Posts Tagged ‘Tampa Bay’

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.

PIP reform is working in Florida, and here are the numbers to prove it

Thursday, April 3rd, 2014

The battle against Personal Injury Protection (PIP) fraud is beginning to pay off in Florida. Better laws and tougher enforcement have pushed down the number of questionable claims related to car accidents, according to a data analysis by the National Insurance Crime Bureau.

Florida has long been a hotbed of PIP abuses, with staged car accidents, insurance claims for medical services not needed or given, and excessive billing. A state reform law that went into effect in 2012 has survived legal challenges and stepped-up prosecution of fraudsters are showing results.

The bureau says that while the number of questionable car insurance claims rose 22.9 percent from 2010 through 2013, the figure fell 7.67 percent between 2012 and 2013.

NICB_questionable_claims_2010-2013

Questionable claims for PIP benefits fall in Florida. Source: NICB

 

 

 

 

 

 

 

 

 

 

The decrease isn’t a statistical oddity. Questionable claims fell an average of 20 percent in four of the five cities with the worst PIP fraud problems:

  • Miami: Up 59% from 2010-2013, down 26% from2012-2013
  • Hialeah: Up 22% from 2010-2013, down 15% from2012-2013
  • Orlando: Up 0.3% from 2010-2013, down 8% from2012-2013
  • Jacksonville: Up 620% from 2010-2013, down 24% from2012-2013

It’s worth noting that questionable claims fell in Tampa during the four-year period due in large part to a county ordinance that cracked down on fraud. However, a lawsuit has blocked that effective tool against crime.

“We are encouraged by the decline in questionable claims that we’ve seen recently, but by no means are we declaring victory in Florida,” said NICB President and CEO Joe Wehrle. “Florida remains a hotbed for fraudulent activity and we can’t afford to ease up for a moment in our fight against those who would abuse the system and burden Florida consumers.”

 

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.

PCI commends conviction of Tampa clinic owner on charges related to PIP fraud

Tuesday, October 29th, 2013

The Property Casualty Insurers Association of America has commended CFO Jeff Atwater, police and state prosecutors following the recent announcement of a conviction of a clinic owner in large-scale PIP fraud ring.

“Curbing fraud and abuse within Florida’s no-fault auto insurance system is a top priority for Florida’s consumers,” said Donovan Brown, state government relations counsel for the association.

“Today’s action by Chief Financial Officer Jeff Atwater, Jacksonville investigators and the state attorney’s office of convicting the Tampa clinic owner who was involved in a large PIP fraud scheme should be commended.”

“Bringing this fraud ring leader to justice is a step in the right direction for the overall effort to provide relief to Florida consumers who continue to be plagued by a $1 billion auto insurance fraud tax,” he said.

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.”

Hillsborough County detectives bust medical therapy clinic for PIP fraud

Friday, January 25th, 2013

The sheriff’s department detectives went undercover in August. When they emerged five months later, they had arrest warrants for employees of Heisha Medical & Therapy Center in Tampa on charges of personal injury protection (PIP) insurance fraud.

Among those arrested was Ana Belen Valdes of Tampa, a legal assistant to attorney Jose Dapena, who practices personal injury law and has offices in Tampa and Miami. Valdes was charged with soliciting motor vehicle tort claims. Dapena was not charged.

It takes months of painstaking work to catch the people who rip off Florida’s auto insurance system. Police and insurance companies work from suspicious insurance claims. Sometimes they get a tip about PIP fraud, as they did this time.

“Two of our undercover detectives came to the clinic and received, filled out all the paperwork, and received massages — received treatment as if they had been in an accident,” Hillsborough County Sheriff’s Office spokesperson Cristal Bermudez Nunez told Fox 13 News.

“At other times, maybe they received a 5-minute massage and still were signing paperwork saying it was an hour-and-a-half long,” Bermudez Nunez told ABC Action News.

On one visit, the detectives witnessed a staged crash, which is a faked auto accident that leads to a false police report and phony insurance claims for treatment. Usually, the participants enter the vehicles after they have collided and pretend they were passengers.

Detectives said that the crash organizer paid the participants between $500 and $1,500 to lie about the incident and injuries.

“If you get three jump-ins in a staged accident, or four, you’re talking $40,000 easy, just out of one vehicle,” Jorge Santa Maria, an investigator with Infinity Insurance, told Fox. “The amount of money is astronomical if you think about it. It’s going to be somewhere between half-million and million dollars per clinic that’s operating in this fraudulent way.”

Police arrested the office manager and several employees, along with the person who detectives say organized the staged accident. Several warrants were outstanding as of Jan. 16.

 

Look who’s making a fortune from PIP; it’s not insurance companies

Thursday, November 17th, 2011

When you dial 1-800-ASK-GARY, you ring up big bucks for Gary Kompothecras, whom Bloomberg Businessweek exposes in a November 2011 article as “a chiropractor who has grown wealthy and gained prominence in Florida catering to car-accident victims.”

Is he on the side of accident victims? Based on the article, the answer would be a big NO. Ask Gary for help, Businessweek reports, and the people who are likely to benefit are Kompothecras, owners of so-called pain clinics, and personal injury lawyers. The injured person they claim to care about comes last, if that.

Kompothecras’s company, Physician’s Group, has plastered billboards with the toll-free number all over Tampa Bay, Orlando and Jacksonville in an effort to snare accident victims. A phone center sends people to a network of 50 or so treatment clinics that file PIP claims. Callers are also referred to attorneys, many of whom send people to clinics in Kompothecras’s network, even if those clinics are more expensive.

