Posts Tagged ‘Tampa Bay’

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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.”

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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.

 

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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.

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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.

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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.”

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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.

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PIP fraudsters captured as police step up enforcement actions

Tuesday, August 2nd, 2011

Law enforcement officials deserve everyone’s thanks for their efforts in fighting personal injury protection (PIP) fraud. On July 13, 2011, police area handcuffed a team in the Tampa Bay area that faked accidents and medical bills.

The arrests demonstrate the increased efforts of the insurance division of the state Department of Financial Services. It had made 201 arrests for PIP fraud as of that date, which was 55 percent more than the 130 arrests during the same period last year.

A state law to combat insurance fraud that took effect July 1 could make matters worse for the perpetrators. They could also face civil penalties if they are convicted of auto insurance fraud or staging an accident.

More intense pressure on PIP cheaters will help Florida drivers, who each pay an extra $50 a year in insurance premiums for fraudulent medical and other PIP-related claims. More vigorous enforcement should slow growth of PIP fraud, which has been out of control for years.

The Florida Department of Financial Services says that the Tampa Bay area had 1,578 questionable auto insurance claims in 2010, 300 more than Miami and almost twice as many as Orlando.

Florida now ranks second in the nation in questionable auto insurance claims, having passed New York and trailing only California, according to the National Insurance Crime Bureau.

In the latest arrests, a woman staged an accident and claimed injuries totaling almost $50,000 for her and three children, according to a report by the St. Petersburg Times. In October 2010, Floribel Figueroa Quiles reported that a truck had hit her car with her children inside. TLC Medical Rehab LLC submitted the invoices. The truck driver, Lazaro Hernandez Cabrales, had been working there.

Investigators later determined that the accident had been staged. No one suffered any real injuries.  Authorities arrested Cabrales and Quiles, and charged both with insurance fraud by staging an accident.

Jeff Atwater, the state’s chief financial officer, has made investigations of PIP fraud a priority since taking office this year. The diligence of his officers is reflected in the higher numbers of arrests. We offer them our congratulations and continued support.

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UAIC helps bust up PIP fraud operation in Tampa

Friday, May 20th, 2011

Congratulations to our UAIC investigators for the work they did with other firms and Florida’s Department of Insurance Fraud in arresting a Tampa medical clinic owner and a massage therapist on charges that they committed Personal Injury Insurance (PIP) fraud.

UAIC joined with the Department of Insurance Fraud, National Insurance Crime Bureau, USAA Insurance and Equity Insurance to investigate American Relax Center, its owner Luis Consuegra Borges, 38, and therapist Solianid Rivera Lopresto, 32.

DIF detectives obtained information that Borges and Lopresto were paying people to lie about receiving treatment. Undercover detectives witnessed false PIP-related claims being signed at Lopresto’s direction. The bills were then sent to insurance companies.

“This is a perfect example of the blatant fraud schemes that operate in our streets every day, driving insurance premiums up for all Floridians,” Florida Chief Financial Officer Jeff Atwater said in a statement. “We must continue to fight these fraud artists and put them behind bars.”

If Borges and Lopresto are convicted of the charges, they each face up to 10 years in prison.

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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.

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Investigations manager at UAIC to participate in PIP roundtable

Tuesday, August 3rd, 2010

Blanca Aparicio, manager of the special investigation unit at United Automobile Insurance Corporation, will be featured in a roundtable discussion on personal injury protection (PIP) fraud on Aug. 4, 2010. Florida insurance companies and drivers lose millions of dollars each year from fraudulent claims submitted by drivers, passengers and medical centers. State regulators and local police have devoted task forces to uncovering the fraud and breaking up criminal rings.

Florida Insurance Consumer Advocate Sean Shaw will host the discussion on ways to curb fraudulent activities, improve the claims process, and ensure that the licensure of health care clinics is adequate. The goal is to ensure that PIP coverage remains a cost-effective means for Floridians to receive medical treatment for minor injuries and to help control automobile insurance rates.

The roundtable on Aug. 4 will be held from 9 a.m. to noon and again from 1 p.m. to approximately 4 p.m.  The event will be held in the Florida House of Representatives’ Committee Room 404, House Office Building. A copy of the agenda is posted on the Insurance Consumer Advocate’s website.

Those unable to attend can watch the round table at the Florida Channel’s website or by listening via conference at (888) 808-6959, Conference Code: 4132880.

Also participating in the roundtable are:

  • Rep. Bryan Nelson, Apopka, Insurance, Business & Financial Affairs Policy Committee
  • Dr. Barry Burak, Affiliated Healthcare Centers Inc.
  • Deborah J. Cunningham, Manager, Florida Special Investigations Unit, Nationwide, Allied, Titan, & Victoria Insurance Companies
  • Attorney Kenneth J. Dorchak of Buchalter, Hoffman & Dorchak, North Miami
  • Kim Driggers, Esq., Assistant General Counsel, Florida Chiropractic Association
  • Attorney Scott W. Dutton of Dutton Law Group, Tampa
  • Wade Fairchild, PIP Claim Process Specialist, Allstate
  • Ralph Glatfelter, Florida Hospital Association
  • Howard Goldblatt, Director of Government Affairs, Coalition Against Insurance Fraud
  • Dr. Gary Kompothecras, Physicians Group LLC, Sarasota
  • Belinda Miller, Deputy Insurance Commissioner Property & Casualty Insurance, Office of Insurance Regulation
  • Tracy T. Pickard, Director of Special Investigations, Direct General Insurance
  • Chris Shakib, Terrell Hogan Law Firm, Jacksonville
  • Dr. Todd Sussman, C.D., Total Healthcare of Florida, Weston
  • Capt. Steven Smith, Department of Financial Services, Division of Insurance Fraud, Operations and Investigations, Miami-Dade Region
  • Jessica Turner, Special Investigations Manager, Farmers Insurance Group
  • Attorney Johnny Moore, Deputy Insurance Consumer Advocate, Office of the Insurance Consumer Advocate
  • R. Terry Butler, Senior Attorney, Office of the Insurance Consumer Advocate
  • Reamonn Soto, FAMU Intern, Academy of Leadership and Excellence Program, Office of the Insurance Consumer Advocate

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