Author Archives: Mark J. Rose, Esq.

Two operators of Lake Worth clinic arrested

Janio Vico and Jharildan Vico, were arrested April 30th for PIP fraud, according to the Palm Beach Post.  Janio Vico and Jharildan Vico owned and operated V & C Rehabilitation Center in Lake Worth which offered chiropractic and message therapy to those involved in auto accidents and solicited patients who were involved in auto accidents.

The two individuals operated the unlicensed clinic since 2009 and have filed at least $1 million in fraudulent insurance claims.  The two men, solicited patients who were involved in auto accidents even though the individuals did not require any treatment.

Janico Vico and Jharildan Vico along with other co-conspirators have been charge with 12 counts of mail fraud and one count of conspiracy to commit mail fraud.  The two individuals face 20 years of imprisonment per count if convicted of the charges.

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Filed under Fla. Stat. 627.736 (2008)

Operator of Unlicensed Orlando PIP Clinics Arrested

Josue Pierrissaint, 30, was arrested by the Florida Division of Insurance Fraud (DIF) for charges related to operating unlicensed Orlando PIP clinics earlier this year.

A string of three PIP clinics were opened by Pierrissaint from 2010 to 2012, as listed below.

  • Edgewater Chiropractic was first opened in 2010. It was based in Lockhart, Fla., located in Orange County northwest of Orlando. Chiropractor Sham Mohammed was named as the straw owner.
  • Dr. Wilson’s Straight Up Chiropractic was opened several months later by Pierrissaint in association with chiropractor Koteuaisa Wilson, who also served as the straw owner. The same Lockhart, Fla. address was used in the AHCA application. Wilson later left the clinic, which reportedly did not stop Pierrissaint from using her name.
  • Dr. Koteuaisa Chiropractic was next launched by Pierrissaint in 2012. The clinic was opened in Orlando without the knowledge or consent of Dr. Wilson, although her name was listed on the AHCA paperwork.

Collectively, the clinics were paid in excess of $425,000 by 16 insurance companies.

Pierrissaint, who is not a doctor, was also arrested early in 2014 on similar charges.

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Filed under Insurance Fraud

Tampa PIP Fraud Investigation Results in Seven Arrests

An office manager who acted as a patient broker as well as her six patient recruits were recently arrested on insurance fraud charges by the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) after a two-year investigation uncovered suspicious insurance claims made by the individuals.

According to a story in the Tampa Tribune, Minette St. Fleur, 50, paid individuals to pose as patients injured in car accidents. The complex scheme, which was centered at Integrated Healing Clinic in Tampa, involved these patients filing fraudulent claims to multiple insurance agencies for their bogus injuries. Prices paid for treatments, some of which never occurred, greatly exceeded actual costs and totaled more than $150,000 in fraudulent claims, DIF found.

The scam was directed at GEICO Insurance Company, 21st Century Insurance, Progressive, Safeco Insurance, State Farm Insurance and Liberty Mutual Insurance. GEICO initially noted some patients repeatedly visited the clinic for many different treatments and that some dates on clinic paperwork did not match the dates on the filing of claims. The company brought the suspicious activity to the attention of DIF who began their investigation.

St. Fleur has been charged with insurance fraud and patient brokering, and was released on $2,000 bond

The others who were arrested for their involvement in the scheme included:

  • Sonthonax Ferdinand, 57
  • Marie Jean Gilles Valcin, 42
  • Marie Celestin, 38
  • Josue Auguste, 42
  • Elisena Louissaint, 48
  • Joseph D Pierre, 39

Hillsborough County State Attorney Mark Ober’s office will prosecute the case.

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Filed under Insurance Fraud

Beyond Texting: Distracted Driving Includes Selfies, PDA & Grooming

Although texting while driving remains a top driving distraction, a recent survey from Erie Insurance found that there are a variety of activities happening behind the wheel that could lead to impending accidents. The online survey of 1,915 U.S. drivers aged 18 and older was conducted in February by Harris Poll on behalf of the insurance provider.

“A distraction is anything that causes a driver to take their eyes off the road, their hands off the wheel, or their mind off their primary task of driving safely,” said Doug Smith, senior vice president of personal lines at Erie Insurance. “Our survey found drivers unfortunately are engaging in a wide range of distracting and potentially dangerous behaviors.”

Erie Insurance said that besides overt phone distractions like texting and talking while driving, survey responders also admitted to: public displays of affection, personal grooming, taking selfies, putting in contact lenses or eye drops, curling eyelashes, scratching off lottery tickets, and even playing the guitar.

Based on the survey, here are distracted driving behaviors and the percentage of drivers who revealed they engaged in the activity:

  • Romantic encounter/PDA: 15%
  • Combing/styling hair: 15%
  • Changing clothes: 9%
  • Putting on make-up: 8%
  • Brushing/flossing teeth: 4%
  • Taking selfies: 4%
  • Changing drivers: 3%
  • Going to the bathroom: 3%

The survey also confirmed that texting while driving remains a serious problem with about 30 percent of drivers reporting that they, themselves, have texted while driving, and almost 75 percent saying that they have seen other drivers do it.In addition, the survey uncovered regional differences as well as distinctions between gender and age. According to the results, drivers in the Northeast text the least, men are more likely to text than women, and younger drivers text more.

