Monthly Archives: August 2012

Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud

Joseph Wagner, a Volusia County chiropractor accused of prescribing pain killers and muscle relaxers to patients under other doctors’ names, has plead guilty to Federal charges on Tuesday.

Reports indicate that Wagner, who operated Wagner Chiropractic & Acupuncture Clinic on North Ridgewood Avenue, has been under investigation since 2009 when auto insurers began reporting the provider for billing services that were never performed.  Investigators discovered Wagner was committing insurance fraud and illegally distributing drugs by using the Drug Enforcement Administration number and name of another physician.  Wagner was not permitted to prescribe drugs as he was a chiropractor and not a licensed Florida medical doctor.

In July 2010, one of Wagner’s patients overdosed within days of being prescribed painkillers, muscle relaxers and anti-anxiety drugs.  Reports indicate that the patient did survive.   Part of Wagner’s fraud scheme involved submitting fake billings in the names of other, presumably properly licensed, doctors.  Prosecutors say that the the insurance company reimbursements were then split between those doctors and Wagner.  Wagner was indicted on 95 charges and plead guilty to three counts on Tuesday: healthcare fraud, conspiracy to distribute controlled substances and transactional money laundering.

The full article from the Orlando Sentinel is available here.

 

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

Property Casualty Insurers Association of America: Allow the New PIP Law Adequate Time to Take Effect to Achieve its Full Potential

Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America (PCI),  recently issued a statement in response to the Office of Insurance Regulation’s (OIR) recent analysis of the Pinnacle Actuarial Resources, Inc. impact report on Florida’s new PIP law.

In the statement Brown emphasizes patience with the expected results of the new law.

PCI has ongoing concerns with the study’s conclusions and the fact that they are based on a law which does not fully take effect until next year. Although we commend Pinnacle for its diligent and thorough work, the study cannot anticipate changes to Florida’s legal, social or economic environment which will directly influence the impact of the new PIP law. The study also cannot calculate the scope of detrimental challenges to the new PIP law that will be filed by plaintiffs’ attorneys or the manner and extent to which corrupt providers will attempt to game the system. In addition, we note that the study cannot foresee the overall impact the PIP law may have on the Bodily Injury and Uninsured Motorist portions of drivers’ auto policies.

Therefore, in order for the new PIP law to achieve its potential, PCI encourages policymakers, regulators and Florida drivers to allow the law adequate time to take effect. PCI also urges policymakers to protect the law from any distortion that will negatively impact its ability to deter fraud and abuse in the PIP system. As with any comprehensive legislative package, there will be implementation processes and other issues that must be addressed in order for the PIP law to attempt to stabilize our auto insurance market.

The full press release is available here.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud

Owners of Sky Imaging, North Miami Beach Arrested Friday, More Than $1.5mil in Fraudulent PIP Claims

On Friday authorities arrested arrested Robbie N. Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging located in North Miami Beach for alleged PIP fraud.  The two are accused of operating an unlicensed accident clinic and fraudulently billing more than $1.5 million in auto-related claims to insurance companies.

Specifically the owners of Sky Imaging lacked licensing from the Agency of Healthcare Administration (AHCA) and instead enlisted a medical doctor to sign paperwork and pose as the clinic owner to qualify to bill Florida PIP insurers.

The article from the SunSentinel is available here.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing

Trial Advocate Quarterly Features Article on 2012 Florida PIP Law Changes by Mark J. Rose

Trial Advocate Quarterly

Trial Advocate Quarterly, Summer 2012

The summer 2012 of the Trial Advocate Quarterly features an article by attorney and FLPIPGuide.com contributor Mark J. Rose on the recent changes to Florida’s PIP/No-Fault Law including: statutory fee schedules, the “emergency medical condition” limitation, PIP payment logs, exhaustion of benefits, explanations of benefits, examinations under oat (EUO), independent medical examinations, and fraudulent PIP claims.

The article will soon be available on the Florida Defense Lawyer Association (FDLA) website at http://www.FDLA.org.  Requests for full copies of the article or for more information on the recent Florida PIP law changes, please contact Mark Rose (mrose@roiglawyers.com) or Michael Rosenberg (mrosenberg@roiglawyers.com).

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Filed under Examinations Under Oath (EUO), Fla. Stat. 627.736 (2012), Independent Medical Examinations (IME), Insurance Fraud, Licensing, The Statutory "Fee Schedules"

Pinnacle Actuarial Resources Initial Report: New PIP Law Could Reduce Premiums 12-20% in 2013

According to Pinnacle Actuarial Resources, the Bloomington, IL company appointed by the state to evaluate the effects of Florida’s recently amended PIP law, Floridians could see a 12 to 20% reduction in PIP premiums.  The initial report does add the caveat that overall insurance premiums could still increase but the potential PIP premium reductions could offset any net increase.

The final report from Pinnacle is due to the Governor and Legislature by September 15, 2012.

The full article from the Miami Herald  is available here.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud