Posts Tagged ‘South Florida’

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.

‘Ambulance-chasing’ attorneys run from spotlight

Monday, March 4th, 2013

If you’re wondering why personal injury lawyers are often called ambulance chasers, an open-and-shut civil suit among seven South Florida law firms provides an answer. Four firms that often represent people injured in accidents such as car crashes sued three competing firms, claiming that they illegally solicited clients.

The lawsuit alleged that the three firms used non-employees, known in the legal trade as “runners,” to direct injured people to those law firms. You see, it’s illegal for attorneys to chase an ambulance up the street, down the hill and over to a hospital in order to sign the banged-up occupant as a client. It’s also against the law for attorneys to pay other people to knock on the doors of patients’ rooms and homes to do the same.

However, some law firms bend or break the solicitation rules. Almost every personal injury attorney knows of at least one firm that’s engaged in the practice. It’s a dirty, little not-that secret which the Florida Bar does little about.

When the situation gets out of control, the offended firms do what they know best: go to court. After all, top attorneys at firms like these regularly make $400 or more an hour suing insurance companies like ours for Personal Injury Protection (PIP) claims. One PIP case can produce upwards of $50,000 in fees, even if the client collects only a few bucks.

That makes runners a source of irritation to the firms that are losing out on the sprint to sign clients. Along with some language about how integrity and the reputation of lawyers are being damaged, the lawsuit says that people working indirectly for the defendants put injured people in touch with their lawyers. For example, an employee of Broward Health Medical Center arranged a meeting between an injured patient and an attorney, according to the lawsuit.

The defendants responded with threats and indignation.

“The true headline, if any, ought to be that these attorneys have abused the judicial process and are maliciously prosecuting false and unsustainable legal claims to serve their own personal and political interests,” one attorney told the Daily Business Review.

The news article may have also prompted the two sides to figure out that publicity helped no one. According to the Broward County Clerk of Court, the lawsuit is done. No details were available, but you can guess that if seven law firms shut down a case in less than two months, they have decided it is better to settle their differences in private.

We’re not going to publicize the names of the law firms here. They neither need nor deserve the attention. But if you want look them up, here’s the case number: CACE13-00031.

Investigators nab food trucks staging accidents and committing PIP fraud

Monday, April 16th, 2012

The bad guys were out to lunch. But the police were not. After a two-year investigation, 15 people were arrested in late March on charges of fraudulent Personal Injury Protection (PIP) and property damage claims involving staged food truck accidents. The defendants sought more than $800,000.

The owners of the food trucks, which cook and serve meals from their vehicles, recruited people who pretended to be the vehicle owners. They staged more than a dozen accidents between 2008 and 2010, according to the Florida Department of Financial Services.

The arrests were part of a continuing crackdown on PIP and other forms of auto insurance fraud by the Florida Division of Insurance Fraud and the National Insurance Crime Bureau. The DIF arrested 392 individuals for PIP fraud in 2011, a 44 percent increase from 2010. This year, 166 people have been charged.

Those arrested on March 27 were from Miami-Dade County. They included Armando Alonso, Yordan Martin Mata, Yanet Soriano, Dunaikis Roche, April Caridad Sequinot, Alberto Paz Hernandez, Yoandris Benitez, Eduardo Alonso Castellanos, Lucia Amigot, Alicia Iris Laurenco Cuesta, Ivan Silva, Robert Jabani Hinklein, Abraham Alliegro, Evelyn Yero Noy and Jesus Iluminado Guerrero and Yoandris Benitez. Additional arrests were anticipated.

The state legislature passed a PIP reform bill in the 2012 session in an effort to cut down on PIP fraud, which is rampant in South Florida, Orlando and Tampa Bay. Estimates are that PIP fraud has raised PIP premiums $1 billion over the past four years.

“I am confident that reforms passed this session will help stop fraud at the source while giving us more tools to go after scam artists,” CFO Jeff Atwater said in a statement. “I will not stand by and let these organized crime rings steal your hard-earned dollars.”

Judge: ‘I don’t believe a PIP attorney is entitled to $450 an hour’

Monday, May 23rd, 2011

Personal Injury Protection (PIP) attorneys don’t deserve the fat fees they try to collect for filing PIP lawsuits, says one well-respected South Florida judge.

“I don’t believe a PIP attorney is entitled to $450 an hour, Miami-Dade County Judge Marvin H. Gillman said at a hearing held May 10, 2011. “There is nothing so complicated about PIP that deserves a neurosurgeon attorney to handle it.”

