Rose Radiology to pay almost $9 million to settle false billing allegations

According to the Tampa Bay Times, Rose Radiology Centers Inc. a Tampa Bay based diagnostic center, will pay the government $8.71 million to settle allegations that it violated the federal False Claims Act by billing federal health care programs for unnecessary radiology procedures.

Rose Radiology Centers Inc. operated approximately a dozen offices in the Tampa Bay area and is the official radiology practice for the Tampa Bay Rays and Tampa Bay Lightning.
The settlement deals with a lawsuit filed by two whistle-blowers under the federal False Claims Act, which allows private parties to bring suit on behalf of the government and to share in any recovery. The lawsuit stated that Rose Radiology Centers Inc. improperly billed for radiology procedures referred by chiropractors, which are not covered by Medicare. Rose Radiology bypassed this constraint when they accepted orders from chiropractors and billed for them as if the tests were actually ordered by a Rose Radiology-employed physician. The whistle-blowers will receive a combined $1.7 million as their share of the recovery from the case.

The radiology center is accused of performing and billing for radiology procedures that were never ordered by the patients’ treatment providers and of sending claims to Medicare for radiology services that were not performed at facilities authorized as Medicare providers, according to the article. In addition to the other allegations, the center is accused of giving kickbacks to referring physicians.

Shimon Richmond, special agent in charge for the Health and Human Service office of the Inspector General stated, “Not only do the kinds of frauds that were alleged in this case rob Medicare of needed funds, they threatened the health of elderly and disabled Americans.”

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Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Two Unlicensed Miami Clinic Owners Use Straw Owner to Defraud Insurance Companies

On January 22, 2015, The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced the arrest of Noel Ruiz of Miami and Alberto B. Franco of Hialeah. The two individuals owned unlicensed clinics and were involved in a “straw ownership” scheme that defrauded numerous insurance companies which resulted in more than $650,000 in financial losses, according to a press release from DIF.

As a result of an investigation led by DIF, it was discovered that Franco and Ruiz both failed to carry the proper licensing required to own a clinic. The two allegedly used a “straw owner” to bypass Florida’s licensing requirements. A “straw owner” is a person who owns a business or property on someone else’s behalf, portraying legal ownership of the property or business all while leaving the actual owner of the business off the books.

The investigation further revealed that Ruiz was the actual owner of Rehab and Wellness Inc. and that Franco was the actual owner of Magic Hands Rehabilitation Center Inc.   The investigation also revealed that the straw owners of the clinic were not aware that Ruiz submitted numerous claims to insurance companies for fictitious rehabilitative services totaling over $361,880.  Franco also submitted numerous claims to insurance companies for illegitimate rehabilitative services totaling $297,677.

Ruiz and Franco were both arrested on January 14, 2016 on charges of operating an unlicensed clinic, insurance fraud, grand theft, and an organized scheme to defraud. Both individuals can face up to 30 years in prison.

Click here to read press release.

 

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Filed under Insurance, Insurance Fraud

Florida Uber Driver Insurance Bill Gains traction

On January 19, 2016, the Florida Senate Banking and Insurance committee unanimously advanced an “Uber bill” that would set statewide insurance standards for drivers of ride-sharing services. The panel voted 10-0 to send Senate Bill 1118 to the next step in the legislative process.

The senate bill was filed by Senator David Simmons, R-Altamonte Springs, and sets separate minimum coverage requirements for when drivers are personally using their vehicles and when drivers are logged into transportation network companies’ apps.

The bill would require transportation network company drivers to carry primary automobile insurance coverage of at least $50,000 for death and bodily injury per person, $100,000 for death and bodily injury per incident, and $25,000 for property damage, under Simmons’ bill. Also, the insurer must be aware that the driver provides TNC services, and the policy must still apply while the driver is logged into a TNC app to receive ride requests but is not in the act of transporting a paying passenger, according to the bill.

“There exists no mechanism in the state of Florida to require that the company even have any insurance,” Simmons said. “My goal is to provide coverage to the person who is the driver and the riders and the persons who may be injured as third parties in the event of an accident.”

S.B. 1118 also provides definitions of TNCs, drivers and other elements of the service, and requires that TNCs cooperate with any claims investigations, including providing precise times that a driver logged on and off the company’s digital network for the 12-hour periods immediately before and after an accident.

The bill aims to go into effect January 1, 2017, and includes a section preempting local governments from imposing any insurance requirements on TNCs.

Click here to read Law360 article (subscription required)

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Filed under FL Legislation, Fla. Stat. 627.736 (2012), Insurance, Transportation Network Companies

Bradenton Insurance Agent Arrested After Defrauding Client of More than $200,000

In a January 5, 2016 press release, The Florida Division of Insurance Fraud (DIF) announced the arrest of Timothy T. Rush, 38 year-old, Bradenton-based insurance agent. Rush was arrested for allegedly stealing $224,600 from an unsuspecting Port Charlotte resident.

