Author Archives: Fernando L. Roig, Esq.

Orlando Clinic Operators Arrested in PIP Fraud Scheme

Dr. Lherisson Domond, a Coconut Creek physician, fronted ownership of the Unity Pain and Injury Center clinic for most of 2012 in exchange for monthly payments of $1,500, according to the Florida Department of Financial Services.

Domond admitted that he agreed to be paid for the use of him name as owner of the unlicensed medical clinic. Further investigation revealed that Nesly Loute of Naples and Pierre Alex Herisse of Orlando actually managed the clinic’s operations.

In investigating Unity Pain and Injury Center, the Division of Insurance Fraud discovered that the clinic illegally provided medical treatment and physical therapy to individuals involved in automobile accidents. The clinic then billed the treatments to various insurance companies under the PIP coverage of patient insurance policies.

The three individuals face felony charges for fraud, operating an unlicensed clinic, and grand theft, all of which carry sentences of up to 30 years.

The Division of Insurance Fraud reports that it has made 249 PIP arrests since July 1, 2014.

Click on the link to read the news announcement about the Unity Pain and Injury Center.

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Filed under Insurance Fraud, Licensing

Drugged Drivers Increase as Drunk Driving Drops

Although the nationwide effort to raise awareness about the dangers of drunk driving have been fruitful, two recent studies show that there is a troubling escalation in the use of marijuana and prescription drugs behind the wheel that could jeopardize the progress to make roads safer. The ground-breaking studies were recently released by the National Highway Traffic Safety Administration (NHTSA).

The first study, which is the latest version of NHTSA’s Roadside Survey of Alcohol and Drug Use by Drivers, found that the number of drivers with alcohol in their system has declined by nearly one-third since 2007 and by more than three-quarters since 1973. However, figures also revealed that the number of drivers using marijuana or other illegal drugs jumped to almost one in four drivers who test positive for at least one drug that could affect road safety. According to the data, the number of weekend nighttime drivers with evidence of drugs in their system climbed from 16.3 percent in 2007 to 20 percent in 2014, while the number of drivers with marijuana in their system grew by nearly 50 percent.

The study, which has been conducted five times in the last 40 years, gathers data from anonymous voluntary participants throughout the U.S.

The second NHTSA survey, which is the largest of its kind ever conducted, assessed whether driver use of marijuana is tied to greater risk of crashes.  The study not only found that marijuana users are more likely to be involved in accidents, but revealed that this increased risk may partially be attributed to the demographics of marijuana users—in particular young men—who are more likely to be part of a group that is at higher risk of crashes overall.

The study also found that drivers who had been drinking above the 0.08 percent legal limit had about 4 times the risk of crashing as sober drivers, and those with blood alcohol levels at 0.15 percent or higher had 12 times the risk.

Conducted in Virginia Beach, Va., the study gathered data over a 20-month period from more than 3,000 drivers who were involved in crashes, in addition to a comparison group of 6,000 drivers who did not crash.

Results from the NHTSA surveys are consistent with a June study by Public Health Reports, a recent article in Claims Journal pointed out. This study, which was funded by Public Health Law Research program of the Robert Wood Johnson Foundation, found that the profile of a ‘drugged driver’ has changed considerably since 1993. Not only are more drivers testing positive for prescription drugs, cannabis, and multiple drugs, they are increasingly likely to be older than 50. The study noted almost 60 percent of marijuana-only users were younger than 30 years old, but 39 percent of prescription drug users were 50 years old or older.

“America made drunk driving a national issue and while there is no victory as long as a single American dies in an alcohol-related crash, a one-third reduction in alcohol use over just seven years shows how a focused effort and cooperation among the federal government, states and communities, law enforcement, safety advocates and industry can make an enormous difference,” said NHTSA Administrator Mark Rosekind. “At the same time, the latest Roadside Survey raises significant questions about drug use and highway safety. The rising prevalence of marijuana and other drugs is a challenge to everyone who is dedicated to saving lives and reducing crashes.”

