Author Archives: Michael A. Rosenberg, Esq.

South Florida Chiropractor Tied to 2013 PIP Fraud Investigation Surrenders License

On our FL-PIP Guide in September 2013, we reported that chiropractor David Hirschenson was arrested and charged with 19 counts of obtaining illegal crash reports and one count of solicitation.

An update in the case is now being reported. According to the Florida Department of Insurance Fraud (DIF), the 56-year old chiropractor was sentenced in a Miami-Dade County Court this September as a result of the charges made against him a year ago. He received five years probation and also surrendered his chiropractor’s license to the Department of Health.

Details in the case revealed that Hirschenson actually worked with two others in the scheme. The first was a runner who solicited accident victims. In an interesting development in that case, the victims were not referred to Hirschenson’s clinic, but instead to another clinic in North Miami Beach—Advanced Chiropractic and Medical Center.

The second co-conspirator was a local radio station staffer who used the media exception status at the station to request accident reports from a variety of police departments. Hirschenson then used this information illegally to solicit accident victims. DIF arrested both co-conspirators, who cooperated in the investigation against Hirschenson.

Hirschenson, who originally received his chiropractor license in Florida in 1982, also had a prior arrest in the late 1980s as part of an investigation involving solicitation and insurance fraud in Broward County. He was placed on probation for two years by the Board of Chiropractic, but retained his state license for cooperating with the State Attorney’s Office. Hirschenson worked at and operated several clinics, including Pines Total Health Center in Pembroke Pines and Body and Mind Wellness Center in Coral Gables.

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Filed under Insurance Fraud

One of Florida’s Most Wanted for Insurance Fraud is Arrested in Maryland

James William Lloyd, Jr., who was part of an organized insurance fraud ring that carried out multiple staged vehicle accidents on Florida’s east coast, was recently arrested in Maryland. Before his arrest, the 42-year old held the dubious distinction of being on Florida’s “Top 10 Most Wanted for the Division of Insurance Fraud.”

According to a recent news story in the Naples Daily News, Lloyd’s elaborate scheme involved having crash participants report the accidents to their insurance companies and then attend treatment sessions at a local medical clinic. An employee at that clinic, who knew Lloyd, would then help process fraudulent bills for phony treatments. Investigators found that participants would pass along the phony bills for reimbursement by their insurance companies—collecting the insurance money, giving Lloyd a cut and pocketing the rest.

Maryland authorities wanted Lloyd in connection to a separate theft ring case and discovered that he was also wanted for crimes in Florida.

According to Maj. Glenn Hughes of the Florida Department of Financial Services, Lloyd often scoped out bars, clubs and restaurants to find participants. Targets were often out of work or down on their luck and needed some extra cash. “He promised if they participated in one of these staged crashes, which are usually very minor, they’d make some money.”

Hughes believes that although some legislative changes have made a dent in insurance fraud in recent years, they do not eliminate fraud. One such law on personal injury protection (“PIP”), which went into effect in 2013, gives a shorter time limit and a smaller coverage limit for those in crashes.

However, “Staged crashes aren’t identifiable to the insurance carriers,” Hughes said. “They look like any other crash really, they’ll have a police report, they’ll have billings from a chiropractic or physicians clinic, so from an insurance company standpoint they’re very hard to detect.”

“It’s a problem that’s not going away,” he said.

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Filed under Insurance Fraud

East Naples Woman Tries to Defraud Insurance Company over Spilled Coffee

An East Naples woman was arrested for phony medical and car wash bills after claiming Dunkin’ Donuts employees did not secure the lid on her coffee, causing it to spill on herself and in her car.

According to the Florida Division of Insurance Fraud, Jennifer Faye Sanders now faces charges of creating a false insurance claim and scheming to defraud.

A story on WINK News reported that Sanders submitted to Nationwide Insurance medical receipts totaling $200 for a doctor visit to treat her burns and an invoice with charges of $170 for the cleaning of her car. However, investigators discovered that Sanders had allegedly altered information on the medical receipt and took letterhead from the car wash establishment to create her own estimate of charges.

Nationwide Insurance referred Sanders’ claim to the Division of Insurance Fraud which arrested her. When she met with detectives, Sanders claimed that she didn’t mean to do anything wrong when she made the documents.

