Category Archives: Insurance Fraud

Insurance Agent Arrested for Fraudulent Polices

Insurance Agent Arrested for Fraudulent Polices

On July 27, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced the arrest of insurance agent Julia Shurdom, 67, for conducting insurance related business with a suspended insurance license, scheming to defraud, and uttering a forged document.

Shurdom was allegedly working for Absolute Insurance Services in Orlando, Florida with a suspended license when the fraud was committed. According to the press release, DIF received a complaint in regards to Ms. Shurdom, after a client who purchased homeowners’ insurance in 2013 and 2014 discovered that her home had remained uninsured. After the complaint, DIF began an investigation which found, per Ms. Shurdom bank records, that she collected two homeowners’ insurance premium payments and used the money for personal profit.

According to the investigation, DIF conducted a license search for the accused agent and found that the Department’s Division of Agent & Agency Services (A&A) had already begun investigating Ms. Shurdom for a number of unrelated events. The investigation also revealed that A&A had suspended Julia Shurdom’s license to conduct insurance related business.

A follow up audit by A&A and the ongoing investigation by DIF revealed that Ms. Shurdom continued to sell insurance polices without the proper licensing from the Department of Financial Services, and that the transactions were fraudulent, according to DIF.

Shurdom was booked into Orange County Correctional Facility with a bond of $6,500 on charges which include scheme to defraud, uttering a forged instrument, and violation of a suspension order. Shurdom’s faces up to 15 years in prison.

Click here for the press release.

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Florida Couple Accused of Allegedly Lying About Sinkhole to Homebuyer

On July 16, 2015, a Spring Hill couple was accused of lying about a sinkhole to a homebuyer, according to a news article by ABC news. Glenn Jasen, 64, and Katheryn Jasen, 63, were indicted on a charge of wire fraud, which is a federal felony. If convicted, they each could face a maximum of 20 years in prison, according to U.S. Attorney A. Lee Bentley III.

According to the indictment, the Jasens found a sinkhole on their property and made a claim to Citizens Insurance. Instead of repairing the sinkhole the Jasens deposited the insurance check for an undisclosed amount into a bank account, as stated by the U.S. attorney’s office.

The Jasens then put the home up for sale, and in the real estate disclosures given to the purchaser of the house, they failed to disclose the sinkhole and the claim on the property, according to the indictment.

Please click here to read news article.

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PIP Fraud Featured on A&E American Takedown

The newest series on A&E, American Takedown, goes behind-the-scenes of a year-long undercover investigation into an accused insurance fraud ring in Palm Beach, Martin, and Miami-Dade counties.  The show aired on A&E on Thursday, July 9, 2015, at 10 pm EST.

The episode followed the breakdown of the investigation of attorneys, chiropractors and clinic employees involved in recruiting, paying, and treating “patients” for injuries that did not exist following staged car accidents.  The investigation was known as “Operation Cold Call” which targeted a network of attorneys, doctors, and clinic employees in Boca Raton, Boynton Beach, Lake Worth, Hobe Sound, Stuart, and Homestead. Investigators from the state’s Department of Financial Services worked undercover and were embedded into the clinics that were accepting patients who were illegally solicited.

Click here to read the Department of Financial Services newsletter

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Miami PIP Fraud Leads to Three Arrests

Three individuals from the Miami-Dade area, who have allegedly been involved in personal injury protection (PIP) fraud schemes, were arrested on June 30, 2015 by the Division of Insurance Fraud (DIF) in separate cases.

The first individual arrested was Mariela Quintana, a licensed massage therapist at D&J Rehabilitation Center in Miami. According to DIF, the 46-year old fraudulently billed for treatments never performed and signed off on treatment forms. Her role in the scheme resulted in more than $10,000 in fraudulent claims and is the second time in less than six months that she has been arrested for similar activities at the same clinic, DIF said. Quintana has been charged with Insurance Fraud, Grand Theft, and Organized Scheme to Defraud.

The second individual arrested, Noel Vazquez Lazo, organized a staged accident and paid for the policy of the at-fault automobile used in the accident. The 44-year old, paid participants in the staged accident to seek treatment for fake injuries. The PIP scheme resulted in filing claims totaling in excess of $89,000, according to DIF. He is charged with Organizing a Staged Accident, Insurance Fraud, and Grand Theft.

