Author Archives: Mark J. Rose, Esq.

Executive Admits to Stealing $860,000 from Coastal Orthopedics

David Brooks, 44, of Ohio plead guilty to mail fraud and faces up to 20 years in federal prison, according to a press release from the U.S. Attorney’s Office of the Middle District of Florida. According to a plea agreement reached in October 2011, Brooks was hired as a Financial Accounting Manager at Costal Orthopedics and Sports Medicine of Southwest Florida located in Bradenton, Florida. During Brooks’ employment at Costal he was convicted of theft, money laundering, and other fraud-related offenses in Ohio. Once Coastal learned of the Ohio charges in June 2013, Coastal fired Brooks and began a review of its books and records.

Coastal found that between January 2012 and June 19, 2013 Brooks has used company accounts to purchase more than $700,000 in American Express gift cards, which he used for personal expenses, including legal fees associated with his Ohio criminal case. In addition, Brooks diverted payroll funds to himself above his normal salary. In order to cover his wrong doing, Brooks altered the company’s books and records.

According to the U.S. Attorney’s Office, Brooks used ten different gift cards to purchase a 2012 Jeep Liberty. The gift cards were shipped directly to Brooks at Coastal on March 15, 2012, and four days later he used them to purchase the vehicle.

In total, Brooks defrauded Costal of $858,883 and of this total he used $702,091.60 to purchase the gift cards for his own personal use and the remaining amount was diverted to his salary.

Click here for press release.

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Filed under Middle District of Florida

Miami Residents Arrested for Conducting $200K in Illegal Insurance Transactions

On September 4, 2015, two Miami residents Alina Del Prado, 60, and Karla Patricia Figueroa, 40, were arrested for deceptively using unsuspecting licensed insurance representatives’ licenses to defraud Florida consumers and illegally conducting more than $200,000 in insurance transactions while operating Quality Insurance Agency (Quality) in Hialeah, Florida.

The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) and the Department’s Division of Insurance Agent and Agency Services (A & A) began an investigation in the beginning of January 2014, which uncovered that Alina Del Prado allegedly submitted an insurance agency license application for Quality using a licensed agent’s name and license number unbeknownst to the agent. A & A conducted an inspection of the agency, which discovered that Del Prado was allegedly using the agent’s name and license number to fraudulently transact insurance business in numerous instances.

The investigation revealed that Del Prado hired Karla Figueroa, who allegedly illegally sold automobile insurance policies as an unlicensed customer representative. Figueroa also utilized an unsuspecting insurance representative’s name and license number to illegally obtain automobile insurance policies.

DIF investigators located the unsuspecting insurance agent and representative whose information was used and confirmed the unauthorized use of their information by Del Prado and Figueroa.

Alina Del Prado and Karla Patricia Figueroa were arrested with a combined bond in excess of $1 million. Del Prado faces over 300 felony charges including money laundering, identify theft, grand theft, transacting insurance without an insurance license, and scheme to defraud. Figueroa faces charges including identity fraud, transacting without an insurance license, and scheme to defraud charges.

Click here to read press release.

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Filed under Fla. Stat. 627.736 (2008)

Water-Loss Claims Hurt South Florida Homeowners

According to an August 25, 2015 article in the Sun Sentinel, South Florida Citizens Property Insurance Co. customers will see a rate increase in their homeowners’ insurance rates. The insurance company stated that South Florida policy holders must pay for the increase in water-loss claims in the region. Citizens pointed out that Miami-Dade, Broward, and Palm Beach counties had a “disturbing rise in water claims and litigation,” which leads many to believe that this is a result of fraudulent claims. Citizens CEO, Barry Gilway, stated that “When you take a look at Miami-Dade and you take a look at the rest of the state, there’s really no major differences in age of the home or frankly, virtually any other characteristic,” which concludes that “there is more fraud.”

According to Gilway, “Water losses are the major reason Citizens is seeking rate hikes for the upcoming year, especially in South Florida. Were it not for water loss, even South Florida policy holders would see rate reductions.” Citizens pointed out that the other counties in the state of Florida will see a rate decrease in their Citizens homeowners insurance.

Click here for full article. (Subscription required)

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Filed under Citizens Property Insurance Co.

Broward Health Offers $69.5 Million to Settle Federal Fraud Probe

Broward Health offered to pay $69.5 million to settle a four-year old federal investigation regarding allegations of massive Medicare and Medicaid fraud. According to an August 21, 2015 post by the, the settlement was offered on August 20, 2015 after a unanimous vote by Broward Commissioners.  The Commissioners offered no public explanation for their decision or how the settlement offer will affect Broward Health’s operations.

The federal investigation into Broward Health began in May 2011, when the U.S. Department of Health and Human Services (HHS) agents subpoenaed Broward Health records regarding a number of doctors, including medical directors associated with the company’s orthopedic, sports medicine and cardiology practices. However, details of the government’s case against Broward Health remain secret. The only known information regarding the case is that the investigation started based on a complaint brought by an unidentified whistleblower.

Broward Health’s settlement offer, if accepted by the government, would be the second largest settlement offered by a large Florida hospital system for a federal probe.

Click here for full article.