A series of additional studies to further understand the risk of drugged driving is being planned by the NHTSA, including the Washington State Roadside Survey, which will assess risk in a state where marijuana has recently been legalized, and a simulator study with the National Institute on Drug Abuse to assess how drivers under the influence of drugs behave behind the wheel.

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Filed under Fla. Stat. 627.736 (2012)

Nine Arrested in Miami PIP Fraud Schemes

There has been no shortage of auto insurance fraud in Miami of late as Chief Financial Officer Jeff Atwater announced the arrests of nine individuals who have been charged in connection with eight separate cases of personal injury protection (PIP) fraud schemes.

According to Atwater’s announcement, the Division of Insurance Fraud (DIF) uncovered seven staged vehicle accidents in which the scammers collectively filed more than $242,000 in fraudulent billings to 11 different insurance carriers. Staged accident participants were referred to at least 13 different South Florida medical clinics.

The nine were arrested for acting in one or more of these capacities:

  • The organizer or staged accident recruiter;
  • The patient broker who encouraged participants to seek post-accident medical treatment for bogus injuries;
  • The licensed medical provider who agreed to sign off on falsified medical documents in exchange for payment billed under PIP insurance benefits.

The investigation into these cases remains ongoing and additional arrests are expected, DIF said.

“While their injuries may have been fake, PIP fraud is real and it is not a victimless crime,” CFO Atwater commented. “When insurance carriers absorb such high-dollar losses to fraud, we all pay in the form of higher insurance premiums. I’m thankful to our dedicated investigative team for shutting down this fraud ring.”

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Filed under Insurance Fraud

Dunedin Man Arrested for Fabricating Vehicle Thefts and Defrauding Insurance Company

A 26-year-old Dunedin man was arrested by Pinellas County Sheriff’s Detectives on January 14 for auto insurance fraud.

Joseph Harris allegedly lied about three incidents of vehicle theft, and then falsely reported the burglaries to his insurance company to collect money.  Harris reported that the thefts took place at his home on February 28, 2014, June 12, 2014, and September 30, 2014.

According to a recent news story on TBN Weekly.com, Harris claimed that parts were stolen off his truck, which was parked in his driveway.   However, during a January 14 interview with detectives, the suspect supposedly admitted that he took the parts and buried them in his back yard in order to report them stolen.

Harris said he lied about the thefts because he needed the money.  He was able to collect over $10,000 from his insurance company as a result of his fraudulent activity.

Detectives charged Harris with two counts of false report of a crime, and two counts of defrauding an insurance company.  He was booked into county jail, and released on $4,300 bond on January 15.

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Filed under Insurance Fraud

Legislators Unlikely to Change Florida’s No-Fault Auto Insurance Law Right Now

Chief Financial Officer Jeff Atwater wants Florida’s legislators to continue to be patient before considering any rash actions that would change personal injury protection (PIP) coverage in the state. That’s because a recent report released by the state Office of Insurance Regulation (OIR) shows that increases in fraudulent PIP claims have basically been stopped.

The Florida Department of Financial Services is attributing these results to the passage HB 119, effective January 1, 2013, which created some exclusions for coverage under PIP insurance and limited for non-emergency conditions. The amended No-Fault Law excluded PIP reimbursements to massage therapists and acupuncturists, and also required individuals involved in car crashes to seek treatment within 14 days of a motor vehicle accident. PIP allows up to $10,000 in benefits for emergency medical conditions, but places a $2,500 cap on non-emergency conditions. It is mandatory for all Florida drivers to carry PIP.

According to a story in the Sun-Sentinel on January 7, the law set benchmarks for insurance carriers to lower rates. The OIR report showed that from 2011 through September 2014, the average medical cost paid through PIP claims dropped 14 percent statewide.  In South Florida, a hotspot of fraudulent PIP activity, the average payment decreased 28.7 percent, the article reported.

