Author Archives: Mark J. Rose, Esq.

by | May 17, 2013 · 4:58 pm

92 Accused in Staged Accident Fraud Ring, $20 million in Fraudulent Claims

 

Operation Sledgehammer

According to investigators, charges were brought on Thursday against 33 people allegedly involved in fraudulent insurance claims totaling $20 million.  The Sun-Sentinel reported the following on the three year long investigation:

Operation Sledgehammer, a state and federal investigation, has led to charges being filed against a total of 92 defendants from Palm Beach, Broward and Miami-Dade counties. Those already convicted have been ordered to pay more than $5 million in restitution to insurance companies so far, prosecutors said.

The investigation revealed the ringleaders of the fraud recruited chiropractors Lazaro Rodriguez, 58, of Doral, and Kenneth Karow, 53, of to serve as owners of clinics involved in the ring.

Of the 92 people charged in the ring, five of the defendants, including alleged ringleaders Vladimir Lopez, 38, and Lazaro Vigoa Mauri, 45, have fled to Cuba.  According to authorities, the other defendants who have not yet been caught are considered fugitives.

Also from the Sun-Sentinel report:

[t]he investigation was kicked off by a tip from a member of the public and urged anyone with information to call their local police department.

The participants in the fraud were trained by recruiters on how to make the accidents look realistic, how to file police reports and insurance claims, how to fake injuries and where to go for treatment . . . The ringleaders made sure that insurance checks were deposited into accounts they controlled so they could pay the participants…

The full article from the Sun-Sentinel is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Tagged as , , , , , , ,

by | May 16, 2013 · 3:57 pm

Fort Myers Chiropractor Arrested, Caught Paying Confidential Informant to Fake Injuries

Fort Myers, FL chiropractor, Dr. David Greydinger, was arrested last week after investigators caught Greydinger submitting fraudulent insurance claims for non-existent auto accidents.  Reports indicate Greydinger, of MYO Health Clinic, paid informants kickbacks to submit claims totaling $6,000 arising out of non-existent accidents.  Reports indicate that MYO Health Clinic remains open for business at this time.

Detective William Quick of the Florida Division of Insurance Fraud stated, “Greed is the primary force behind everything with insurance fraud. It all comes down to money.”

The full report is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Tagged as , , , , ,

by | February 28, 2013 · 8:02 am

PIP Clinic Owner Arrested for Improper Campaign Donations

Florida Wellness & Rehabilitation Center owner, Mark Cereceda, surrendered Friday to charges of illegal campaign donations throughout Florida.  The owner of the Hialeah injury clinic, a chiropractor himself, donated over $25,000.00 from 2010 to 2012 to the campaigns of: Florida Senate President Don Gaetz, state Sen. Joe Negron and Miami-Dade County Commissioner Rebeca Sosa in addition to candidates for state representative Carlos Trujillo, Katie Edwards and Eddy Gonzalez.  Cereceda and his brother, Kemel Cereceda, were in jail Friday night on felony charges.  Cereceda is charged with illegally forcing his employees to donate to these campaigns and reimbursing them for these donations in violation of Florida law.

Mark Cereceda was recently in the news due to his involvement with former county court judge Ana-Maria Pando.  According to the Miami Herald:

Detectives began investigating after news broke last year that Ana Maria Pando, a Hialeah-branch county court judge, had penned a letter to state authorities — on official letterhead — asking that Cereceda’s company be reinstated.

The clinic had let its business license lapse. The Florida Division of Corporations treated the judge’s letter as a court order and reinstated the company for free.

Pando was investigated for ethics violations, a probe eventually dropped when she lost a reelection big last year and she agreed not to run again. At the time, companies affiliated with Cereceda had cases pending before Pando. And Cereceda also contributed to her reelection campaign. The Florida Judicial Qualifications Commission accused Pando of not reporting a “financial gift” from Cereceda.

The full article from the Miami Herald is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Licensing

Tagged as , , , , ,

by | December 17, 2012 · 7:20 am

“Operation Never Ends” Leads to Closure of Two Clinics, Multiple Arrests

“Operation Never Ends,” the multi-organizational investigation organized by Miami police, the Secret Service, local and state agencies and insurance companies, has led to the closure of two clinics involved in staging accidents and making fraudulent insurance claims.

The more than one year long operation led to the arrest of, among others, Jorge Felix Felipe Pupo, 49, accused of being the ringleader, and Yanaris Ramirez Paneque, 36, a receptionist at one health clinic, according to authorities.  According to the report from NBC 6:

Police say they went undercover inside a medical building in the 700 block of Northwest 23rd Avenue and at another location near Flagler and the Palmetto Expressway.

Detectives said recruiters would find those willing to participate in the staged accidents, then bring them to medical clinics where paperwork was done to get money back from insurance companies.

Police Sgt. Luis Taborda explained the scheme.

“The clinics are the main,” he said. “They provide the money to a runner and the runner puts together the crash — orchestrates the crash.”

Police said the ring was making big money on the claims.

“I could tell you that in one investigation that we did at the beginning, they were up to $80,000 before we shut them down — in just one crash,” Taborda said.

The article from NBC 6 South Florida is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing

Tagged as , , , , ,

by | December 14, 2012 · 1:56 pm

Suit to Deem Florida’s PIP Law Unconstitutional Blocked in Florida Federal Court

On December 12, 2012, Federal Court Judge Richard A. Lazzara entered an Order denying a group of medical provider’s attempt at a prelimary injunction, blocking the implementation of changes in Florida’s new PIP law which take effect January 1, 2013. Judge Lazarra found, ” that the motion is due to be denied without the necessity of a hearing because Plaintiffs have utterly failed to demonstrate that there is a substantial likelihood they will eventually prevail on the merits.”