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Filed under Insurance Fraud

Operation Sledgehammer Arrests another Staged Accident Recruit

Ricardo Pargas, 49, of West Palm Beach was arrested on Wednesday, September 24, 2014 for his participation in a staged auto crash ring, according to the Sun-Sentinel.

Acting on information from Allstate Insurance and the FBI, the Florida Division of Insurance Fraud discovered that Pargas and his wife had participated in a staged car crash while acting on directions from the fraud scheme’s ringleader, Alien Moya, 30, also of West Palm Beach. The couple, recruited by Moya, was paid $2,000 each for their part in the crash. As of this time it appears that Pargas’ wife has not been charged.

The crash at issue occurred on January 11, 2010 in West Palm Beach. Pargas and his wife were driving in a 2005 Ford pickup truck when they were intentionally rear-ended by a 1998 Chevrolet pickup driven by another participant in the scheme. A sheriff’s deputy responding to the scene reported that there were no injuries and that both drivers drove away.

Two days later, however, Pargas was being treated for injuries from the crash at Karow Chiropractic Center in West Palm Beach. The treatment center billed the insurance company $34,065, of which the company paid $19,386.25.

When interviewed by federal agents at his home on April 12, 2012, Pargas admitted to having been recruited by Moya to take part in the scheme. Pargas and his wife were instructed by Moya to undergo treatment at the Karow Chiropractic Center following the crash. They each visited the clinic twice a week, where they reportedly received massages and other treatments. Investigators pieced together their case against Pargas over two years, and he was booked into Palm Beach County Jail on Wednesday on a staged accident fraud charge.

Karow Chiropractic Center’s owner was convicted in April 2014 of conspiracy to commit mail fraud in connection with the staged crash.

Moya was arrested earlier this year by the FBI on separate federal charges of theft of an interstate shipment and selling stolen property after he and an accomplice were caught stealing the contents of a Walmart truck that they were hired to drive to a distribution center. At the time of the trucking theft in early February, Moya was out on bond while awaiting sentencing for his role in the Operation Sledgehammer staged accident fraud, according to an earlier Sun Sentinel article.

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Filed under Insurance Fraud

Adjusters Unsure about Questionable Claims Delve into Accident Data

In an earlier FL-PIP Blog post titled “Accident Reconstructionists assist Insurance Adjusters in Uncovering Staged Accidents,” we reported how insurance companies may hire accident reconstructionists to analyze car crash data from police reports, photographs, incident descriptions, and repair records to help determine whether car accident claims are real or if crashes were staged.

A recent article in Property Casualty 360° took a look at common scenarios where accident reconstructionists provide input to insurance adjusters. A summary appears below.

Car Accident Scenario #1

The driver of a vehicle said another car hit him from behind when he was slowing for traffic. The other car did not stop to exchange information.

The claims adjuster, who photographed the damage, was suspicious because he thought the damage looked old, the vehicle had recently been added to the policy, and the claimant received a check a few months earlier on a different vehicle but with a similar story.

The data that the accident reconstructionist researched for the different model years and their variants found that the top of the bumper of these vehicles was always at or below 22 inches. It was also determined that the damage showed no signs of paint transfer. Using this information, the accident reconstructionist was able to definitively conclude that the damage seen on the vehicle did not match the driver’s testimony. The claims adjuster denied the claim in full.

Car Accident Scenario #2

Minor contact between the rear of a Chevrolet Malibu and the front of a Hyundai Elantra was reported with the scuff on the Elantra noted to be consistent with a sliding motion. Further investigation was called in uncovering that the Malibu was in a previous crash severe enough to be sold with a salvage title. No other details, including repair records, were available. The driver of the Malibu claimed that in addition to a small dented area on the right rear corner of the rear bumper cover, there was damage to the Malibu’s trunk area, more prominent on the left side of the vehicle.

The accident reconstructionist had test data run on an Elantra from the same model from a 3-mile-per-hour corner impact test and was able to determine that the damage for the Elantra involved in the incident is consistent with a collision at less than 4.2-miles-per-hour. A Conservation of Momentum analysis was then performed and found that an impact resulting in a Delta-V (the change in velocity of the vehicle from its pre-impact, initial velocity, to its post-impact velocity) of 4.2 miles per hour for the Hyundai Elantra would result in a Delta-V of 3.5 miles per hour for the Chevrolet Malibu.

