On November 6, 2015, four former employees of the now defunct healthcare provider Health Care Solutions Network Inc. (HCSN) were sentenced for their role in a scheme to fraudulently bill Medicare and Florida Medicaid for approximately $63 million. U.S. District Judge Robert N. Scola of the Southern District of Florida sentenced Roger Rousseau, 73, of Miami, the former medical director of HCSN to192 months in prison: Liliana Marks, 49, of Homestead, former therapist was sentenced for 72 months in prison; therapist Doris Crabtree, 63, of Miami, and Anglea Salafia, 68, of Miami Beach, were each sentenced to 60 months in prison. All four defendants were sentenced to three years of supervised release.
On August 24, 2015, a Miami jury convicted all four defendants of conspiracy to commit healthcare fraud and Rousseau was additionally convicted of two counts of healthcare fraud. To date a total of 22 defendants have been charged and convicted for their roles in the HCSN scheme, which focused on performing services that were not medically necessary and were never provided.
The HCSN scheme provided intensive mental health services to Medicare and Medicaid beneficiaries in Miami and North Carolina from 2004 to 2011. HCSN paid kickbacks to assisted living facilities owners and operators in Miami who, in exchange, referred beneficiaries to HCSN. In order to support the scheme, Rousseau signed, forged, and altered medical records and Crabtree, Salafia, and Mark also falsified medical records. As a result of the scheme, HCSN submitted approximately $63.7 million in false and fraudulent claims to Medicare, and received payments totaling approximately $28 million on those claims.
Please click here to read the U.S. Department of Justice Press release.
On October 15, 2015, the Florida Department of Financial Services Division of Insurance Fraud (DIF) announced the arrest of Eric Wiegandt, 41, on multiple felony fraud charges for conducting a $1.5 million insurance fraud scheme, according to a press release from DIF. DIF led a joint state and federal investigation, which revealed that Wiegandt allegedly coordinated a scheme that fraudulently billed Blue Cross Blue Shield (BCBS) for services that were never rendered at his clinic, the Broward Spine and Rehab Center, located in Hollywood, Florida.
According to investigators, Eric Wiegandt fraudulently signed and submitted nearly $1.5 million worth of fictitious and falsely represented insurance claims between 2013 and early 2015. As a result, Wiegandt received commission payments from BCBS in excess of $230,000.
Wiegandt was evicted in 2014 from his Coral Gables practice location because of alleged mismanagement, and lost his license for failure to complete continuing education requirements. Despite not having a license, Wieghandt opened a new clinic located in Hollywood, Florida. The Hollywood Police Department became aware of Wiegandt’s unlicensed practice and arrested him for continuing to conduct an insurance-related business without an active license. Soon after, the Hollywood Police Department brought in DIF to review the insurance transactions related to the clinic’s day to day operations. As part of its investigation, DIF found that BCBS flagged Wiegandt due to the high volume of insurance claims and patient visits. The investigation also revealed that patients who previously visited the Coral Gables location were allegedly receiving duplicative treatments at the Hollywood location.
Wiegandt was arrested on eight counts of healthcare fraud and the case is being prosecuted by the U.S. Attorney’s Office of the Southern District of Florida.
Click here for press release.
Zian Scott Snyder, 29, and Alicia Maria Hill, 26, of Cantonment, Florida have been charged with scheme to defraud, insurance fraud, grand theft, and conspiracy to commit insurance fraud by the Florida Division of Insurance Fraud (DIF) for alleged false claims over a custom-made engagement ring.
According to an article on NorthEscambia.com, the couple filed a false claim on a $15,000 ring that Hill claimed she lost swimming in the Gulf. She was also recorded claiming she lost the ring on a boat in the Gulf. Four days after filing the claim with her insurance company, Hill took the ring to Marks and Morgan Jewelry store in Ft. Walton Beach to have the ring repaired.. The custom-made ring was identified by photographs taken at the Ft. Walton Beach jewelry store.
Around the same time the couple filed the insurance claim, the store manager of the Jewelry store told authorities she witnessed the ring for sale on Craigslist and that she was positive that it was the same ring in question because she was the one who custom made the ring. The couple told her that the ring had not been stolen, but was eaten by a dog and was later recovered.
A month after the couple filed the insurance claim, Hill called the insurance company to report that the ring had been recovered. The insurance company then advised that the ring or the check must be returned. Three days after Hill informed the insurance company of the recovery, she changed her story once again, stating that it was actually a different ring that was recovered.