Texting while Driving by Region:

  • Midwest: 28%
  • South: 35%
  • West: 30%
  • Northeast: 24%

Texting while Driving by Gender:

  • Female: 28%
  • Male: 32%

Texting while Driving by Age:

  • 18-34: 51%
  • 35-44: 39%
  • 45-54: 33%
  • 55-64: 14%
  • 65 and older: 7%

According to U.S. government statistics, in 2012, more than 420,000 people were injured in car crashes involving distracted driving and more than 3,300 people were killed. In 2013, Erie Insurance analyzed police data and found that daydreaming was the most fatal distracted driving behavior behind the wheel.

Erie Insurance released its findings in conjunction with National Distracted Driving Awareness month in April to bring attention to distracted driving behaviors and their dangerous threat to roadway safety.

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Filed under Insurance Fraud

Uber and Lyft Oppose Florida Push for Increased Insurance Coverage

Florida Sen. David Simmons, R-Altamonte Springs, is pushing for stronger insurance requirements for transportation network companies that connect drivers with passengers through smartphone apps. According to a recent article in the Herald-Tribune, the Senate Banking and Insurance Committee supported the measure (SB 1298), despite opposition from Uber and Lyft—the two leaders in the burgeoning app-connected industry of for-hire drivers.

The proposed legislation would create the following distinctive coverage requirements:

  1. the “on call” period from when a driver is notified about a customer to pick up to when the passenger gets in the vehicle—which currently is considered a coverage gap
  2. when a customer is actually riding in the vehicle—called the ‘ride acceptance’ period

Sen. Simmons believes the proposal is necessary to protect people who may be harmed by ride-service drivers who are on their way to pick up a passenger. In addition, the proposed changes could protect the companies themselves if drivers bypass the app service and notify customers that they are available directly for future rides.

Lobbyists for the transportation network companies, however, dispute the necessity for “on-call” coverage, which they say, will lead to increased fares. Part of the success of Uber and Lyft is a result of traditionally lower fares than standard taxicab company rates.

Currently, these for-hire drivers only need the state minimum of insurance.

Under the proposed legislative bill, the driver or company would be required to carry liability coverage of at least $125,000 for death and bodily injury, at least $50,000 for property damage, and at least $250,000 in uninsured and underinsured motorist coverage. When a passenger is riding in the vehicle, the coverage would jump to at least $1 million for death, bodily injury and property damage, and $1 million in uninsured and underinsured motorist coverage.

Taxi and limousine services, the majority of which are currently controlled by local governments, must carry policies under Florida law that include minimum limits of $125,000 per person for bodily injury, up to $250,000 per incident for bodily injury, and $50,000 for property damage.

The proposal, which still has to clear two additional Senate committees and has not been heard in the House as of yet, comes on the heels of industry requests for the state to clarify insurance requirements in the “for hire” transportation industry.

Click on the link for more information about Florida SB 1298, Insurance for Short-term Rental and Transportation Network Companies.

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Filed under FL Legislation

Fort Lauderdale residents arrested for PIP Fraud

The Florida Department of Financial Services’ Division of Insurance Fraud announced on March 19, 2015 the arrest of two Fort Lauderdale Residents for PIP fraud following a staged accident. Kendrick Callins and Lashaunda Gibbs were arrested for staging auto accident, patient brokering and personal injury protection insurance fraud.

The Division of Insurance Fraud, Federal Bureau of Investigation, Broward County Sheriff’s office and the Fort Lauderdale Police Department investigation revealed that Callins and Gibbs organized and participated in a staged accident on September 22, 2012, in Fort Lauderdale. The staged accident involved participants, recruited by Callins and Gibbs, who intentionally drove a rented U-Haul truck into a passenger vehicle occupied by arrestees. The arrestees submitted fraudulent insurance claims which were paid by the insurers. Callins and Gibbs each face a maximum sentence of 25 years.

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Filed under Insurance Fraud

Insurance Bill addresses issues with Assignment of Benefits

Florida House of Representative, John Tobia of the 53rd district, has introduced CS/HB 669 which addresses consumer issues related to “Assignment of Benefits”. The bill is still alive after a hearing on March 19, 2015 in front of the House Insurance and Banking Subcommittee. The bill addresses insurance-claims issues regarding AOB’s dealing with property insurance. An AOB occurs when a policyholder has a loss and signs a contract with a third party to reconcile the damage. Once the AOB is signed the contract allows for the third party to be assigned the proceeds from the homeowner’s insurance policy. AOB’s are currently a hot topic with property insurance carriers and for years have been the keystone of PIP/No Fault Litigation.

CS/HB 669

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Filed under FL Legislation