Test data was obtained from the Insurance Institute for Highway Safety (IIHS) for the Chevrolet Malibu and it was determined that the claim was for more severe damage than was sustained and that the damage was partially in an area that was too far away from the actual point of contact.

It was found that not all of the claimed damages to the Malibu could be attributed to contact from the Elantra, and the insurance company subsequently denied all costs associated with the underlying damages.

Every case is unique, and claims with injuries will be treated differently.

Click on the link to read the full article, “Is that auto accident staged? Here’s how to tell.”

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

JFK Medical Center Target of Lawsuit Alleging Excessive Billing in PIP Claims

Two women injured in unrelated 2013 car accidents have filed suit in Hillsborough County Circuit Court against a holding company that operates several hospitals in Florida, according to an article in The Tampa Tribune. The women allege that HCA Holdings grossly overcharged for emergency room radiological services.

The plaintiffs claim that the alleged overcharging harmed them in two ways:

  • First, because PIP covers only 80% of emergency medical care, they were left to pay 20% of the inflated charge.
  • Second, the excessively high rates prematurely sapped their $10,000 PIP benefits, leaving them each to pay the remainder of the costs.

One of the women, Marisela Herrera of West Palm Beach, underwent CT scans and x-rays at JFK Medical Center in Atlantis following her traffic accident. (JFK Medical Center is owned by HCA; it is the only HCA medical facility specifically named in the suit). The images done at JFK allegedly cost Herrera nearly $18,000. Plaintiffs say Medicare would typically pay only $465 for the same number and type of images.

Florida’s PIP statute mandates that insurers pay 80% of all reasonable expenses. Such exorbitant charges, plaintiffs allege, are well in excess of this reasonable amount. These charges form the basis of the plaintiffs’ claim that they were victims of “unreasonable, unconscionable and unlawful pricing and billing practices.”

The lawsuit seeks reimbursement for the plaintiffs of the out-of-pocket expenses due to the “excessive and artificially inflated medical bills.” Plaintiffs also request that the court prohibit HCA from charging those fees and order it to stop efforts to collect outstanding emergency radiological bills. The lawsuit seeks class-action certification.

The case brought by Ms. Herrera is Herrera, Marisela v. JFK Medical Center Limited Partnership, Case No. 14-CA-008372, filed on 8/18/14 in Hillsborough County Circuit Court.

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Filed under Insurance Fraud

Labor Day Highway Safety Programs Underway in Florida

Florida drivers will see more speed traps and DUI checkpoints this holiday weekend as law enforcement personnel hit the roads with several safety initiatives aimed at stopping risky drivers.

Drive Sober or Get Pulled Over, supported by The Florida Highway Patrol, is a national campaign that began on August 15 and will run through Labor Day on September 1. FHP officers will be on the lookout for impaired drivers across the state.

“Take a shot at drinking and driving, and we’ll provide the chaser,” said FHP Director Col. David Brierton. “The choice to drink and drive is a bad decision that could have grave consequences. Be responsible, don’t drink and drive.”

The annual “Hands across the Border” is a separate Southeastern U.S. regional campaign coordinated by highway safety agencies from Florida, Georgia, Alabama, and Tennessee, among others, to look for drivers under the influence (DUI) of alcohol as they cross state lines.

The blood alcohol content (BAC) is .08 in all 50 states, note the program sponsors, meaning that impaired drivers cannot claim ignorance of the law. Drivers who fail a sobriety test are likely to be arrested.

The “Hands across the Border” program, which is now in its 23rd year, also encourages safe driving habits such as the use of seat belts and observance of speed limits.

AAA Travel predicts that almost 35 million Americans will travel 50 miles or more from home during the Labor Day holiday weekend, defined as Thursday, August 28 to Monday, September 1. Automobile travel makes up the largest portion of this number, with 29.7 million travelers planning a road trip. The overall traffic projections represent a 1.3 percent increase from 2013 and the highest Labor Day traffic volume since 2008. Recent reductions in gas prices are contributing to increased travel plans, notes AAA.

Drive safely!

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