Category Archives: Insurance Fraud

Fraud Charges Filed in West Palm Beach False Insurance Claim Case

The fact that Frank Assouman was not even in his truck at the time it was hit in a Boca Raton parking lot did not stop him from filing more than $25,000 in false insurance claims.

The crash report and a witness statement taken at the time of the accident indicate that the West Palm Beach resident was not in his parked vehicle when it was struck by another driver. Damage to Assouman’s vehicle was estimated at $1,500.

Days later he sought medical care, including an MRI at Delray Diagnostics and other treatment obtained from Modern Medicine, Inc.

In addition to filing a claim for property damage, Assouman reportedly filed a $21,815 injury claim with State Farm and a $3,035 claim with his own carrier of Windhaven Insurance.  Both claims were denied.

The Florida Division of Insurance Fraud filed a fraud charge against Assouman for less than $20,000.

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Vehicular Arson Cases Climbing Nationwide

The slow economy could be contributing to an increase in claims involving auto fires, according to an official with the Washington, D.C.-based Coalition Against Insurance Fraud.

“Common sense tells you that more desperate people will take more desperate measures to get themselves out of trouble,” said Coalition representative James Quiggle in a News 4 I-Team report.

Cracking the case on vehicular arson is difficult to prove in court, as Maryland officials are discovering. Of more than 2,000 suspected auto arsons in the state during 2013, fewer than 50 cases had sufficient evidence to turn the matter over to prosecutors.

Findings from a 2009 report of the U.S. Fire Administration’s (USFA’s) National Fire Incident Reporting System (NFIRS) reveal the following:

  • Approximately 10 percent of all vehicle fires are intentionally set.
  • Intentional vehicle fires are at their highest during the summer, with a July peak.
  • Matches are the leading heat source (20 percent) of intentionally set vehicle fires.
  • Vehicle seats (34 percent) and uncontained fuel (14 percent) represent the starting point of many intentionally set vehicle fires.

Arson generally has a low clearance rate, according to crime reports from the U.S. Department of Justice. Arson involving motor vehicles, which represent 20 percent of all arson cases, have a particularly low closure rate of approximately 7.4 percent nationwide.

The Florida Department of Law Enforcement statistics indicate that motor vehicle arson may not be a major concern in the state, with fewer than 300 cases of auto arson reported for 2012.

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

Woman Arrested for Forging Doctors’ Signatures to File $80,000 in Fraudulent Medical Insurance Claims

A Florida woman, who recently moved to Georgia with her family, had racked up more than $80,000 in false medical insurance claims when she was arrested last week.

According to a news release by Florida Chief Financial Officer Jeff Atwater, Tawania Weekley faces 80 different criminal counts after illegally filing claims for emergency room care, hospital stays, medical equipment, and multiple medical tests including MRIs, EKGs and x-rays that were never performed.

Weekley’s insurance carriers tipped off the Department of Financial Services’ Division of Insurance Fraud (DIF).

A subsequent investigation uncovered a plan where Weekley doctored and created new medical claim forms with forged physicians’ signatures, and then submitted those documents for reimbursement under her accidental and cancer indemnity policies.

The DIF found that she filed a total of 20 claims under the accidental policy for herself and immediate family members, and one additional claim under the cancer policy for herself.

“Every fraudulent claim drives up the cost of insurance in Florida,” CFO Atwater said. “I’m grateful to our investigative team and partners for working tirelessly to protect the hard working and honest people of Florida from harmful acts of fraud.”

DIF investigators worked with the Grady County Sheriff’s Office in Cairo, Georgia, to make Weekley’s arrest. She remains in jail while awaiting extradition to Florida.

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Fraudulent PIP Billings of $80K Lead to Fort Lauderdale Arrests

Three Fort Lauderdale residents—Claudio Boyett, Leslie Sanchez Martinez and Claudia Hoy—were arrested for participating in a staged accident that resulted in the submission of $80,000 in fraudulent PIP claims, according to Florida Chief Financial Officer Jeff Atwater.

The three participants allegedly staged an accident involving a U-Haul truck, which hit a parked Dodge Caravan carrying eight occupants. Fraudulent claims were then filed with multiple clinics across South Florida. More arrests are expected in the case.

In other PIP fraud news across the state, David Torres was convicted for his work as a recruiter on behalf of the Indian Rehabilitation Center in Jacksonville. He was charged with eight counts involving a staged accident. Torres was ordered to repay $109,000 in restitution to eight insurance companies, and will serve five years in jail.

