Miami Couple Sentenced For Operating Clinic to Defraud Medicare

On June 29, 2015, U.S. District Judge Susan C. Bucklew sentenced Gladys Fuertes, 41, and Mario Fuertes, 41, of Miami for operating a sham clinic. Gladys Fuertes was sentenced to 19 years and 6 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, aggravated identity theft, and obstruction of healthcare fraud investigation. Mario Fuertes was sentenced to 11 years and 3 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, and obstruction of a healthcare fraud investigation. The couple was ordered to forfeit $1,036,759.72. A federal jury convicted the Fuerteses on March 24, 2015.

According to a Department of Justice release, the couple established and operated Gables Medical and Therapy Center for the purpose of committing healthcare fraud by employing unlicensed medical professionals. The Fuerteses misused the Medicare billing numbers of other medical professionals, without their knowledge, in order to claim medical treatments.

Prosecutors say Gladys and Mario Fuertes paid a co-conspirator to recruit Medicare beneficiaries and to drive patients to the Gables Medical for basic and sham medical services. The couple fraudulently billed Universal Medicare in excess of $900,000 for treatments not rendered and for treatments requiring a physician’s presence.

Gladys and Mario Fuertes also facilitated the provision of fraudulent prescriptions for controlled substances to Gables patients and allowed a co-conspirator to assist patients in filling prescriptions for controlled substances such as oxycodone, according to the Department of Justice. The co-conspirator also purchased the controlled substances from Gables patients and sold them on the street.

Gladys and Mario Fuertes also obstructed the federal investigation by instructing Gables Medical patients to lie to law enforcement agents. The couple provided federal agents with altered Medicare documentation.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,300 defendants who collectively billed the Medicare program for over $7 billion, according to a Department of Justice report.

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Filed under Insurance Fraud

Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies

Dr. Troy Godsey and Renata Berriel Deazevedo were arrested in connection with an illegal insurance scheme involving multiple insurance companies and totaling more than $100,000. Godsey, a licensed chiropractor, served as an owner of the clinic, and Deazevedo managed the day-to-day activities of the business.

According to the Florida Department of Financial Services, Godsey and Deazevedo ran Spine Health Solutions PA in Orlando, and provided medical treatments to people who were injured in car accidents. The pair billed insurance companies for reimbursements for “patients” under their Personal Injury Protection coverage. Three insurance companies were billed nearly $300,000 for the alleged treatment of 20 injured individuals.

They both face more than 50 years in prison if convicted under the felony charges, including operating an unlicensed health care clinic, and filing false and fraudulent insurance claims.

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Filed under Insurance Fraud

Jacksonville Clinic Owner Arrested for Racketeering and Insurance Fraud

Sandy Morales, who owned and operated Gate Parkway Diagnostic Center, has been arrested for racketeering and insurance fraud charges, as reported in a June 18, 2015 article by the Jacksonville Business Journal.

According to the Florida Department of Financial Services, Sandy Morales organized a complex Personal Injury Protection (PIP) fraud scam that resulted in over $100,000 in fraudulent filing claims for injuries in accidents which did not occur.

Investigators stated that Morales’ arrest is one of 180 arrests since September 2012 that are tied to the fraud network. According to the Division of Insurance Fraud, Morales elaborately staged multiple car accidents, paid people to pose as passengers, and then paid those individuals to seek treatment in his clinic for bogus injuries. Morales is also accused of recruiting other clinic owners to participate in the fraud, and sending patients to those clinics in order to increase the fraud network.

The clinics involved in the PIP scam, now closed, include:

  • Arlington Rehabilitation Services Inc.
  • Baymeadows Injury Center LLC
  • Health Point Injury Center LLC
  • One Touch Therapy Center Inc.
  • Saint Jose Injury Center LLC
  • Therapy Diagnostics Tech Medical Inc.
  • Wellness Rehab Services Inc.
  • Atlas Massage Therapy Corp.

Morales could face a maximum of 45 years in prison, and is currently being held in Duval County Jail with a bond of over $600,000.

Click here to read article.