Well put! We’ve been saying all along that attorneys who charge upwards of $350 an hour to file basic paperwork are using the legal system for personal gain and forcing honest drivers to pay too much for their auto insurance. We applaud the courage Judge Gillman showed.

At issue was a demand by the Patino Law Firm of Hialeah to be paid more than $40,000 in legal fees for 98.5 hours of work at $425 per hour. Attorney Ryan Peterson of the firm represented one of his bosses, Richard Patino, who worked on the case when it was originally filed in 2001. Peterson sought to block UAIC’s request to take a deposition of Patino.

“I don’t understand why anybody who is seeking, in this case $40,000 in attorney’s fees ten years after the fact would object to being deposed to defend their claim for $40,000 in fees,” Judge Gillman said, according to a transcript of the hearing.

Judge Gillman went on to question the fees that PIP lawyers demand of insurance companies as part of a legal settlement.

“You know, some guy swinging a hammer playing ordinary lawyer should be able to handle these cases for $150 to $200 an hour,” Judge Gillman said. “You don’t need somebody at $450 an hour to handle PIP, not unless it’s become so complicated in the past ten years that it’s beyond my comprehension.”

“People two years out of law school are doing PIP cases, Judge Gillman said. “And they don’t get $450 an hour. They wouldn’t even dare ask for that amount of money.”

“It just offends me that Mr. Patino asks for that kind of money from a third party,” Gillman said. “Now, if he wants to get [that] from his client, that is his client’s deal and himself. But not from the third party with the court’s approval. I can’t condone that at all.”
UAIC argued before Judge Gillman that it was entitled to know more information before going into a fee hearing over the amount. Peterson had objected, arguing that “other county courts have called depositions after the fact ‘Rambo-like overkill,’” according to a court transcript.

Judge Gillman disagreed, saying, “Why should that be treated any differently than a plaintiff who is seeking to collect a judgment against somebody?”

Peterson’s response carried no weight. Judge Gillman ordered a deposition, saying that the UAIC attorney could “take his deposition until the cows come home as long as it pertains to the point about the $40,000. Or why he’s entitled to $450 an hour, which, in my opinion is an outrageous amount of money.”

We hope the other county court judges take notice of Judge Gillman’s comments. Too often we hear from plaintiff attorneys that they have no incentive to settle because they know the judges are going to give them everything they want.

Some judges have even mentioned that they know the rates awarded to plaintiff PIP attorneys are out of control, but they can’t do anything about it because they fear they won’t be re-elected.  It’s a very sad state of affairs, and one of the reasons South Florida is rated the Number One judicial hellhole year after year.

Celebrity news: TV fashion guru charged with insurance fraud

Wednesday, May 18th, 2011

What’s the right thing to wear to a criminal court hearing? That question can be answered by Carlos Mejia, the fashion guru for Univision’s “Escandolo TV.”

Mejia, 27, was arrested in early May and charged with filing false Personal Injury Protection (PIP) insurance claims and two counts of submitting forged bills. The TV star was booked after United Auto’s Special Investigations Unit (SIU) looked into his claims for lost wages. Investigators determined that Mejia used counterfeit and forged documents to file his claims. Mejia was booked in Miami-Dade County and held on a total bond of $10,000.

Officers of the Miami police department arrested him at a local mall. Apparently, he was shopping for his next event. Mejia is known as the fashion guru for “Escandolo TV,” a three-hour gossip and entertainment show that appears weekday afternoons on TeleFutura, a Spanish-language network that Univision owns.

Mejia said in an interview posted on Univision’s website that he has helped rich and famous people with their clothing selections, including Eva Longoria and former baseball player Sammy Sosa. Mejia also said that he teaches people how to look good without spending too much money.

People much less famous than Mejia have made news through their arrests on charges of committing insurance fraud. PIP fraud is rampant in South Florida and other parts of the state, say state officials. Individuals, often working with medical clinics, put in claims for auto accidents that never occurred and injuries that don’t exist.

In this case, Mejia was caught submitting forged documents for proof of lost wages in the amount of $2,500.  When his alleged employer was contacted, it knew nothing about it and indicated that the signature was a fake.  It just goes to show how prevalent insurance fraud is in the South Florida community.

Fake auto accident? Fake injuries? No problem

Sunday, May 8th, 2011

If you’re demanding proof that auto injuries are faked so that insurance companies can be ripped off, look no further than the undercover investigation of Eileen Dvorkin, a North Miami Beach chiropractor. Police arrested her in April 2011 on charges of billing insurance companies for services she never performed and patients she never treated, according to this report on NBC Miami.

