Author Archives: Michael A. Rosenberg, Esq.

Florida Still a Top 10 State in Vehicle Thefts Despite Dramatic Decreases Overall

The good news—the probability of your car being stolen has been dwindling over the past two decades. The bad news—if you live, work or play in Florida, your chances are still higher than in 47 other states.

That assessment is supported by the National Insurance Crime Bureau (NICB), which recently released a national analysis of vehicle theft since 1960.

This report, which compared annual statistics for thefts, population, and vehicle registrations from 1960 through 2013, found that even with an increase in population and registrations of over 60 million in 2013, thefts were down to 699,594. Based on the most recent FBI crime figures, these numbers translate to a whopping 58 percent reduction in the number of vehicles stolen last year from 1991, when vehicle theft reached an all-time high of 1,661,738.

Florida has historically been a state with a high level of vehicle theft. From the years 2000-2013, Florida ranked third in the number of stolen vehicles nationwide, surpassed only by Texas and California. There have only been a few years (1963 and 1966-69) when Florida did not rank in the Top 10.

The NICB attributes a variety of factors which together have brought about such positive national results, including:

  • Law enforcement efforts to develop innovative investigative processes
  • The sharing of these processes across law enforcement communities as well as with the International Association of Auto Theft Investigators and the International Association of Special Investigative Units
  • Collaboration and coordination among these agencies
  • New technologies incorporated into vehicles during the auto manufacturing process
  • New technologies available to purchase in the after market

Click on the link to read the NICB national analysis of vehicle theft.

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Filed under Insurance Fraud

Third DCA Upholds Ruling in PIP Case Millennium Radiology v. State Farm

On December 10, 2014, the Third District Court of Appeal affirmed a trial court ruling in Millennium Radiology (a/a/o Yesenia Arango) v. State Farm. In the case, Yesenia Arango’s $10,000 PIP policy limits were exhausted after a lawsuit was filed and served on State Farm by Millennium Radiology.

Roig Lawyers attorney Mark Rose had successfully argued in the lower court that paying out the entire $10,000 was a complete bar to additional claims against the policy of insurance, absent bad faith on the insurer’s part or the insurer’s payment of untimely submitted bills. Following the ruling, the case was certified as a question of great public importance to the Third District Court of Appeal.

The Third District Court of Appeal affirmed the ruling, finding that in an action brought by an assignor of PIP benefits that is founded upon a breach of contract, exhaustion of PIP benefits after a lawsuit is filed “absolves the insurer from any responsibility to pay an otherwise valid claim” where the exhaustion occurred (1) after the insurer paid an amount less than the provider feels was appropriate; (2) after a lawsuit has been served on the insurer; and (3) absent any bad faith by the insurer in the handling of the claims.

The case is Millennium Radiology v. State Farm, Case No. 3D12-3143 (Fla. 3rd DCA, December 10, 2014). Click on the link to view the court ruling.

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

SIUs Detect Soft Fraud with Technology

Unlike the criminals guilty of ‘hard’ fraud—such as the ones we often report about on our blog involving PIP insurance schemes through staged car accidents—there is another group of people who commit ‘soft’ fraud without fully realizing the impact it has on increasing their insurance costs.

Soft fraud, also known as opportunity fraud, is the bane of the insurance industry and the Special Investigative Units (SIUs) that serve them. The little lies, exaggerations, and exclusions that make up this type of fraud are difficult to detect, and when they are uncovered, are often difficult to investigate without offending long-term customers.

According to a commentary by Joseph Bracken on InformationWeek Insurance & Technology, soft fraud includes circumstances like:

  • Overstating the extent or origin of damage when filing a claim
  • Overestimating the value
  • Minimizing annual mileage driven
  • Neglecting to mention the existence of teenage drivers

Consumers’ tolerance to soft fraud has been shown in an Insurance Research Council 2013 study in which 24 percent of respondents thought it was acceptable to overstate the amount of a claim submission as a way to offset the cost of a deductible, and 10 percent said that insurance fraud “doesn’t hurt anyone.”

However, the Coalition Against Insurance Fraud, reveals just how much insurance fraud hurts—it costs the economy $80 billion annually, which is enough to cover salaries of 2.2 million American workers for a year.

This is where analysis using technology can come into play, Bracken says, to help SIUs protect policyholders from soft fraud, including the following:

  1. Establish a baseline on the number of claims being investigated, keeping in mind that based on industry data, about 10-20% of insurance claims have the potential to be fraudulent.
  2. Establish patterns of activity according to type of claim or claimant demographic to identify inconsistencies.
  3. Set up business rules and maximum limits to identify the claims that need closer review, basing them on claim characteristics (exceeding a certain dollar limit) or insured behavior (such as a change in the coverage limit up to 60 days before a claim).
  4. Develop norms for common claims and flag those that veer from the norm.
  5. Compare in-house and third-party data to identify inconsistent behavior.
  6. Compare average retail store values with claim values.
  7. Eliminate data silos so investigators can merge data from different sources within the company.