The insurance company told state investigators that neither the ring nor the insurance proceeds were ever returned by the couple.
On August 13, 2015, The Florida Department of Financial Services Division of Insurance Fraud (DIF) announced multiple arrests related to a large scale personal injury protection fraud scheme across the Central Florida region.
According to the Orlando Business Journal, DIF and the Federal Bureau of Investigation (FBI) partnered to investigate two clinics, First Medical Rehab of Bradenton and Kirkman Family Chiropractic Care in Orlando. Their investigation led to the arrest of five people, arrest warrants issued for three additional people, and three related arrests in the Fort Myers area. Insurance carriers and former patients raised allegations of possible illegal activity happening at these two personal injury clinics.
The Kirkman Family Chiropractic investigation disclosed their plot of bypassing clinic licensure requirements set by the Agency for Health Care Administration. Co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only because licensed health care professionals can operate clinics without the necessity of an additional clinic license. To date, more than $100,000 in fraudulent claims have been paid by multiple insurance carriers.
The charges varied depending on each individual’s alleged role which included: patient brokering, conspiracy to commit patient brokering, false and fraudulent insurance claims, solicitation, grand theft, organized scheme to defraud and conspiracy to commit insurance fraud. All individuals arrested, if convicted can face anywhere from five to 30 years in prison as well as face fines as large as $10,000.
Click here for the full story.
On August 12, 2015, an undercover operation led to the arrest of three Bradenton clinic operators and a search for another suspect for insurance fraud charges, according to the Bradenton Herald. The Florida Division of Insurance Fraud (DIF) began investigating the First Medical & Rehab clinic in an undercover operation in March.
Investigators found evidence of the clinic paying people involved in automobile accidents to report that they had specific procedures done that were later billed to the insurance company.
DFS collaborated with Farmers Insurance to purchase a fictitious policy and expose the insurance fraud at the clinic. These three arrests were part of a greater scheme of arrests that took place statewide, resulting in a total of six arrests in Fort Myers and two in Orlando.
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On August 5, 2015, four South Florida men were arrested for their alleged involvement in insurance- billing fraud cases. According to The Florida Department of Financial Service’s Division of Insurance Fraud (DIF), they have been accused of orchestrating crashes and processing phony claims roughly totaling $145,000.
The first individual arrested was Nayef Casas Diaz, the owner of M&N Rehabilitation Center in Miami. According to DIF, Casas was charged for conspiring with bystanders to crash cars, call the police, and collect insurance money. There are suspicions that he paid the participants $1,000 each to receive treatment at M&N Rehab and another rehab facility. The insurance company paid a total of $63,000.
The second and third individuals arrested Alexis A. Gonzalez and Erik A. Perez, directed an undercover state insurance-fraud agent to pose as a patient and sign documents for treatment that was never carried out. The undercover agent was given $1,000 compensation while the total arrangement produced over $11,000 in claims.
According to the State of Florida, the last offender, Vicente Ortiz Alpizar, was arrested for staging an accident resulting in over $70,000 in false claims. He is accused of receiving $1,500 from A&J Rehabilitation Center and D&J Rehabilitation Center in Miami, FL and received unnecessary treatments following these staged accidents.
Click here to read press release from the Florida Department of Financial Services.
On August 4, 2015, WFLA News Channel 8 showcased private investigator Paul Colbert’s methods of hunting down workers compensation fraud suspects through the use of the most cutting-edge technology of our time, remote robotic cameras and drones.
According to WFLA, Colbert has witnessed first hand how beneficial this technology has proven to be. These built-in “hidden cameras” have the ability to detect motion, follow targets and even zoom in without the touch of a button. Colbert showed live video clip feeds of “disabled” workers throwing footballs, doing yard work, walking around without assistance and even lifting heavy loads after claiming they were far too “disabled” to attempt such things. According to Colbert, these false claims are sheer examples of incidents that these machines are aimed at eradicating. Every year workers compensation fraud costs each of us $1,000 to promote as a deterrent to such fraudulent acts per industry statistics.
Colbert understands that his surveillance approach can seem very unconventional, but believes this breakthrough technology can have the capacity to save companies thousands of dollars on fake or exaggerated workers compensation injury claims.
Please click here for the full story.