Two more arrests were made as a result of a personal injury protection (PIP) fraud scheme in Manatee County involving patient brokering. The arrests of Nerber A. Iglesias, 40, and Michael Borkowski, 42, were the result of an undercover sting, according to an announcement made by Florida Chief Financial Officer Jeff Atwater.
According to the Claims Journal report:
An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Iglesias approached a Sarasota chiropractor about becoming the straw owner of Garden Relief Center, LLC. The chiropractor contacted law enforcement and, under the direction of the department, applied for a clinic exemption certificate to begin operating the facility. The chiropractor, working undercover, was also contacted by a local body shop owner named Michael Borkowski, who made arrangements to provide accident patients to the clinic for a fee. During the course of the investigation, Garden Relief Center submitted almost $40,000 in fraudulent insurance claims to six different insurance companies.
The full article is available here.
Tampa Bay Fox 13 recently featured a segment regarding the effect of House Bill 119, the 2012 PIP law change, on PIP premium rates. Lynne McChristian of the Insurance Information Institute, shed some light what appears to be a lack of a premium decrease. McChristian indicates that the recent insurer reports are not indicative of what could likely be the case after January 1, 2013, when all of HB119′s changes take effect.
Maria “Cary” Molina of West Palm beach plead guilty to one count of “mail fraud conspiracy” in Federal court last Thursday. Molina was accused of perpetrating an insurance fraud scheme at two chiropractic clinics, OVY Rehabilitation Medical Center and HHR Medical Center, where Molina served as an office manager. Records indicate Molina submitted bills for individuals known to be involved in staged motor vehicle accidents. Prosecutors stated that the clinics received $540,000 from PIP insurers as a result of the fraud.
Molina’s co-defendant, Obelio “Ovy” Rodriguez, 43, has been declared a fugitive.
The full report from the Sun-Sentinel is available here.
Florida’s Chief Financial Officer, Jeff Atwater, announced Tuesday that eight individuals involved in multiple staged accidents in Miami-Dade County were connected to six different PIP fraud rings. The press release from the the CFO states:
An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Alexander Cid, 47; Luis Rivero Dominguez, 35; Franklyn Chaviano, 38; Robert E Bayona, 55; Carlos Padron Fernandez, 38; Yosmel Ramos Peraza, 24; Andres Vega Fleites, 61; and Jorge Fernandez Rodriguez, 52, participated in staged accidents in coordination with six fraud rings as organizers or drivers between May 2009 to May 2011.
The staged auto accidents resulted in more than $340,000 in fraudulent auto insurance claims. If convicted, the eight individuals involved could serve a total of 455 years in prison.
The Division of Insurance Fraud (DIF) recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity.
The full press release is available here.
Joseph Wagner, a Volusia County chiropractor accused of prescribing pain killers and muscle relaxers to patients under other doctors’ names, has plead guilty to Federal charges on Tuesday.
Reports indicate that Wagner, who operated Wagner Chiropractic & Acupuncture Clinic on North Ridgewood Avenue, has been under investigation since 2009 when auto insurers began reporting the provider for billing services that were never performed. Investigators discovered Wagner was committing insurance fraud and illegally distributing drugs by using the Drug Enforcement Administration number and name of another physician. Wagner was not permitted to prescribe drugs as he was a chiropractor and not a licensed Florida medical doctor.
In July 2010, one of Wagner’s patients overdosed within days of being prescribed painkillers, muscle relaxers and anti-anxiety drugs. Reports indicate that the patient did survive. Part of Wagner’s fraud scheme involved submitting fake billings in the names of other, presumably properly licensed, doctors. Prosecutors say that the the insurance company reimbursements were then split between those doctors and Wagner. Wagner was indicted on 95 charges and plead guilty to three counts on Tuesday: healthcare fraud, conspiracy to distribute controlled substances and transactional money laundering.
The full article from the Orlando Sentinel is available here.
Donovan Brown, state government relations counsel for the Property Casualty Insurers Association of America (PCI), recently issued a statement in response to the Office of Insurance Regulation’s (OIR) recent analysis of the Pinnacle Actuarial Resources, Inc. impact report on Florida’s new PIP law.
In the statement Brown emphasizes patience with the expected results of the new law.
PCI has ongoing concerns with the study’s conclusions and the fact that they are based on a law which does not fully take effect until next year. Although we commend Pinnacle for its diligent and thorough work, the study cannot anticipate changes to Florida’s legal, social or economic environment which will directly influence the impact of the new PIP law. The study also cannot calculate the scope of detrimental challenges to the new PIP law that will be filed by plaintiffs’ attorneys or the manner and extent to which corrupt providers will attempt to game the system. In addition, we note that the study cannot foresee the overall impact the PIP law may have on the Bodily Injury and Uninsured Motorist portions of drivers’ auto policies.
Therefore, in order for the new PIP law to achieve its potential, PCI encourages policymakers, regulators and Florida drivers to allow the law adequate time to take effect. PCI also urges policymakers to protect the law from any distortion that will negatively impact its ability to deter fraud and abuse in the PIP system. As with any comprehensive legislative package, there will be implementation processes and other issues that must be addressed in order for the PIP law to attempt to stabilize our auto insurance market.
The full press release is available here.
On Friday authorities arrested arrested Robbie N. Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging located in North Miami Beach for alleged PIP fraud. The two are accused of operating an unlicensed accident clinic and fraudulently billing more than $1.5 million in auto-related claims to insurance companies.
Specifically the owners of Sky Imaging lacked licensing from the Agency of Healthcare Administration (AHCA) and instead enlisted a medical doctor to sign paperwork and pose as the clinic owner to qualify to bill Florida PIP insurers.
The article from the SunSentinel is available here.