The Federal lawsuit filed by attorney Luke Lirot on behalf of a group of chiropractors, acupuncturists massage therapists and a “John Doe” plaintiff, sought to block the implementation of changes to the amended Florida PIP law, effective January 1, 2013. Among other issues, the plaintiff’s sought to block the law’s ban on PIP benefit reimbursement to acupuncturists and massage therapists.

Christian Camara, Florida Director at R Street, a non-profit public policy research organization stated: “While this is just a short-term procedural victory and the case will now go on to trial, [Judge] Lazzara has handed down a defeat to the opponents of reform. This also marks a win for Florida consumers, who stand to benefit from containing the escalating costs in our auto insurance market.”

The PropertyCasualty 360 article is available here. For more information on the ruling and it’s effect on Florida insurers please contact Mark Rose (mrose@roiglawyers.com) or Michael Rosenberg (mrosenberg@roiglawyers.com).

Comments Off

Filed under Fla. Stat. 627.736 (2012)

Tagged as , ,

by | November 30, 2012 · 9:43 am

Volusia County Chiropractor, Joseph Wagner, Sentenced to 15 years and $2 million in Restitution

Wednesday, Volusia County chiropractor, Joseph Wagner, was sentenced to 15 years in federal prison and $2 million in restitution as a result of years of healthcare fraud.  Wagner, in addition to billing insurance companies and Medicare for services never rendered, illegally prescribed controlled substances under another doctor’s name.  Patients who were without insurance paid Wagner $100 cash each month for these prescriptions.

According to the Orlando Sentinel article on Wagner’s sentencing:

Senior U.S. District Judge G. Kendall Sharp said Wagner relegated the trust he had as a chiropractor, and now taxpayers will have to pay the price for his fraud.

The full article is available here.

See also: Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud

Comments Off

Filed under Insurance Fraud, Licensing

Tagged as , , , ,

by | November 7, 2012 · 9:10 am

Broward County Chiropractor Pleads Guilty to Insurance Fraud Involving Accident Staging Ring

On Tuesday, Broward county chiropractor Jennifer Adams, 39, of Boca Raton, admitted to one count of conspiring to commit mail fraud and agreed to pay more than $1.92 million in restitution to 10 insurance companies.

Adams permitted her name to be used to create two chiropractic clinics: Ovy Rehabilitation Medical Center, Inc. in West Palm Beach, and Chiropractic Office of South Florida, LLC in Palm Springs. Both clinics submitted fraudulent PIP claims on behalf of individuals involved in staged accidents.

Adams, a chiropractor in Florida since 1999, agreed to relinquish her medical licenses. According to the Sun-Sentinel report:

The maximum punishment is 20 years in prison and a fine of $250,000 though she will likely face a much lesser penalty when she is sentenced by U.S. District Judge Daniel T. K. Hurley in federal court in West Palm Beach in the next several weeks.

The full story is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing

Tagged as , , , , , , ,

by | November 6, 2012 · 5:34 pm

Nerber A. Iglesias, 40, and Michael Borkowski, 42 Arrested in Undercover PIP Fraud Sting

Two more arrests were made as a result of a personal injury protection (PIP) fraud scheme in Manatee County involving patient brokering. The arrests of Nerber A. Iglesias, 40, and Michael Borkowski, 42, were the result of an undercover sting, according to an announcement made by Florida Chief Financial Officer Jeff Atwater.

According to the Claims Journal report:

An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Iglesias approached a Sarasota chiropractor about becoming the straw owner of Garden Relief Center, LLC. The chiropractor contacted law enforcement and, under the direction of the department, applied for a clinic exemption certificate to begin operating the facility. The chiropractor, working undercover, was also contacted by a local body shop owner named Michael Borkowski, who made arrangements to provide accident patients to the clinic for a fee. During the course of the investigation, Garden Relief Center submitted almost $40,000 in fraudulent insurance claims to six different insurance companies.

The full article is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing

Tagged as , , ,

by | October 24, 2012 · 9:20 am

Insurance Information Institute Comments on PIP Premium Changes and Significance of the January 1, 2013 Effective Date of 2012 PIP Law Changes

Tampa Bay Fox 13 recently featured a segment regarding the effect of House Bill 119, the 2012 PIP law change, on PIP premium rates.  Lynne McChristian of the Insurance Information Institute, shed some light what appears to be a lack of a premium decrease.  McChristian indicates that the recent insurer reports are not indicative of what could likely be the case after January 1, 2013, when all of HB119′s changes take effect.

Comments Off

Filed under Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing, The Statutory "Fee Schedules"

Tagged as , , , , , , ,

by | October 1, 2012 · 9:06 am

Office Manager of Two Chiropractic Clinics, Maria Molina, Pleads Guilty to Mail Fraud Conspiracy, Submitting False Claims for Staged Accidents

Maria “Cary” Molina of West Palm beach plead guilty to one count of “mail fraud conspiracy” in Federal court last Thursday.  Molina was accused of perpetrating an insurance fraud scheme at two chiropractic clinics, OVY Rehabilitation Medical Center and HHR Medical Center, where Molina served as an office manager.  Records indicate Molina submitted bills for individuals known to be involved in staged motor vehicle accidents.  Prosecutors stated that the clinics received $540,000 from PIP insurers as a result of the fraud.

Molina’s co-defendant, Obelio “Ovy” Rodriguez, 43, has been declared a fugitive.

The full report from the Sun-Sentinel is available here.

Comments Off

Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Tagged as , , , , ,