United Auto Courts Reports

For an inside look as to how a health clinic can rip off car insurance companies and drivers, look to Orlando. There, detectives from the Florida Department of Financial Services conducted an undercover operation to expose a pattern of phony medical bills and patient recruitment.

The investigation uncovered the type of seamy operations that defraud insurance companies and boost drivers’ premiums. United Automobile Insurance Company (UAIC) commends the state investigators for their good work.

According to affidavits from state investigators who posed as accident victims, All Family Medical Center in Orlando, Florida, billed for medical treatments and evaluations never received. A person connected with the clinic paid for patient referrals and offered one detective money to stage an accident.

Florida’s Office of the Department of Insurance Regulation has stated that more than 80 percent of all automobile accident injury claims are in fact falsified or overstated in some way.

The problem of personal injury protection (PIP) fraud is becoming greater, says the Florida’s Division of Insurance Fraud. It reported last August that PIP fraud jumped 41 percent in the fiscal year that ended June 2009.

State investigators suspected All Family Medical Center was defrauding insurance companies when a patient told them in April 2009 that the clinic was dirty, equipment did not work and that her insurance company had been billed for treatment she never received.

In late May 2009, a detective from the department’s fraud division posed as a potential patient using a fictitious traffic accident report and a driver’s policy supplied by an insurance company that helped in the undercover operation. A clinic employee told the detective to sign blank medical and insurance forms before receiving any treatment. The same person told the detective to mark one form with a high pain-level indicator.

About two weeks later, the detective brought in another investigator who was also posing as an accident victim, according to an affidavit. That person was also told to sign blank forms.

And a few weeks after that, Jeff Toussaint, a person associated with the clinic, paid the first detective $500 for referring the second detective to the clinic, according to an affidavit. Toussaint told the first detective that she would receive more money if she brought in more patients.

During the summer of 2009, the clinic and its physician, Dr. Emmanuel Eloi, submitted insurance bills for treatment and evaluation on dates when neither undercover officer went to the clinic, according to an affidavit.

The investigation continued in September 2009, when the first detective brought in a third undercover detective who was also posing as a patient using fictitious documents, according to an affidavit. For that referral, Toussaint offered to pay the first detective $750 and said that the detective could give the newest patient $250 of that money.

A week later, Toussaint offered the first detective $400 to stage a false accident, according the affidavit. Toussaint also asked the detective to recruit three friends to create the phony wreck. The detective declined the offer.

Using the results of the undercover investigation, the fraud division of Florida’s Department of Financial Services sought warrants for Eloi and Toussaint.

Both men were charged with third-degree felonies on Jan. 28, 2010, according to Orange County court records. Eloi was accused of making a false and fraudulent insurance application. Toussaint was charged with two counts of making a false insurance claim and split-fee patient brokering.

UAIC wants to see justice done for insured drivers, and clinics that commit fraud put out of business.