It’s a big-money game. The ASK-GARY network spends $12.6 million a year to advertise its toll-free number, according to Nielsen Holdings. In 2010, it paid $1.2 million for the naming rights to the amphitheater on the Florida State Fairgrounds in Tampa.

Kompothecras has done very well for a gone-bust stockbroker who became a chiropractor. Businessweek says that he lives in a $7.4 million mansion, owns a private jet, and in 2011 bought the Captiva Beach Resort.

He and his company have also attracted the attention of state and federal investigators. They are looking into allegations that some treatments weren’t needed and that people outside the clinic were directing care.

Businessweek found that “Physician’s Group patients were treated until their insurance benefits were gone, even when they felt no pain.” Ernestine Brantley, a former office manager for the company, told the magazine that “using up all the benefits was referred to internally as ‘milking the system.’”

Those allegations are nothing new to readers of this website. There are more claims in the article, all detailed with names, dates and horror stories of how patients were manipulated to make the most profit from them with little to no regard for their health.

Read the entire article and draw your own conclusions. Does Florida need PIP reform? Who stands to lose if clinics are more closely scrutinized and marketing companies like ASK-GARY are put out of business? And what about Florida drivers who are paying some of the highest insurance rates in the country because of PIP fraud? Who’s looking out for that person? You can bet it’s not Gary.

Florida’s consumer advocate questions how long PIP can stay viable

Thursday, November 3rd, 2011

Robin Westcott, Florida’s insurance consumer advocate, says that the current system no-fault auto insurance may not be sustainable.

The cost of Personal Injury Protection (PIP) is rising so rapidly that it is becoming unaffordable. At the same time, auto insurance companies continue to lose money on PIP coverage, raising doubts about whether they will continue to do business in Florida.

Families with two teenage drivers that State Farm insures in Tampa saw premiums rise from $1,279 in 2008 to $1,997 this year. according to Insurance Journal’s article on Westcott’s report to the Florida Cabinet.

“We’re talking $2,000 out of someone’s budget for a $10,000 benefit,” Westcott said.

Florida has two choices — reforming the system or seeing fewer companies providing the coverage at higher rates, Journal reported.

“To keep companies here, we are going to have to make this business model work or the insurance commissioner will have no choice but to approve premium increases,” said Atwater.

The way that injured individuals are treated and insurance companies are billed makes it all but impossible to check PIP claims for fraud. Insurers and regulators cannot monitor certain health care clinics and their services due to loopholes in a previous PIP reform measure.

Westcott said lawmakers must weigh the costs and benefits of monitoring the clinics to eliminate fraud.

“We have a dramatic system to police for a $10,000 benefit,” she said.

Hillsborough County takes bold step in stamping out PIP fraud

Tuesday, September 27th, 2011

Kudos to Hillsborough County commissioners for cracking down on medical clinics that have helped criminals commit staged accidents and file fraudulent Personal Injury Protection (PIP) claims.

An ordinance passed on Sept. 21, 2011, requires medical and rehabilitation clinics to designate a physician who actively practices there. That person must put his or her name on the clinic’s bank accounts and liability insurance. The county would have the right to inspect the clinics as necessary.

The new requirement closes a loophole in state law that exempts clinics from licensing rules when a clinic puts a physician’s name on its business application.

Tampa led Florida and was second in the nation with 487 staged accidents in 2010, according to the National Insurance Crime Bureau (NICB). Only Brooklyn, New York, had more accidents in which the perpetrators caused cars to collide so that false claims for damage and injury could be filed. Under Florida law, each person in a car accident can claim up to $10,000 in PIP benefits for injuries and lost wages.

Phony medical clinics had become rampant in Hillsborough County. In April 2010, the sheriff’s office issued arrest warrants for 22 people accused of insurance fraud. The organizers had recruited people for accidents and coached them what to say to deputies.

Undercover detectives found four medical clinics that existed just to file phony claims. The sheriff’s office estimated that there were another 164 other similar clinics in the county.

Insurance agents told commissioners that PIP insurance premiums were rising rapidly because of fraud, according to Tampa Bay Online/Tampa Tribune.

“Since 2008 I’ve had to reduce my staff by 45 percent,” said insurance agency owner Jeanette Foley. “I cannot get companies to write policies. It’s the PIP fraud that’s causing all this to happen.”

Hernando County says ‘no’ to staged accidents, PIP fraud

Tuesday, September 27th, 2011

Hillsborough County was Ground Zero for staged accidents and Personal Injury Protection (PIP) fraud in recent years. Since a massive crackdown on perpetrators, the problem has lessened and Hernando County law enforcement officials want to make sure that the bad guys don’t move north into their area.

In September, Hernando County Sheriff Al Nienhuis obtained special training for his deputies in how to identify staged accidents and stop them from becoming a widespread problem. At this point, only one crash is suspected of being staged, and the sheriff wants to keep it that way.

“Just like any crime, the better it’s investigated in one area, criminals move to an area where the training is not quite as good,” Nienhuis told FOX 13, a Tampa Bay TV station.

Hernando drivers cannot afford the costs of fake injury claims associated with PIP claims. While car damage is usually minor, each person supposedly involved in a crash can claim up to $10,000 in benefits for injuries and lost wages. People who participate in staged crashes, file false claims and split the money with medical clinics that help perpetrate the fraud.

“Studies show this is costing upwards of a billion dollars a year in Florida, which equates the average person with two cars per household at least $100 a year,”  Nienhuis said.