Category Archives: Fla. Stat. 627.736 (2012)

“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

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)

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

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

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"

Eight Arrested for Staging Accidents in Miami-Dade County, Connections to Six Different PIP Fraud Rings

Florida’s Chief Financial Officer, Jeff Atwater, announced Tuesday that eight individuals involved in multiple staged accidents in Miami-Dade County were connected to six different PIP fraud rings.  The press release from the the CFO states:

An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Alexander Cid, 47; Luis Rivero Dominguez, 35; Franklyn Chaviano, 38; Robert E Bayona, 55; Carlos Padron Fernandez, 38; Yosmel Ramos Peraza, 24; Andres Vega Fleites, 61; and Jorge Fernandez Rodriguez, 52, participated in staged accidents in coordination with six fraud rings as organizers or drivers between May 2009 to May 2011.

The staged auto accidents resulted in more than $340,000 in fraudulent auto insurance claims.  If convicted, the eight individuals involved could serve a total of 455 years in prison.

The Division of Insurance Fraud (DIF) recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity.

The full press release is available here.

Comments Off

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

Property Casualty Insurers Association of America: Allow the New PIP Law Adequate Time to Take Effect to Achieve its Full Potential

Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America (PCI),  recently issued a statement in response to the Office of Insurance Regulation’s (OIR) recent analysis of the Pinnacle Actuarial Resources, Inc. impact report on Florida’s new PIP law.

In the statement Brown emphasizes patience with the expected results of the new law.

PCI has ongoing concerns with the study’s conclusions and the fact that they are based on a law which does not fully take effect until next year. Although we commend Pinnacle for its diligent and thorough work, the study cannot anticipate changes to Florida’s legal, social or economic environment which will directly influence the impact of the new PIP law. The study also cannot calculate the scope of detrimental challenges to the new PIP law that will be filed by plaintiffs’ attorneys or the manner and extent to which corrupt providers will attempt to game the system. In addition, we note that the study cannot foresee the overall impact the PIP law may have on the Bodily Injury and Uninsured Motorist portions of drivers’ auto policies.

Therefore, in order for the new PIP law to achieve its potential, PCI encourages policymakers, regulators and Florida drivers to allow the law adequate time to take effect. PCI also urges policymakers to protect the law from any distortion that will negatively impact its ability to deter fraud and abuse in the PIP system. As with any comprehensive legislative package, there will be implementation processes and other issues that must be addressed in order for the PIP law to attempt to stabilize our auto insurance market.

The full press release is available here.

Comments Off

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

Owners of Sky Imaging, North Miami Beach Arrested Friday, More Than $1.5mil in Fraudulent PIP Claims

On Friday authorities arrested arrested Robbie N. Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging located in North Miami Beach for alleged PIP fraud.  The two are accused of operating an unlicensed accident clinic and fraudulently billing more than $1.5 million in auto-related claims to insurance companies.

Specifically the owners of Sky Imaging lacked licensing from the Agency of Healthcare Administration (AHCA) and instead enlisted a medical doctor to sign paperwork and pose as the clinic owner to qualify to bill Florida PIP insurers.

The article from the SunSentinel is available here.

Comments Off

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

Trial Advocate Quarterly Features Article on 2012 Florida PIP Law Changes by Mark J. Rose

Trial Advocate Quarterly

Trial Advocate Quarterly, Summer 2012

The summer 2012 of the Trial Advocate Quarterly features an article by attorney and FLPIPGuide.com contributor Mark J. Rose on the recent changes to Florida’s PIP/No-Fault Law including: statutory fee schedules, the “emergency medical condition” limitation, PIP payment logs, exhaustion of benefits, explanations of benefits, examinations under oat (EUO), independent medical examinations, and fraudulent PIP claims.

The article will soon be available on the Florida Defense Lawyer Association (FDLA) website at http://www.FDLA.org.  Requests for full copies of the article or for more information on the recent Florida PIP law changes, please contact Mark Rose (mrose@roiglawyers.com) or Michael Rosenberg (mrosenberg@roiglawyers.com).

Comments Off

Filed under Examinations Under Oath (EUO), Fla. Stat. 627.736 (2012), Independent Medical Examinations (IME), Insurance Fraud, Licensing, The Statutory "Fee Schedules"

Pinnacle Actuarial Resources Initial Report: New PIP Law Could Reduce Premiums 12-20% in 2013

According to Pinnacle Actuarial Resources, the Bloomington, IL company appointed by the state to evaluate the effects of Florida’s recently amended PIP law, Floridians could see a 12 to 20% reduction in PIP premiums.  The initial report does add the caveat that overall insurance premiums could still increase but the potential PIP premium reductions could offset any net increase.

The final report from Pinnacle is due to the Governor and Legislature by September 15, 2012.

The full article from the Miami Herald  is available here.

Comments Off

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