“In early 2015, the Manatee County Sheriff’s Office received a complaint regarding Timothy R. Rush after one of his clients suspected that the money he had been paid was not being used for the insurance annuities that Rush and his client had agreed upon,” according to DIF. After the complaint, DIF and Florida’s Division of Agents and Agency Services launched an investigation into the practices of Rush.

The investigation revealed that Rush was a licensed insurance agent in Florida and was authorized to sell Bankers Life annuities. Rush worked with a Port Charlotte resident to secure a Medicare insurance supplement and the client agreed to make payments on a Bankers Life annuity which Rush sold her. According to the investigators, Rush opened a fictitious corporation through Florida’s Division of Corporations that was used to open a separate bank account.  Rush then illegally deposited the diverted annuity payments from the Port Charlotte resident totaling$224,600.

On December 30, 2015, Rush was arrested and booked into the Manatee County Jail with a bond of $100,000 and was charged with one count of an organized scheme to defraud, a felony of the first degree. This case will be prosecuted by the Office of Manatee State Attorney Ed Brodsky and if convicted, Rush will face up to 30 years in prison.

Click here to read press release.

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Filed under Fla. Stat. 627.736 (2008)

Florida Insurance Commissioner Kevin McCarty resigns

On January 5, 2016, Kevin McCarty resigned as Florida’s top insurance regulator and stated that his departure would be effective May 2, 2016, according to Bradenton Herald. McCarty, 56, is the state’s Insurance Commissioner who decides how much homeowners pay for their property insurance.  He was appointed to the position in 2003 by Governor Jeb Bush and has served under the leadership of three Governors since then. Under Bush tenure, McCarty helped navigate the state through a series of devastating hurricanes while seeking to protect elderly consumers from fraudulent merchants of insurance products.

After many years of navigating the capital’s perilous political landscape McCarty was viewed as vulnerable after Governor Rick Scott took the oath as governor for the second time. Scott’s office already had a replacement in mind: Ron Henderson, a Louisiana insurance official who was being promoted by Fred Karlinsky, a Tallahassee Lobbyist for insurance interests and Scott supporter. Consumer groups rallied to McCarty’s side as a result of the controversy following Scott’s removal of Gerald Bailey as the state’s top law enforcement official.

McCarty is the state’s first appointed insurance commissioner and director of the state Office of Insurance Regulation. His successor must win the support of both Scott and Jeff Atwater, Chief Financial Officer, in a vote by the Governor and Cabinet.

McCarty’s departure leaves an empty position, one of the most challenging jobs in state government due to the sensitivity surrounding the cost and availability of insurance in a state vulnerable to hurricanes and insurance fraud.

Click here to read article.

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Filed under Florida, Insurance, Insurance Fraud

Allstate Wants High Court to Enter PIP Dispute

Allstate Insurance Co. has asked the Florida Supreme Court to address the issue of reimbursement for medical services under the state’s No-Fault auto insurance system as a result of conflicting opinions in the lower courts. Allstate is looking to overturn a ruling in August 2015 by the 4th District Court of Appeal in favor of medical providers.

The 4th District Court of Appeal ruling addressed whether policies were clear that Allstate would reimburse the providers under a statutory fee schedule. The providers argued that the policies were “ambiguous” on the issue of whether such an election to pay at the fee schedule was made and the 4th District Court of Appeal agreed.

In the brief filed by Allstate to the Florida Supreme Court, Allstate argues that the August ruling conflicted with a decision by the 1st District Court of Appeal and that similar cases are currently pending in two other appellate courts. “Given that every Florida driver must carry PIP insurance, and the vast numbers of claims processed under such coverage, this conflict (between appeals courts) creates confusion and instability in the lower courts and impacts thousands of insureds and many other citizens and business in Florida”, according to the brief filed by Allstate.

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Filed under Fla. Stat. 627.736 (2008)

Man arrested/accused of running unlicensed medical clinic

A Central Florida man has been arrested by State investigators for running an unlicensed medical clinic to rip off insurance companies for tens of thousands of dollars, according to a WFTC article.

State insurance fraud investigators stated that the clinic on Pine Hills road was a front for Yves Joseph’s lavish lifestyle. He was running an unlicensed medical clinic in Orange County and had millions of dollars moving through his accounts. As a result of his bank records, the Florida Division of Insurance Fraud was able to detect the fraud.

Investigator stated that Joseph’s office first opened in 2006, and that he would hire medical doctors and chiropractors to pose as the owners of the clinic in order to make the medical clinic appear legitimate. Joseph however, was the real owner of the clinic and managed the clinic. According to investigators, Joseph billed more than $158,000 to several insurance companies that they currently know of.  During the investigation, investigators found that from 2011 to 2014 there was more than $1.7 million in credits and $1.2 million was withdrawn from bank accounts in cash.

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Filed under Fla. Stat. 627.736 (2008)