Author Archives: Mark J. Rose, Esq.

Pilot program of self-driving cars comes underfire

It has come to light through an investigation conducted by the Associated Press that four of the 48 self-driving cars on California’s roads have been involved in four accidents since September 2014. In a recent article published on Quartz.com, two of the accidents occurred while the self-driving vehicle was driving, and the other two accidents occurred while the human safety driver was in control.  The two companies responsible for the self-driving vehicles were Google and Delphi. Google’s Director of self-driving program, Chris Urmson, revealed that the tech giant’s fleet has experienced 11 minor accidents in 1.7 million miles in six years since the driverless car program began.

The AP reported that the national rate for reported “property damage only crashes” is about 0.3 per 100,000 miles driven, according to data from the National Highway Traffic Administration.  If one uses this statistic and compares Google’s crashes in about 140,000 miles the crash rate seems high.

The self-driving car program is required to submit data to the California Department of Motor Vehicles; however this information has not been readily released to the public based on the state’s Vehicle Code which requires accident reports concerning traffic injuries or fatalities to remain confidential.

Many believe that as a matter of public policy the government does not want to reveal to much information since they do not want these tech companies to be put under a microscope while this program is still in its testing phase.

The self-driving car program has yet too prove to be as flexible and responsive as humans on the road in dealing with unpredictable situations on the road.

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Filed under Fla. Stat. 627.736 (2008)

Insurnace Fraud Sweep has resulted in 31 individuals charged

State Attorney Katherine Fernandez Rundle announced today at a press conference the success of “Operation Flames and Flood Two” which charged 31 individuals with insurance fraud.  According to the State Attorney’s Office the operation focused on public adjuster, Jorge Fausto Espinosa, who was hired by policy holders to damage the insured homes for the purpose to collect ill-gotten gains from insurance companies. Jorge Fausto Espinosa, who is already facing charges in a similar fraud case from last year, called “Operation Flames and Flood One”, deliberately staged fire and water damage claims to residential homes in Miami-Dade County, Lehigh Acres, and Naples.

“Operation Flames and Flood Two” focused on the expansion of Espinosa’s fraud activities through his Miami-Dade company, Nationwide Adjusters LLC, into the west coast of Florida into Collier and Lee counties. According to the State Attorney’s Office operation two involved 20 staged fires with loses close to $ 7 million. Several homeowners also face charges for their role in the fraud.

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Filed under Insurance Fraud

Three Arrested in Lauderdale-by-the Sea PIP Scam

On May 6, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of three Broward County men on charges of insurance fraud. The men reportedly collected more than $77,000 in insurance payments after staging a Lauderdale-by-the-Sea car crash, recruiting and paying people to feign injuries and undergo unnecessary therapy.

Ronie Petidos, 34, of Coral Springs, Patrick Logene, 39, of Fort Lauderdale, and Marc la Pierre, 27, of Coconut Creek, each face a single count of insurance fraud. Each of these felony charges carries a maximum penalty of 15 years in prison.

The arrested individuals staged an automobile accident using a hotel van filled with passengers who participated in the scam and sent the participants to clinics that they controlled.  The arrested van passengers include Shaeronda Jackson, Kennsly Giles and Jeffrey Louis of Fort Lauderdale, Jean Regisma of Lauderhill, Stephen Blanc of Lauderdale Lakes.

Ronie Petidos and Marc La Pierre were previously arrested in 2014 for their role in another staged accident that occurred in 2012. The criminal case is still pending in Broward County Court.

Clink on the link for the Florida Department of Financial Services announcement.

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Filed under Fla. Stat. 627.736 (2008)

Allstate battles in Appellate courts

Allstate is under fire in various courts addressing the language of its policy following the Florida Supreme Court’s ruling in Geico Gen. Ins. Co. v. Virtual Imaging Services, Inc., 141 So.3d 147 (Fla.2013). In Virtual Imaging, the Court ruled in favor of Virtual Imaging finding that GEICO had not made the election in the policy that they would use the Medicare fee schedules of Florida’s PIP statute to reimburse the medical providers.

Multiple appellate courts have been asked to address the issue of the language in Allstate Insurance Co.’s policy regarding its election to use the Medicare fee schedules to limit benefit reimbursements. The various Appellate courts are addressing the following question: “Did Allstate provide the requisite notice that it would use the fee schedule payment limitations authorized by Subsection 5(a)(2)?”

The following cases are under review throughout Florida’s Appellate courts:

Allstate v. Stand-Up MRI

Case No. 1D-14-1213

First District Court of Appeal

This case includes several consolidated county court appeals. Allstate is the Appellant, and former Judge Gary Farmer represents the Plaintiffs. The First DCA ruled in favor of Allstate in March (see earlier post titled, 1st DCA Upholds Allstate Use of Medical Fee Schedules). On April 24, the First DCA denied Appellee’s April 2nd motion for rehearing, rehearing en banc and certification.

Allstate v. Markley Chiro.

Case No. 2D-14-3818 in the Second District Court of Appeal on cert. question of great public importance

Allstate is Appellant

The case was fully briefed in February, 2015 and argument is requested.

Fla. Wellness v. Allstate

Case No. 3D-15-0151

Third District Court of Appeal

There are five consolidated county court appeals. Allstate is the Appellee. Marlene Reiss represents the Plaintiffs/Appellants. The briefing has not yet begun.

Ortho. Specialists v. Allstate

Case No. 4D-14-0287

Fourth District Court of Appeal

There are several consolidated county court appeals. Allstate is the Appellee. Former Judge Gary Farmer represents the Plaintiffs. The appeal was argued on April 14th.

Florida Wellness v. Allstate

Case No. 15-11590

The U.S. Court of Appeals for the Eleventh Circuit

The federal district court’s summary judgment order is being appealed by Plaintiff South Florida Wellness. Allstate is the Appellee. The briefing has not yet begun.

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

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