Author Archives: Mark J. Rose, Esq.

Uninsured Motorists Declining but Still a Concern in Florida, New Study Finds

A new study released by the Insurance Research Council (IRC) found that the estimated percentage of uninsured motorists has been in decline since 2010. According to the organization’s latest report, “Uninsured Motorists, 2014 Edition,” 14.9 percent of drivers were uninsured in 2003, but that figure dropped to 12.6 percent in 2012. That’s about one in eight drivers on the road who are uninsured, according to the study’s most recent data.

The study’s numbers were figured based on a ratio of insurance claims made by individuals who were injured by uninsured drivers to claims made by those who were injured by drivers who had insurance.

Although there is an overall downward trend nationwide, the IRC has broken the percentages down by numbers for each state and discovered great variation. Nationally, the number of uninsured drivers peaked at 29.9 million in 2009 and moderately declined to 29.7 million in 2012.

In terms of states, Florida ranked second in the highest total number of uninsured drivers with 3.2 million. California ranked highest with 4.1 million, while Texas followed Florida with 1.6 million, the report found.

The study also revealed that Florida ranked high in terms of the estimated percentage of uninsured motorists per state. That number is highest in Oklahoma at 26%, followed by Florida (24%) and then, Mississippi (23%).

The “Uninsured Motorists” study also analyzed the total number of uninsured motorist claim payments and found that amount has climbed drastically in spite of an overall drop in the number of uninsured drivers.

Not counting fatalities and total permanent disability claims, the IRC estimates that $2.6 billion was paid in the U.S. on 2012 uninsured motorists’ claims. This is a 75 percent increase over the past 10 years, translating to $14 per insured individual in 2012.

According to Elizabeth A. Sprinkel, CPCU, senior vice president of the IRC, these numbers show that “responsible drivers who pay for insurance end up also paying for injuries caused by uninsured drivers.”

“The declining trend in the percentage of uninsured motorists is a positive development for consumers; however, the heightened levels of uninsured motorists and the rising claim payments involved still remain a concern for insured drivers, insurers and policymakers,” she said.

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Filed under Insurance Fraud

Disbarred Florida Attorney Gets Prison Sentence in $28.3 Million Medicare Fraud

A disbarred Florida attorney who participated in a $28.3 million Medicare fraud scheme involving false claims for physical and occupational therapy services was recently sentenced in federal court in Tampa to 70 months in prison, the Justice Department announced.

Margarita Grishkoff, formerly of southwest Florida, initially pleaded guilty on January 24 to conspiracy to commit health care fraud. In addition to her prison term, U.S. District Judge Susan C. Bucklew of the Middle District of Florida sentenced the 60-year old to three years of supervised release and ordered her to pay $14,424,856 in restitution, jointly and severally with her co-conspirators.

Grishkoff, who is currently a resident of Charlotte, North Carolina, acknowledged in her guilty plea that approximately $28.3 million in fraudulent claims were submitted to Medicare by her and the scheme’s co-conspirators. Medicare paid approximately $14.4 million of those claims, which were made through physical therapy clinics throughout Florida from 2005 through 2009.

Court documents reveal that Grishkoff, who was disbarred in Florida in 1997, was vice president and director for Ulysses Acquisitions Inc., a Delaware holding company that purchased several comprehensive outpatient rehabilitation clinics and physical therapy providers to gain control of Medicare provider numbers. These clinics included: West Coast Rehab Inc. in Fort Myers; Rehab Dynamics Inc. in Venice; Polk Rehabilitation Inc. in Lake Wales; and Renew Therapy Center of Port St. Lucie LLC in Port St. Lucie.

The Justice Department also said that Grishkoff and her co-conspirators paid kickbacks to patient recruiters and clinic owners to get identifying information of Medicare beneficiaries and physicians. They subsequently took this information to create and submit false claims to Medicare through the clinics Ulysses Acquisitions owned. Claims for reimbursement were made on therapy services that were not legitimately prescribed or actually provided.

But it didn’t end there. Grishkoff and her co-conspirators used the clinics they controlled to submit false reimbursement claims on behalf of other clinics not owned by Ulysses, in exchange for a percentage of the Medicare reimbursement received.