However, it is thought that these numbers are too preliminary and do not show the full impact of the law, yet.

House Insurance & Banking Chairman John Wood, R-Winter Haven, noted in the article that he would be “surprised if there was ‘major’ PIP legislation before the issue is settled in court.”

Senate Banking and Insurance Chairwoman Lizbeth Benacquisto, R-Fort Myers, said that she is still reviewing the OIR report, and likes to ensure that if changes are made, they have “a very positive effect on policyholders and our constituents.”

The annual legislative session begins in March.

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

Mario Rene Ruiz added to Florida Division of Insurance Fraud’s Most Wanted Fugitive List

A post on our December 1st FL-PIP Guide reported that five individuals were arrested for their roles in an alleged staged accident scam in 2012 that resulted in fraudulent Personal Injury Protection (PIP) claims costing three insurance carriers almost $40,000.  The five cases will be prosecuted by the Broward State Attorney’s Office.

A sixth individual wanted in connection with this crime—Mario Rene Ruiz—has yet to be apprehended and is now considered a “Most Wanted Fugitive” for insurance fraud, the Division of Insurance Fraud (DIF) announced.

According to DIF, Ruiz has lived in Fort Lauderdale but may have returned to Honduras, his native country. The 32-year old reportedly measures 5’6” in height, weighs 152 lbs., and has brown eyes and hair.

Anyone with information regarding Mario Ruiz’s whereabouts is asked to contact DIF at 1-800-378-0445 or the Broward County Sheriff’s Office.  Tipsters can remain anonymous and may be eligible for a reward as part of the Florida Department of Financial Services’ Anti-Fraud Reward Program.

To date, the department has awarded almost $349,000 to nearly 60 citizens as part of its Anti-Fraud Reward Program, which rewards individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

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Filed under Insurance Fraud

Florida Needs 35 More Judges, Says Florida Supreme Court

The texting while driving law that took effect in October, 2013 is one of several reasons why the Florida judicial system needs 32 additional county court judges and three new circuit court judges, according to an annual Certification of Need for Additional Judges published December 22 by the Florida Supreme Court.

The recent news that Florida has surpassed New York to become the third largest state in the nation, while not cited by the Court, coincides with increasing pressure on the state’s judicial system.

The Florida Supreme Court analysis breaks down judicial needs by county, with the greatest number of county court certified judicial position recommendations as follows:

  • Three judges in the Fourth Circuit of Duval County (Jacksonville area)
  • Eight judges in the Eleventh Circuit of Miami-Dade County
  • Eight judges in the Thirteenth Circuit of Hillsborough County (Tampa area)
  • Five judges in the Fifteenth Circuit of Palm Beach County

A total of three circuit court judges are also suggested. One circuit court certified judicial position is requested for the First Judicial Circuit, which serves Escambia, Santa Rosa, Okaloosa, and Walton counties in northwest Florida. This circuit experiences a heavy criminal workload and a steady number of tobacco cases, according to the court analysis.

Two circuit court judicial positions are recommended for the Fifth Judicial Circuit, which encompasses Citrus, Hernando, Lake, Marion, and Sumter Counties. The Fifth circuit is the ninth most populous circuit with 5.5% of Florida’s population, according to the court.

There is no request for new judges in the District Courts of Appeal at this time

In its analysis, the Court cites recent trends in the volume and type of cases:

  • Six percent increase in probate filings
  • Nine percent increase in dependency filings
  • One percent increase in circuit civil filings (excluding real property)

The Court also reported declines in domestic relations filings (three percent), felony and juvenile delinquency filings (seven percent each).

The Florida Supreme Court request notes that judges across the state continue to bear the burden of increasing workloads after the number of support staff – including case managers, law clerks and magistrates – was reduced in earlier budget cut backs.

Click on the link to read the full annual Certification of Need for Additional Judges published December 22 by the Florida Supreme Court.

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Filed under Case Law, Fla. Stat. 627.736 (2008)