Don’t believe the cops? Then watch the undercover video they took of her at her office, which is part of the same online report. In it, Dvorkin told a police informant that she would pay money for every referral willing to participate in the alleged fraud.

“Let them know that’s the story if it continues and we get everything worked out. There will be no problem whatsoever,” Dvorkin said on a hidden camera. “I have no problem doing even better.”

Dvorkin pleaded not guilty to the charges.

How much was Dvorkin willing to pay? According to the police, $800 per person.

Think about that the next time you look at your car insurance bill. How much does fraud contribute to your cost for personal injury protection (PIP) insurance?

Across the state, insurance companies have been presented with more than $850 million in phony claims, according to experts. And there were more than 2,700 faked accident claims in 2010.

South Florida is one of the worst places in the state for PIP fraud, state and private investigators say. So are Tampa Bay and Orlando. Aggressive police work like undercover investigations can stop some criminals, but the police need more resources and stronger laws to bring the problem under control.

Florida regulators say PIP costs on the rise

Wednesday, April 13th, 2011

The state of Florida is now saying what we have been posting for years: Personal Injury Protection (PIP) costs for drivers are going up, up, up.

The Florida Office of Insurance Regulation reported on April 11, 2011, that PIP claims and payments have increased, as reported by the Sun-Sentinel that same day:

“The OIR report examines changes reported by 31 companies that make up more than 80 percent of the property insurance market over five years, from 2006 to 2010:

  • The number of PIP claims increased 26 percent to 386,464 in 2010. In South Florida, the number increased by 48 percent to 148,910.
  • Insurers paid out 66 percent more for all PIP claims, and 81 percent more in South Florida. But legal, adjusting and other costs associated with claim decreased by 4 percent, including by 25 In South Florida. Insurers paid out more than $1 billion in PIP claims in South Florida in 2010, more than the combined amount for four other regions: the Tampa and St. Petersburg area, Southwest Florida, Central Florida and Northeast Florida.
  • The number of PIP claims insurers closed without paying increased by 11 percent to 115,421 while the number closed after paying increased 56 percent to 293,230. The gap was wider in South Florida.”
  • Pending and settled lawsuits over PIP claims both more than tripled.
  • There was also an uptick to 14.4 percent from 8.6 percent in the proportion of claims filed within the first 30 days of a policy’s start date, which is “a potential indicator of fraud,” according to the report.

Fraud in the system? Not a surprise. State, local and private investigators have found repeated instances of fraud perpetrated by organizers of faked accidents, faked injuries, faked medical treatments and faked medical billings.

This legislative session, bills are working their way through the Florida House and Senate. Write your elected officials to tell them that you support PIP reform.

Otherwise, honest drivers will see the cost of PIP insurance rise in coming years. Those are not our words, they’re from regulators who say in the same report that PIP premiums would need to climb 29 percent in the next year to cover expected losses. Who wants that?

2011: The year of action on PIP fraud

Wednesday, February 23rd, 2011

What does 2011 hold for efforts to fight personal injury protection (PIP) fraud in Florida?

Lots.

And Florida residents can help in the PIP fraud clean-up by supporting the Chief Financial Officer and the dedicated investigators and prosecutors of his Division of Insurance Fraud (DIF).

CFO Jeff Atwater recently said he will be seeking tough sentences for perpetrators who try to rip-off the system. Now we get word from the Florida’s director of the division of insurance fraud that a new PIP squad has been added in Tampa to crack down on what’s ranked the worst region in the United States for PIP fraud.

“There is no shortage of criminals who seek to commit fraud at every opportunity,” writes director John Askins in his division’s January 2011 newsletter.” The dedicated law enforcement officers at DIF are determined to do their best to investigate and arrest them.”

The division has also hired a senior attorney in Miami to coordinate efforts and improve results in prosecutions. In addition, the division “is working for legislation that will eliminate loopholes used by accident clinics,” Askins writes in the newsletter. “We are asking for additional dedicated prosecutors to help us send more of these criminals to jail.”

How can Floridians help? By writing urging legislators to vote for legislation that would crack down on the PIP fraud that keeps pushing insurance premiums higher and higher. Legislators should also fund, even in these tough economic times, staffing to chase down and lock up PIP fraudsters.

The auto insurance industry is doing its part in 2011. The International Association of Special Investigation Units, a non-profit organization funded by insurers, is educating insurers on how to spot PIP fraud and helping law enforcement officials with their investigations.

Insurers are putting more than money into the effort to fight PIP fraud. Ohio Farmers Insurance Company has donated a car to DIF that it can use in undercover surveillance along the west coast of the state. The car will help law enforcement officials uncover the PIP fraud rings that are rampant that region.