These Miami-based therapy clinics included: Hallandale Rehabilitation Inc., Tropical Physical Therapy Corporation, American Wellness Centers Inc., and West Regional Center Inc. According to court documents, Grishkoff and her co-conspirators kept approximately 20 percent of the fraud proceeds and paid the remaining 80 percent to the co-conspirator clinic owners. Grishkoff further admitted that she arranged sham sales of her clinics to nominee or straw owners to disassociate herself and Ulysses Acquisitions from the fraudulent scheme. Those new owners were recent immigrants with no background or experience in the health care industry.

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Filed under Insurance Fraud

Allstate to Recover Almost $1 Million in PIP Case against Dr. Sara Vizcay

In a case brought by Allstate in the Florida Middle District, the court ruled on August 1st that the Defendant’s Motion for Declaration of Mistrial was denied, the Plaintiff’s Motion for Declaratory Judgment was granted in part, and the final judgment was ordered.

Dr. Sara C. Vizcay and the seven medical clinics listed below were the Defendants in the case.

  • Best Care Medical Center, Inc.
  • Caleb Health Care, Inc.
  • Florida Rehabilitation Practice, Inc.
  • Global Diagnostic Center, Inc.
  • Personal Medical Center, Inc.
  • P.V.C. Medical Center, Inc.
  • Regional Enterprises for Health Corporation

Fraudulent billing practices and failure to comply with the licensing requirements of the Florida Health Care Clinic Act (HCCA) formed the basis of Plaintiff allegations. In a jury trial earlier this year, the jury found that each Defendant misrepresented material facts.

The court noted that the “jury unanimously found Plaintiffs proved, by a preponderance of evidence, that Dr. Vizcay failed to substantially comply with her statutory medical director duties to systematically review bills … and to ensure those bills were not fraudulent or unlawful.”

The total amount to be recovered by Allstate is $942,883.41, and Plaintiff is not obligated to pay any unpaid amounts.

The case is Allstate v. Sara C. Vizcay, M.D. et al., U.S. District Court for the Middle District of Florida, Case No. 8:11-CV-804-EAK-EAJ. Click on the link to read the August 1, 2014 Order of Judgment.

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Filed under Case Law, Insurance Fraud

Defendant’s Motion to Dismiss Granted with Prejudice in PIP Benefits Case Involving Challenge to “Emergency Medical Condition” (EMC) Provision

In a second ruling within one week involving Florida’s amended PIP law, the U.S. District Court for the Southern District of Florida dismissed a case challenging reimbursement under the amended statute’s “emergency medical condition” or “EMC” provision. See our earlier post titled Court Grants Defendant’s Motion to Dismiss in Robbins v. Garrison P & C.

Sendy Enivert sued her auto insurance company, Progressive Select, alleging breach of contract for failing to pay her PIP benefits to a limit of $10,000. Enivert’s claim involved the newly added provision to Florida’s PIP law which limits PIP benefits depending on whether a claimant has suffered an emergency medical condition.

Plaintiff Enivert interpreted this language to mean that an insured is limited to $2,500 only if a medical provider determines that there is no emergency medical condition. She argued that because, in her case, no medical provider ever made such a determination, she was entitled to the full $10,000. In other words, because no medical provider determined that she did not have an emergency medical condition, she was entitled to full benefits.

Defendant Progressive read the statute to mean the opposite, i.e., that a medical provider must affirmatively determine that an emergency medical condition does exist in order for the insured to be eligible for reimbursement of the full amount.

The court agreed with Progressive, concluding that the PIP statute clearly indicates that a determination that a claimant has suffered an emergency medical condition is required in order to receive benefits in excess of the $2,500 limit. Since a medical provider did not determine that Enivert had an emergency medical condition, she was not entitled to the full $10,000 in benefits.

The court also looked to the legislative intent behind the PIP statute. It concluded that the clear legislative intent was to decrease PIP fraud by placing more stringent requirements in order to receive the maximum amount of benefits.