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Filed under Insurance Fraud

Tampa Chiropractor arrested on Insurance Fraud Charges

Douglas Price was arrested for insurance fraud and three counts of patient brokering, according to a June 15, 2015 news story by ABC Action News. Investigators stated that Price had been under investigation for 8 months under suspicion of insurance fraud and patient brokering. Investigators focused on Price’s South Tampa and Auburndale clinics.

Price is accused of paying patients to seek unnecessary treatments at his clinics. According to investigators, Price would pay patients up to $1,000 each to seek unnecessary medical treatment at both clinics.

Investigators also arrested, Sonya Rivera, an employee of Price who is accused of recruiting patients, and assisting in the fraud.

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Filed under Fla. Stat. 627.736 (2008)

GEICO and the Florida Department of Transportation Announce Partnership Against Distracted Driving

On June 1, 2015, the Florida Department of Transportation (FDOT) announced a partnership with GEICO Insurance to help curb the issue of distracted driving on Florida’s roadways. According to the announcement, sixty-four different “Safe Zones” are being created at different rest areas, welcome centers, and turnpike service plazas. “Safe Zones” are to be used by drivers for calling, texting, and accessing mobile apps.

“Motorist safety is our top priority and we are committed to reducing distracted driving on our roads,” stated Brian Blanchard, FDOT Assistant Secretary for Engineering and Operations. According to the Florida Highway Patrol, distracted driving accidents in Florida have increased 25 percent since 2012.

GEICO is sponsoring the addition of new signage along highways directing drivers to rest areas, welcome centers, and turnpike service plazas in order to remind drivers to use the “Safe Zones.”

“Distracted driving is a major concern for motorists in Florida and across the country. Each year, there are a growing number of injuries and fatal accidents directly related to this issue,” said George Rogers, GEICO Regional Vice President.

Click here to read news release.

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Filed under Fla. Stat. 627.736 (2008)

Separate PIP Fraud Cases Lead to Two Miami Arrests

Two individuals from Miami who have allegedly been involved in personal injury protection (PIP) fraud schemes have recently been arrested by the Division of Insurance Fraud (DIF) in separate cases.

Ariel Santana was arrested after he was revealed to be the owner of A & J Rehabilitation Center, a PIP clinic located in Miami, that illegally submitted more than $350,000 in fraudulent claims to various insurance companies, according to a press release issued by the Florida Department of Financial Services’ Division of Insurance Fraud.

DIF’s investigation found that Santana hired chiropractor Peter Maffetone to operate as the clinic’s straw owner and fraudulently obtained a licensure exemption from the Agency for Health Care Administration which resulted in the clinic operating without a license for more than three years. Santana and Maffetone submitted fraudulent claims totaling nearly $367,000 to four insurance carriers: Esurance, Geico, Progressive and United Auto.

Raul Antonio Perez Payes was apprehended, in an unrelated case, after DIF detectives discovered that he organized a staged car accident in August 2012. According to investigators, Payes recruited and paid accomplices to participate in the scam, which resulted in fraudulent insurance claims totaling more than $86,000.

Both cases will be prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle.

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Filed under Fla. Stat. 627.736 (2008)

Insurance Trade Group Recommends Changes to Florida Insurance Coverage Laws

In a recent article, Property Casualty Insurers Association of America (PCI) advised the State of Florida to address potential insurance coverage issues under Florida law related to Transportation Network Companies (TNCs) such as Uber and Lyft. Insurance trade groups are concerned about the gray area regarding insurance coverage as it relates to TNCs.

The issue centers on when auto insurance coverage provided through transportation network companies begins. According to PCI, “Personal auto insurance policies are not intended for commercial use and will not cover damages if it is determined the driver was using their vehicle for hire.’’ This issue could leave drivers at financial risk if they were in an accident since they may not have the proper insurance coverage when driving for a TNC.

During the 2015 Florida Legislative Session, House Bill 817 and Senate Bill 1298 were introduced to address the insurance coverage issues. However, the sudden end to the legislative session prevented these vital bills from coming to a full vote on the floor.

PCI, along with other trade groups, hopes to see this insurance coverage issue resolved by the Florida Legislature and hopes to see progress in the upcoming legislative session. California, Colorado and most recently Georgia have adopted insurance coverage parameters to address the insurance gap related to TNCs.

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Filed under FL Legislation