While this analytical investigative approach may seem a heavy-handed way to combat soft fraud, it ends up being an essential component to achieving several goals—it’s successful in detecting claims that are most likely to be fraudulent, it’s cost-effective for SIU investigators to zero in on those claims, and it ultimately decreases premium costs.

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Filed under Insurance Fraud

Miami D & J Rehabilitation Center Target of Another DIF Fraud Arrest

Yalily Clavero Ruiz is the latest to be arrested by the Florida Division of Insurance Fraud (DIF) in connection with deceptive activities at D & J Rehabilitation Center, a Miami clinic that was incorporated in 2009. According to DIF, the 34-year old manager is charged with insurance fraud, grand theft and organized scheme to defraud.

Clavero Ruiz allegedly instructed patients, many of whom were staged accident participants, to sign for treatment that was not provided to them. In one instance, video surveillance conducted on behalf of State Farm showed that Clavero Ruiz paid $1,000 to a patient, who did not receive any treatment, to sign off as if treatment was provided.

DIF has made numerous arrests this year tied to staged accidents and participants who were referred to D & J Rehabilitation.

In October, our FL PIP Guide reported on two recently arrested in the scheme—Victor Manuel Hernandez and Vladimir Caro—whose involvement caused hundreds-of-thousands in fraudulent billings to be submitted to insurance companies.

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Filed under Insurance Fraud

PIP Fraudster/Alligator Whisperer Remains Free but Cannot Cavort with Gators

On our FL PIP Guide on November 10, we told you about how federal prosecutors were trying to get the bond revoked of a Miami Beach PIP scammer who touted himself as an ‘alligator whisperer’-for-hire while waiting to start his jail term. The former chiropractor, 51-year old Hal Mark Kreitman, would swim and frolic with the reptiles and was even photographed kissing them.

However, according to an update in the Sun-Sentinel, prosecutors were overruled as U.S. District Judge Kenneth Marra declared that Kreitman can remain free until January 5, but only if he abides by new conditions set forth by the judge.

The former chiropractor-turned-alligator-whisperer was originally convicted of fraud in October in a staged accident ring case. The scheme revolved around Personal Injury Protection (PIP) payments that were used to defraud insurance companies through mail fraud and money laundering. Kreitman was sentenced to eight years and ordered to pay more than $1.63 million in restitution.

In a strange turn of events, Kreitman was then arrested on October 29 in the Everglades in Monroe County on state charges that he was harassing alligators. Federal prosecutors wanted to use these new charges against him—to have his bond revoked and to move up his surrender date.

While Judge Marra did not revoke bond, he agreed that the evidence showed that Kreitman committed a federal misdemeanor by touching the alligators. Judge Marra set new rules for Kreitman’s release designed to prevent him from posing a danger to the public and the gators.

Kreitman “shall not harass, harm, pursue, hunt, wound, kill, trap, capture, collect, feed, touch, tease, or frighten any wildlife,” the judge wrote in his order.

Prosecutors said Kreitman has also been driving on a suspended license, but according to his attorney, evidence presented showed the license was incorrectly suspended due to a case of stolen identity by Kreitman’s brother.

The judge ordered that Kreitman cannot drive until his license is reinstated; in addition, he could still face state wildlife charges in Monroe County, the Sun-Sentinel article said.

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Filed under Insurance Fraud

Wake Up Call: Drowsy Driving Plays Significant Role in Fatal Crashes

As daytime hours shorten and evening commutes darken due to the end of daylight saving time, the AAA Foundation for Traffic Safety is pointing out that the prevalence of driver fatigue plays a bigger role in fatal crashes than previously thought.

According to new research, more than 21 percent—or one-in-five—fatal crashes involve drowsy driving. These findings, which show a greater occurrence than official National Highway Traffic Safety Administration (NHTSA) statistics, bear out what experts have long suspected.

The report also found that one-third of crashes involving a drowsy driver resulted in injuries. Even more serious, is that each year more than 6,000 fatigue-related crashes result in at least one fatality, the research revealed.

Prior research from the AAA Foundation uncovered that young adult drivers, ages 19-24, are the most serious offenders with 33 percent admitting to driving while drowsy in the last month. In contrast, the oldest (ages 75+) and the youngest (ages 16-18) drivers were the least likely to report the same offense.

“Despite the fact that 95 percent of Americans deem it ‘unacceptable’ to drive when they are so tired that they have a hard time keeping their eyes open, more than 28 percent admit to doing so in the last month,” said Peter Kissinger, president and CEO of the AAA Foundation for Traffic Safety. “Like other impairments, driving while drowsy is not without risk,” he warned.

AAA is urging drivers to recognize warning signs of driver fatigue and take action to avoid tragedy during normal driving, and through the upcoming holiday season.

The AAA Foundation for Traffic Safety’s Prevalence of Motor Vehicle Crashes Involving Drowsy Drivers report is based on the analysis of a representative sample of 14,268 crashes that occurred in years 2009–2013 in which at least one vehicle was towed from the scene.

AAA is highlighting the risks of drowsy driving in support of the National Sleep Foundation’s Drowsy Driving Prevention Week®, which runs November 2-9. For more information, visit their website at www.DrowsyDriving.org.

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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