Based on the above, the court granted Progressive’s motion to dismiss Enivert’s case.

The case is Sendy Enivert v. Progressive Select Insurance Co., Civil Action No. 14-CV-80279-Ryskamp/Hopkins (S.D. Fla. July 23, 2014). Click on the link to read the court ruling.

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Filed under Case Law, Fla. Stat. 627.736 (2012)

State Farm Granted Summary Judgment in Lake Worth Chiropractic PIP Benefits Case

On July 14, 2014, the 15th Judicial Circuit for Palm Beach County affirmed a lower court decision granting summary judgment to State Farm in a claim for PIP benefits brought by Lake Worth Emergency Chiropractic Center.

In the underlying case, Judge Bosso-Pardo granted defendant’s Motion for Final Summary Judgment, entering final judgment for the defendant, State Farm, upon finding that the pre-suit demand letter, required by Florida Statute 627.736(10) (2010), was insufficient in that it demanded payment for services that were never billed to State Farm.

Judge Bosso-Pardo found that the Plaintiff’s “withdrawing” the unbilled service after suit had commenced was insufficient to cure the defect and that the demand letter requirements under Florida Statute 627.736(10) must be strictly construed and adhered to by those seeking to initiate litigation against a Florida PIP insurer.

The Circuit Court affirmed this decision, concluding that section 627.736(10) requires strict compliance and that, in this case, the demand letter did not strictly comply with the PIP statute requirements. As such, Lake Worth Emergency Chiropractic Center failed to satisfy the condition precedent to filing its law suit, and the trial court was correct in awarding final summary judgment in favor of State Farm.

The case is Lake Worth Emergency Chiropractic Center v. State Farm, in the Fifteenth Judicial Court for Palm Beach County, Case No. 502012AP000034XXXXMB. Click on the link to read the court opinion.

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

Safe Driving Tips for the Fourth of July

As Florida residents make last minute plans to celebrate the Fourth of July holiday, drivers are encouraged to take a few minutes to conduct a quick safety check.

The Florida Department of Highway Safety and Motor Vehicles offers the following travel tips for those planning a road trip this weekend.

  • Plan a safe return trip before you leave for holiday activities.
  • Buckle Up. Seat belt use is the most effective way to save lives and reduce injuries.
  • If you plan to drink, appoint a designated driver.
  • If you find that you have had too much to drink, call a taxi or a sober friend or family member for a ride.
  • If you notice an impaired driver on the road, notify local law enforcement or dial *347.
  • If friends or family members who have had too much to drink plan to drive home, take their keys away and help them arrange safe travel.
  • Remember that possession of an open alcoholic beverage container in a vehicle (in motion or stopped) by the driver and or the passenger(s) is a violation of Florida law.

This is a public service message from Roig Lawyers. Have a safe and happy holiday.

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Filed under Uncategorized

“Family & Friends” Staged Accident Ring Uncovered in Duval County

A couple faces 20 years in prison as a result of their participation in a PIP insurance fraud scheme which involved staging a car accident, and subsequently collecting money from the false insurance claims they filed.

Jose Alberto Velez, 30, and April Rosita Wynn, 23, were both convicted of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims, according to a news release issued by the Office of the State Attorney for the Fourth Judicial Circuit of Florida.

Their convictions stem from a staged car crash that happened in May 2012, the same year that the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) began investigating a series of questionable car accidents in Duval County.

Their investigation uncovered a larger Personal Injury Protection (PIP) insurance fraud scheme where nearly 100 individuals have been arrested over the past 18 months.

It was discovered that Velez and Wynn, who are now married, persuaded family and friends to participate in their staged car crashes. After the accidents, Velez, Wynn and their accomplices would go to designated rehabilitation clinics that would provide mock therapy for fictional injuries, and then file PIP claims through those clinics.

One of the ringleaders of the scheme, David Rodriguez Lopez, was sentenced to 15 years on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash. Other cases resulting from the investigation are currently pending.

Besides their present charges, Velez and Wynn are still awaiting other charges for allegedly staging additional accidents. They will be sentenced the week of July 28.

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Filed under Insurance Fraud