Category Archives: Insurance Fraud

Insurnace Fraud Sweep has resulted in 31 individuals charged

State Attorney Katherine Fernandez Rundle announced today at a press conference the success of “Operation Flames and Flood Two” which charged 31 individuals with insurance fraud.  According to the State Attorney’s Office the operation focused on public adjuster, Jorge Fausto Espinosa, who was hired by policy holders to damage the insured homes for the purpose to collect ill-gotten gains from insurance companies. Jorge Fausto Espinosa, who is already facing charges in a similar fraud case from last year, called “Operation Flames and Flood One”, deliberately staged fire and water damage claims to residential homes in Miami-Dade County, Lehigh Acres, and Naples.

“Operation Flames and Flood Two” focused on the expansion of Espinosa’s fraud activities through his Miami-Dade company, Nationwide Adjusters LLC, into the west coast of Florida into Collier and Lee counties. According to the State Attorney’s Office operation two involved 20 staged fires with loses close to $ 7 million. Several homeowners also face charges for their role in the fraud.

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Filed under Insurance Fraud

Century Woman charged with Auto Insurance Fraud

The Florida Department of Financial Services Insurance Fraud Division charged Trisha Michelle Milstead a resident of Century, FL with one felony count of insurance fraud. Assistant State Attorney Greg Marcille stated that on September 8, 2014 Milstead was involved in a vehicle accident, but at the time her vehicle policy had lapsed for non-payment. She then reinstated her insurance policy on September 9, signing a statement that there had been no previous damage during the lapsed time period.  Two days after the policy was reinstated she filed a claim for the accident and damage associated.

Trisha Milstead remains in the Escambia County Jail with bond set at $10,000 and is scheduled for an arraignment hearing next month.

Click here for news article.

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Filed under Insurance Fraud

Florida Insurance Fraud Education Committee (FIFEC) Conference

Roig Lawyers attorneys and healthcare policy advisor will speak at 23rd annual Florida Insurance Fraud Education Committee (FIFEC) Conference on June 12, 2015 in Orlando, FL.  Nelson C. Bellido, Dennis La Rosa, Miguel Roura, and Diego Arredondo will present “Mechanisms Available to Adjusters During Review for Regulatory and Compliance Issues”.  The presentation will focus on recent developments in the law, insurance adjuster review process for regulatory compliance issues, administrative regulation and the relationship to PIP under §627.732(11), and PIP amendments and licensing issues.

FIFEC is a non-profit corporation comprised of special investigative unit investigators, law enforcement personnel and dedicated individuals whose purpose is to organize and present an annual statewide educational seminar related to deterring, detecting, investigating and prosecuting insurance fraud. FIFEC is proud of its mission to provide insurance fraud education and training by giving grants to the law enforcement and criminal justice community that attend what is now known as the annual FIFEC Conference.

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, corporate law, real estate, banking and finance, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

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Filed under Insurance Fraud

Jacksonville PIP Fraud Scheme Involved Staged Auto Accidents

Roxana Suarez La Rosa was arrested for PIP fraud, according to an April 28 release by the Florida Department of Financial Services’ Division of Insurance Fraud.

Suarez La Rosa owned and operated the Saint Jose Injury Center in Jacksonville that was behind a string of staged auto accidents, according to witnesses. Crash participants were asked to sign for medical services they never received, which were then billed to insurance companies. More than 50 insurance claims were generated in the alleged scam. Billing amounts were not disclosed.

If convicted, Suarez La Rosa faces up to 50 years in prison on racketeering and fraud charges. Additional cases against the medical clinic are pending.

The Office of the State Attorney in the 4th Judicial Circuit of Florida, which covers Duval, Clay and Nassau Counties, is handling the case.

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Filed under Insurance Fraud

Operator of Unlicensed Orlando PIP Clinics Arrested

Josue Pierrissaint, 30, was arrested by the Florida Division of Insurance Fraud (DIF) for charges related to operating unlicensed Orlando PIP clinics earlier this year.

A string of three PIP clinics were opened by Pierrissaint from 2010 to 2012, as listed below.

  • Edgewater Chiropractic was first opened in 2010. It was based in Lockhart, Fla., located in Orange County northwest of Orlando. Chiropractor Sham Mohammed was named as the straw owner.
  • Dr. Wilson’s Straight Up Chiropractic was opened several months later by Pierrissaint in association with chiropractor Koteuaisa Wilson, who also served as the straw owner. The same Lockhart, Fla. address was used in the AHCA application. Wilson later left the clinic, which reportedly did not stop Pierrissaint from using her name.
  • Dr. Koteuaisa Chiropractic was next launched by Pierrissaint in 2012. The clinic was opened in Orlando without the knowledge or consent of Dr. Wilson, although her name was listed on the AHCA paperwork.

Collectively, the clinics were paid in excess of $425,000 by 16 insurance companies.

Pierrissaint, who is not a doctor, was also arrested early in 2014 on similar charges.

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Filed under Insurance Fraud

Details Emerge on Unlicensed Clinics Behind $243K in PIP Fraud

The FLPIPGuide previously reported that Dr. Lherisson Domond, 82, was arrested earlier this year for acting as the straw owner of Unity Pain and Injury Center in Orlando. The Florida Division of Insurance Fraud (DIF) recently revealed that Domond also fronted as the straw owner of Blesscare Chiro Center, also in Orlando.

Blesscare, an unlicensed clinic, was operated by Fortunard Dieuveillant Fonrose, 42. Medical billings totaling in excess of $86,000 were generated between May 2012 and November 2014 under Fonrose’s management, according to DIF reports.

Domond was behind the unlicensed Tamarac clinic of J.J. Health & Wellness also, according to DIF. Jonas Fils, 52, and Obinson Louis, 37, were reportedly the real owners of the clinic, which illegally billed almost $72,000 from May to September of 2013.

Keeping with the pattern of interconnections, Louis also operated the unlicensed Oakland Park clinic of Innovative Medical Rehab Center.

Overall, seven individuals were arrested for the fraudulent operation of the four unlicensed medical clinics.

The clinics were behind personal injury protection (PIP) fraud schemes responsible for more than $243,000 in illegal billings. DIF investigations are on-going, and additional arrests are expected.

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Filed under Insurance Fraud

Broward PIP Fraud Scam Leads to Four Arrests

Four Florida residents were arrested on April 1 for participating in a Broward County scheme to defraud insurance companies by filing false PIP claims.

The defendants filed eight claims concerning a Mercedes that belonged to one of them, according to a statement from the Florida Department of Financial Services, Division of Insurance Fraud.

Claims alleged that the Mercedes had been run off the road. It was ultimately determined that only one of the eight claims was lawfully made and that the other seven were filed in furtherance of the defendants’ scam.

According to the statement, the four individuals arrested are:

  • Ermes Falero, Boca Raton
  • Gary Lee, Boca Raton
  • Javier Navarro, Miami
  • Michael Rumain, Point Pleasant

Falero, with Lee’s help, is alleged to have organized a scheme by which he and Lee would falsify documentation and use that false documentation to file fraudulent insurance claims. The remaining two defendants are accused of making fraudulent statements supporting Falero’s and Lee’s false insurance claims.

Falero, the scam’s main organizer, faces 150 years in prison. Lee faces up to 90 years, and the defendants who made the false statements each face 15 years in prison.

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