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.
Roig Lawyers attorney Miguel R. Roura will present “Emerging Trends in PIP SIU” to a national insurance carrier in Tampa on August 5, 2015.
The presentation will educate adjusters on recent SIU trends, help identify fraud, and discuss various investigative tools used to fight fraud. Also, the presentation will review caselaw which will aid adjusters in determining what issues and facts create a solid or weak defense.
Miguel concentrates his practice in the areas of Personal Injury Protection (PIP)/No-Fault litigation and fraud (SIU) investigations. He also defends clients in cases involving bodily injury, uninsured motorist, property damage, and general liability litigation. The identification and investigation of fraudulent claims represents a significant portion of Miguel’s practice.
Miguel is a graduate of Stetson University College of Law (J.D., 2008) and the University of Florida (B.A., 2004).
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.
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.
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.