Monthly Archives: June 2012

11 Additional Palm Beach County Defendants Charged In Staged Accident Fraud Scheme

According to a June 18, 2012 FBI press release from Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, José A. Gonzalez, Special Agent in Charge, Internal Revenue Service, Criminal Investigation Division (IRS-CID), and Jeff Atwater, Chief Financial Officer, Florida Department of Financial Services, 11 others are charged in two separate indictments for involvement in a staged accident PIP fraud scheme.

From the FBI press release:

In two separate indictments, defendants Obelio Rodriguez, a/k/a Ovy, 43, formerly of West Palm Beach, Maria Molina, a/k/a Cary, 41, of West Palm Beach, Yuliet Tapanes, 25, of West Palm Beach, Moises Madrid, 40, of Orlando, a licensed massage therapist, Dagoberto Milian Lopez, a/k/a Lavadora, 56, formerly of West Palm Beach, Amaurys Hernandez, a/k/a El Manco, 40, of West Palm Beach, Gilda Garcia, a/k/a Hilda, a/k/a La Que Carta, 49, of Greenacres, Javier De La Caridad Troncoso, 45, of Lake Worth, Ana Ovando, 42, of Lake Worth, and Janice Velez, 39, of West Palm Beach, were each charged with one count of conspiracy to commit mail fraud, in violation of Title 18, United States Code, Section 1349. Defendant Jennifer Adams, 38, of Boca Raton, a licensed chiropractic physician, was charged in an Information with one count of conspiracy to commit mail fraud, in violation of Title 18, United States Code, Section 1349. The charge carries a maximum sentence of 20 years’ imprisonment.

Those involved were allegedly involved in recruiting individuals to participate in staged automobile accidents and instructing participants on how to conduct accidents, what to tell responding police officers, insurance company representatives and independent medical examination (IME) physicians, how to collect police reports, and what clinic to go to for treatment, even though the participants did not need treatment.

Records also indicate the defendants prepared fraudulent insurance documentation and fraudulent PIP Automobile Insurance Claims for chiropractic and massage therapy treatments for the staged accident participants, claiming that that the treatments were medically necessary and that the patients had received the treatments when, in fact, the treatments were not necessary and usually not received.

The clinics involved include:

OVY Rehabilitation Medical Center, located on Congress Avenue, West Palm Beach, Florida;

HHR Rehab Medical Center, located on Congress Avenue, West Palm Beach, Florida

Chiropractic Center of Palm Beach Corp, located on Belvedere Road, West Palm Beach, Florida;

Chiropractic Office of South Florida, located on Congress Avenue, in Palm Springs, Florida

Florida Mango Massage Therapy Center, located on Forest Hill Boulevard, Lake Clarke Shores, Florida;

New York Medical and Rehab Center, located on Forest Hill Boulevard, Lake Clarke Shores, Florida;

and

KCC, located in West Palm Beach, Florida.

The full press release from the FBI is available here.

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Filed under Examinations Under Oath (EUO), Fla. Stat. 627.736 (2008), Independent Medical Examinations (IME), Insurance Fraud

State Hires Pinnacle Actuarial Resources to Analyze Impact of Florida PIP Law Changes

On Tuesday the Florida Office of Insurance Regulation (OIR) signed a $150,000 contract with the independent firm Pinnacle Actuarial Resources, to evaluate the impact of the recent changes to Florida’s PIP law.  The review, headed by former Insurance Services Office (ISO) employee LeRoy Boison, was commissioned as a part of the recent PIP law changes which permitted the OIR to spend up to $200,000 on the study.  Pinnacle was selected out of 37 vendors, three of which including Milliman, Melinos, and Pinnacle submitted proposals.   The findings from Pinnacle are due no later than September 15, 2012.

The full article from Florida Health News is available here.

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Filed under Examinations Under Oath (EUO), Fla. Stat. 627.736 (2012), The Statutory "Fee Schedules"

Alexis Lambert, Communications Director for CFO Jeff Atwater on Florida Insurance Fraud

The Coalition Against Insurance Fraud recently sat down with Alexis Lambert, the Communications Director for Florida’s Chief Financial Officer Jeff Atwater.  Lambert emphasized the importance of public outreach in spurring change to the public’s attention to insurance fraud.  Lambert also specifically addressed the issue of PIP fraud on Floridians:

Since Florida’s Chief Financial Officer Jeff Atwater took office in January of 2011, our key communications goal has been to educate Floridians about the impact of Personal Injury Protection (PIP) fraud on their bottom line. Although PIP fraud has been an issue in Florida for many years, we were surprised to find that many Floridians were not aware of the impact it was having on their auto insurance rates. As the public awareness grew, so did the outcries for reform.

The full interview is available here.

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

National Insurance Crime Bureau: 37% Increase In Questionable Claims Resulting from Duplicate Billing 2010-2011

According to an Insurance Information Institute (III) report and an National Insurance Crime Bureau (NICB) study, questionable claims arising out of duplication billing rose 37% from 2010 to 2011.  Also increasing over the same period were questionable claims arising out of excessive treatment which increased 24% over the same period.  Also noted in the III report:

The III reported in December 2011 that widespread criminal activity and abuse of the state’s no-fault auto insurance system would result in an additional $658 million “fraud tax” on auto insurance costs in 2011, a 7 percent increase from 2010. On a per-vehicle basis, the $658 million works out to $58 for every vehicle in Florida. Since 2009 no-fault fraud has cost the state’s drivers and insurers nearly $1.3 billion.

The full report is available here.

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

411-Pain Hit With $550,000 Fine, Ordered to Change Advertising Practices

In a June 1, 2012 press release from Florida Attorney General Pam Bondi’s office, Attorney General Bondi stated: “We are protecting consumers by requiring 411-PAIN to change its representation of services and its advertising practices.”

411-Pain, an alleged “Medical and Lawyer Referral Service” according to their website, was fined $550,000.00 by the Attorney General for misrepresenting that consumers could be eligible for up to $100,000 or more for their injuries and lost wages or more than $10,000 in Personal Injury Protection (PIP) benefits, which is in violation of 627.736, Florida Statutes.

According to the press release:

The Broward Circuit Court, simultaneously with the filing of the lawsuit, entered a consent judgment barring the companies from the following practices: advertising any specific amount of monetary reward or lost wages; using a dollar amount in any advertising that promises more than $10,000 in PIP benefits; and depicting a police officer in an advertisement that does not clearly state the individual is a “Paid Actor.”

The $550,000 fine, arising out of a consent judgment, is to be paid to charitable organisations.  The full Complaint and settlement agreement is available here.

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