Last but not least, Rodney Fabian, 27, was charged with Solicitation, Patient Brokering, Insurance Fraud, and Grand Theft for his role for soliciting an individual of a hit and run accident and offering to pay for their treatment at a specific clinic, DIF reported. Fabian paid the individual $1,000 for seeking treatment at the specific clinic. However, the insurance company suspected the fraud scheme and refused to process the claims, which caused Fabian to demand the money back from the individual.

According to DIF, the three individuals face jail sentences ranging from 5 to 30 years and each case will be prosecuted by the Miami-Dade Office of the State Attorney Katherine Fernandez Rundle.

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

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Miami Couple Sentenced For Operating Clinic to Defraud Medicare

On June 29, 2015, U.S. District Judge Susan C. Bucklew sentenced Gladys Fuertes, 41, and Mario Fuertes, 41, of Miami for operating a sham clinic. Gladys Fuertes was sentenced to 19 years and 6 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, aggravated identity theft, and obstruction of healthcare fraud investigation. Mario Fuertes was sentenced to 11 years and 3 months in federal prison for conspiracy to commit healthcare fraud, healthcare fraud, and obstruction of a healthcare fraud investigation. The couple was ordered to forfeit $1,036,759.72. A federal jury convicted the Fuerteses on March 24, 2015.

According to a Department of Justice release, the couple established and operated Gables Medical and Therapy Center for the purpose of committing healthcare fraud by employing unlicensed medical professionals. The Fuerteses misused the Medicare billing numbers of other medical professionals, without their knowledge, in order to claim medical treatments.

Prosecutors say Gladys and Mario Fuertes paid a co-conspirator to recruit Medicare beneficiaries and to drive patients to the Gables Medical for basic and sham medical services. The couple fraudulently billed Universal Medicare in excess of $900,000 for treatments not rendered and for treatments requiring a physician’s presence.

Gladys and Mario Fuertes also facilitated the provision of fraudulent prescriptions for controlled substances to Gables patients and allowed a co-conspirator to assist patients in filling prescriptions for controlled substances such as oxycodone, according to the Department of Justice. The co-conspirator also purchased the controlled substances from Gables patients and sold them on the street.

Gladys and Mario Fuertes also obstructed the federal investigation by instructing Gables Medical patients to lie to law enforcement agents. The couple provided federal agents with altered Medicare documentation.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 2,300 defendants who collectively billed the Medicare program for over $7 billion, according to a Department of Justice report.

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Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies

Dr. Troy Godsey and Renata Berriel Deazevedo were arrested in connection with an illegal insurance scheme involving multiple insurance companies and totaling more than $100,000. Godsey, a licensed chiropractor, served as an owner of the clinic, and Deazevedo managed the day-to-day activities of the business.

According to the Florida Department of Financial Services, Godsey and Deazevedo ran Spine Health Solutions PA in Orlando, and provided medical treatments to people who were injured in car accidents. The pair billed insurance companies for reimbursements for “patients” under their Personal Injury Protection coverage. Three insurance companies were billed nearly $300,000 for the alleged treatment of 20 injured individuals.

They both face more than 50 years in prison if convicted under the felony charges, including operating an unlicensed health care clinic, and filing false and fraudulent insurance claims.

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Jacksonville Clinic Owner Arrested for Racketeering and Insurance Fraud

Sandy Morales, who owned and operated Gate Parkway Diagnostic Center, has been arrested for racketeering and insurance fraud charges, as reported in a June 18, 2015 article by the Jacksonville Business Journal.

According to the Florida Department of Financial Services, Sandy Morales organized a complex Personal Injury Protection (PIP) fraud scam that resulted in over $100,000 in fraudulent filing claims for injuries in accidents which did not occur.

Investigators stated that Morales’ arrest is one of 180 arrests since September 2012 that are tied to the fraud network. According to the Division of Insurance Fraud, Morales elaborately staged multiple car accidents, paid people to pose as passengers, and then paid those individuals to seek treatment in his clinic for bogus injuries. Morales is also accused of recruiting other clinic owners to participate in the fraud, and sending patients to those clinics in order to increase the fraud network.

The clinics involved in the PIP scam, now closed, include:

  • Arlington Rehabilitation Services Inc.
  • Baymeadows Injury Center LLC
  • Health Point Injury Center LLC
  • One Touch Therapy Center Inc.
  • Saint Jose Injury Center LLC
  • Therapy Diagnostics Tech Medical Inc.
  • Wellness Rehab Services Inc.
  • Atlas Massage Therapy Corp.

Morales could face a maximum of 45 years in prison, and is currently being held in Duval County Jail with a bond of over $600,000.

Click here to read article.

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