miami-Dade wants, but the county is on track this year to pass Tampa-St. Petersburg as having the worst rate in Florida for auto insurance crime. The metropolitan area boosted its numbers on May 1 when authorities announced the arrest of 21 people on charges related to Personal Injury Protection (PIP) fraud.

Prosecutors say the group staged five car accidents, sent people who were not injured to four clinics, and filed PIP claims totaling $400,000 for medical services never provided. Among those arrested was Dr. Hugo D. Goldstraj, medical director of Clarke Medical Services in Miami. The other clinics involved were Emoge Medical Services in Doral, Magic Hands Medical Services in Coral Gables and New Life Rehab Services in Miami.

The alleged crimes were discovered through an undercover investigation dubbed “Operation No Med Services.” The arrests were announced at a press conference attended by Florida CFO Jeff Atwater, reports El Nuevo Herald.

“For many people, this is an invisible crime because no bodies, guns, knives and sometimes there is no witnesses,” Katherine Fernandez Rundle, State Attorney for Miami-Dade County said at the press conference. “But this fraud affects all of us, out of our pockets when paying for auto insurance.”

The Insurance Fraud Division of the Department of Finance of Florida directed the fraud investigation. Director Dan Anderson said most auto insurance fraud takes place in Miami-Dade.

“In the first 10 months of this fiscal year, we have made more than 500 arrests,” Anderson told El Nuevo Herald. “Of those, more than 200 cases are being prosecuted by the Office of Miami-Dade.”

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.

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.