“PIP fraud schemes drive up auto insurance rates for all Floridians, which is why we are working day and night to prevent it from happening in the future and hold the fraudsters who have broken the law accountable,” said CFO Atwater.

The Florida Department of Financial Services reports that it has made almost 2,000 PIP fraud arrests since early 2011. Convictions are up 17% for the current fiscal year, with a total of 1,225 to date.

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“Family & Friends” Staged Accident Ring Uncovered in Duval County

A couple faces 20 years in prison as a result of their participation in a PIP insurance fraud scheme which involved staging a car accident, and subsequently collecting money from the false insurance claims they filed.

Jose Alberto Velez, 30, and April Rosita Wynn, 23, were both convicted of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims, according to a news release issued by the Office of the State Attorney for the Fourth Judicial Circuit of Florida.

Their convictions stem from a staged car crash that happened in May 2012, the same year that the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) began investigating a series of questionable car accidents in Duval County.

Their investigation uncovered a larger Personal Injury Protection (PIP) insurance fraud scheme where nearly 100 individuals have been arrested over the past 18 months.

It was discovered that Velez and Wynn, who are now married, persuaded family and friends to participate in their staged car crashes. After the accidents, Velez, Wynn and their accomplices would go to designated rehabilitation clinics that would provide mock therapy for fictional injuries, and then file PIP claims through those clinics.

One of the ringleaders of the scheme, David Rodriguez Lopez, was sentenced to 15 years on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash. Other cases resulting from the investigation are currently pending.

Besides their present charges, Velez and Wynn are still awaiting other charges for allegedly staging additional accidents. They will be sentenced the week of July 28.

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Three Arrests Made in Connection to a Fort Lauderdale Staged Auto Crash

Three people in Fort Lauderdale have been arrested for their involvement in staging an auto accident in a church parking lot in order to collect $80,000 from an insurance company, a June 19 article in the Sun Sentinel said.

According to police records, Claudio Boyett, 44, Leslie Martinez, 45, and Claudia Hoy, 31, all of Fort Lauderdale, are accused of grand theft and insurance fraud. Boyett was arrested earlier this week while the other two were arrested last week.

A report from Florida’s Division of Insurance Fraud showed a U-Haul truck struck a Dodge Caravan in the parking lot of the Pare De Sufrir Church on August 7, 2012. Martinez was driving the Caravan, which had Hoy and six others as passengers. Boyett struck the van with the U-Haul he was driving, the report said.

After the accident, Martinez, Hoy and Boyett allegedly went for medical treatment and filed a personal injury protection claim with United Auto Insurance worth $80,000, according to insurance company investigators.

Officials from the insurance company said investigators found that one witness was offered $1,500 for the use of her Caravan; another acknowledged the accident was staged.

These arrests have come as a result of Operation Sledgehammer, the effort between the FBI and state authorities which launched three years ago to crack down on insurance fraud from staged auto accidents.

According to the story, investigators have found almost $20 million in illegal payouts and have charged almost 100 people in Broward, Palm Beach and Miami-Dade counties. Also, $5 million in restitution has been ordered to be paid back to insurers by some of those convicted.

These types of efforts have been making an impact in Florida, according to a study by the nonprofit National Insurance Crime Bureau. The organization has found fraudulent claims from staged crashes have actually been falling since Florida’s PIP reform has been enacted in the past two years, as our FL-PIP Blog reported in March.

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Another Staged Accident Story Reminds Drivers to be Alert to Florida Auto Insurance Scams

Florida State Rep. Jim Boyd, R-Bradenton, helped pass legislation in 2012 aimed at reducing the tremendous number of staged accidents and injuries in the state, and deter claims made after accidents in which victims had not even been present.

Once estimated as a billion-dollar industry in Florida due to the ease of receiving PIP payouts from insurance companies, Boyd’s changes helped strengthen requirements for medical evidence and stipulated that police reports list everyone involved, including all of the passengers.

Credited with reducing personal injury insurance costs and premiums, Boyd feels that the updated law put a dent in a serious problem where opportunistic scam artists still turn dents and dings into major injuries.

One such example of heavy-duty suspicions stemming from a marginal accident was featured in a recent Tom Lyons’ column in the Herald-Tribune.