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Filed under Fla. Stat. 627.736 (2008)

Insurance Companies Are Using Drones Instead of Insurance Adjusters

According to a July 24, 2015 article in the Boston Business Journal, the Federal Aviation Administration (FAA) granted Liberty Mutual Insurance permission to use four types of drones of varying sizes with several conditions regarding the use of the drones. The drones cannot ascend more than 400 feet off the ground and travel no more than 100 miles per hour. The FAA stated that the drones are small and do not weigh more than 55 pounds.

Liberty Mutual Insurance plans to use these drones to photograph houses and businesses damaged by fires or natural disasters for some claims, in place of manned planes or adjusters on ladders.  According to spokesman Glenn Greenberg, Liberty Mutual plans to begin using the drones later this year “on a limited basis.” The drones will initially be used to inspect sites damaged in hurricanes and other large-scale natural disasters, which will help adjusters assess a wide area of damage in a relatively short amount of time.

According to Liberty Mutual, the drones will help protect and keep their claims adjusters and contractors safer since they will not have to risk piloting planes or falling off ladders during roof inspections. Greenberg stated that “they are very excited by this technology that helps our claims professionals more safely help our customers after a loss.” The drones will also provide the insurer with higher-quality photos.

State Farm and AIG have recently received FAA approval to use drones as well. The FAA is asking that the insurance companies have both a visual observer and a pilot with a commercial, private, or other flying certificate to monitor the drone’s flight.

Click here for article.

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Filed under Technology

South Florida Men Arrested For Insurance-Billing Fraud

On August 5, 2015, four South Florida men were arrested for their alleged involvement in insurance- billing fraud cases. According to The Florida Department of Financial Service’s Division of Insurance Fraud (DIF), they have been accused of orchestrating crashes and processing phony claims roughly totaling $145,000.

The first individual arrested was Nayef Casas Diaz, the owner of M&N Rehabilitation Center in Miami. According to DIF, Casas was charged for conspiring with bystanders to crash cars, call the police, and collect insurance money. There are suspicions that he paid the participants $1,000 each to receive treatment at M&N Rehab and another rehab facility.  The insurance company paid a total of $63,000.

The second and third individuals arrested Alexis A. Gonzalez and Erik A. Perez, directed an undercover state insurance-fraud agent to pose as a patient and sign documents for treatment that was never carried out. The undercover agent was given $1,000 compensation while the total arrangement produced over $11,000 in claims.

According to the State of Florida, the last offender, Vicente Ortiz Alpizar, was arrested for staging an accident resulting in over $70,000 in false claims. He is accused of receiving $1,500 from A&J Rehabilitation Center and D&J Rehabilitation Center in Miami, FL and received unnecessary treatments following these staged accidents.

Click here to read press release from the Florida Department of Financial Services.

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Filed under auto insurance fraud, Insurance Fraud

Roig Lawyers Attorneys Present on Regulatory Compliance

Roig Lawyers, a minority-owned, multi-practice litigation law firm dedicated to serving clients across six offices throughout Florida, is pleased to announce that Jessica Z. Martin, Partner (Deerfield Beach), and Dennis LaRosa, Healthcare Policy Advisor (Tallahassee), will present a program on August 11, 2015 to a national insurance carrier’s SIU Team in Orlando covering regulatory compliance as it relates to insurance defense.

“At Roig Lawyers we believe that continually updating and educating our lawyers is one of the most important aspects of a comprehensive PIP defense.  It is even more important that SIU’s stay on the cutting edge of new and innovative issues so that cases that come to defense counsel utilize the most current thought in the industry,” said Martin.

The presentation will cover specific topics such as medical director responsibilities and the implications of clinic licensing, and exemptions under current and newly enacted legislation together with innovative ideas in defending insurance law suits.  In recent years, regulatory compliance has become a significant tool for auto insurers in fighting personal injury protection fraud and abuse. It will also cover recent case law regarding Section 627.736(6)(b) requests for pre-suit discovery, and other investigative tools to obtain information regarding whether a clinic is operating lawfully.

Martin has been practicing since 2006 defending Personal Injury Protection (PIP)/No-Fault, bodily injury and uninsured/underinsured litigation and aiding insurance carriers with fraud (SIU) investigations, through Examinations Under Oath (EUO), Section 627.736(6)(c) Petitions/Motions for Discovery, and leading affirmative litigation against fraudulent medical providers. Martin is a skilled trial attorney and is also experienced in the use of alternative dispute resolution techniques, including mediation and arbitration, as a means of litigation avoidance. Martin joined the firm in 2002, became a licensed attorney in 2006, and the first female partner in the firm in 2009.

LaRosa has over 40 years experience in state licensing, including 10 years as a supervisor at the Agency for Health Care Administration implementing and overseeing health care clinic licensure and exemptions. LaRosa is a sought after speaker in discussing the relationship between state licensing and automobile insurance having made presentations to the Florida Bar, National Insurance Crime Bureau, the International Association of Special Investigative Units, attorneys and judges and has been a witness in numerous federal criminal and civil cases dealing with this subject.  While a practicing attorney, he prosecuted scores of administrative law cases, appeals, and represented the State of Florida in both state and federal courts on diverse issues ranging from taxation, state licensing, and environmental law to admiralty.  He has been a healthcare policy advisor with Roig Lawyers for the past two years.

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, community association law, corporate law, real estate, banking and finance, immigration, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit

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Filed under Health care, insurance defense, PIP/No Fault