In Lyons’ piece, a Sarasota retiree was supposedly involved in an accident when backing out of an on-street parking spot. This driver felt the accident was so small that he wasn’t even sure it happened. However, the driver of the other car claimed that he caused the collision and filed a police report. The retiree was issued a ticket.

He later found out from his insurance company that the woman driving the other car filed an insurance report claiming she and her passenger suffered trauma and were feeling pain in their neck, legs and back. The retiree says, “his insurance company is about to take a hit, but he’s not at all sure it is a legitimate one.”

Some unscrupulous staged accident rings rely on each other to carry out these scenarios to receive insurance reimbursement, according to the article. Although some parties face charges in the end, it isn’t easy to know when someone is faking an injury. It is even harder, as demonstrated in the retiree’s case, to prove the circumstances surrounding the injury are bogus.

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

Insurance Scammers Target Unsuspecting Drivers in Staged Auto Accidents

It could happen to anyone. A stopped driver waves you on and then slams into your car, causing an accident that looks like it’s your fault and has produced injuries.

A recent story on News4Jax.com revealed how insurance scammers did just that to two victims, both of whom found themselves in the midst of staged accidents either when driving in traffic or pulling out of a parking spot.

One of those victims was one of 80 targeted by a group of schemers, according to postal inspectors.  Total losses in this case came to $130,000.

Drivers who are involved in an accident that seems like it may have been staged are advised to make careful records. Although inspectors say these aren’t easy scams to avoid, they recommend documenting details—both the accident victims and any vehicles at the scene—with photos and video if possible.

The Coalition Against Insurance Fraud provides different scenarios that scammers typically use to stage auto accidents. The organization’s site also provides steps innocent drivers can take to prepare themselves and fight back.

One suggestion is that a driver count how many passengers are in the other car, get their names, phone numbers and driver’s licenses. Accident victims are also advised to get the other car’s license number, and to take cell phone photos of the damage caused to both cars, as well as the passengers in the other car.

 

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Three PIP Scammers Sentenced in Jacksonville Fraud Scheme

Three men, who staged car crashes and subsequently filed false Personal Injury Protection (PIP) claims through rehab clinics, were recently sentenced to multiple years in prison for their role in an insurance fraud scheme based in Jacksonville.

According to a news story on News4Jax.com, the defendants were described as “mid-level recruiters,” who were arrested as part of a larger scheme that investigators from the Division of Insurance Fraud and State Attorney’s Office first uncovered in 2012. More than 20 people were arrested as a result of this investigation.

The participants would fake accidents and then go to clinics that prosecutors say were owned by the organizers of this scheme. These clinics provided bogus treatment for non-existent injuries.

George Orlando Ortiz Jr., 33, was sentenced to 9½ years in prison. He pleaded guilty to four counts of committing a staged motor vehicle accident, false insurance claims and schemes to defraud.

Also getting sentences were Noylan Barreto, 21, who received a three-year prison term and 10 years probation on two counts of committing a staged motor vehicle accident and one count of false insurance claims, and Freddie Alberto Freytes, 43, who received six years in prison on two counts of committing a staged motor vehicle accident and three counts of false insurance claims.

Insurance companies ran up a tab of more than $150,000 in claims resulting from accidents involving Ortiz, Barreto and Freytes.

Ringleader David Rodriguez Lopez, who we wrote about in our FL-PIP blog on December 11, 2013, was convicted and sentenced to 15 years in prison on charges of: schemes to defraud over $50,000, filing false insurance claims totaling over $100,000, and helping stage a deliberate automobile accident.

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Hollywood Police Look for Insurance Fraud during Traffic Stops

Broward County drivers traveling through Hollywood may be part of routine traffic stops that police are conducting throughout Wednesday to make sure drivers have appropriate auto insurance.

According to an article in the May 28 Sun Sentinel, agents from more than 20 insurance companies are helping police officers spot fake documents.

The joint operation between the National Insurance Crime Bureau and Hollywood Police aims to check drivers and crackdown on insurance fraud, which occurs in about one in every four drivers in Florida, the Insurance Research Council (IRC) says.

Penalties will vary with the level of the offense. Motorists with expired insurance cards are likely to receive a citation. Arrests may be in store for drivers with fraudulently altered insurance documents, according to officials.

Florida is one of the leaders in insurance fraud. According to the IRC, almost 24 percent of all Florida drivers don’t carry auto insurance, putting it in the top five states.

Operations like this one will help to drive down insurance rates and ensure coverage for those involved in auto accidents, the article explained.

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