Florida Decision States That Uber Drivers Are Independent Contractors

On December 3, 2015, the Florida Department of Economic Opportunity (DEO) determined that Uber drivers in Florida will be considered independent contractors rather than employees. This reverses an earlier state decision and shows the State’s position in a countrywide debate regarding the classification of Uber drivers.

Executive Director of the DEO, Jesse Panuccio, stated in his decision that “Technology is allowing hundreds of thousands of people to go into business for themselves. Those in business for themselves may not have the same guarantees and benefits of those in the employ of others, but there are many other benefits of being your own boss. …Technological advances are opening up that dream to many more people, and we should not malign (or perhaps misclassify) that trend as worker misclassification.” This decision means that the San Francisco-based company can avoid paying drivers’ unemployment benefits, workers’ compensation and other employee-related costs.

This decision follows Uber’s appeal of a prior state revenue department decision in May, which dealt with the classification of former Uber drivers Darrin McGillis and Melissa Ewers as company employees, entitling them to unemployment benefits after Uber dismissed them from the service. Darrin McGillis states that he is planning to appeal the decision to the District Court of Appeals.

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Filed under Fla. Stat. 627.736 (2008)

Lyft Sued for Wrongful Death Over Miami Crash

On November 18,2015, a Miami widow of a car crash victim sued Lyft for alleged negligence leading to the wrongful death of a motorcyclist. The widow is alleging that the ride-hailing company failed to properly train the driver that caused the fatal accident.

Poliana Perez, whose husband Loinier Perez was killed while riding his motorcycle on October 31, believes that Lyft Florida Inc. is liable for the crash caused by driver Pirooz Pakdel. Pakdel was carrying a pair of Lyft passengers when he allegedly made an improper left-hand turn and rammed into Loinier Perez.

Perez’s attorney, Ervin Gonzalez of Colson Hicks Eidson, stated that “Lyft, which isn’t even authorized to operate in Miami-Dade County, fell far short of its obligation to act in the best interests of public safety and an innocent life was taken.” The suit alleges that Lyft knew or should have known that Pakdel was not properly trained or suited for the job. The San Franciso-based Lyft allows passengers to use a smartphone app to hail rides from drivers in their personal cars.

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Filed under Fla. Stat. 627.736 (2008)

Four Miami Residents Sentenced for Their Roles in $63 million HealthCare Fraud Scheme

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.

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Filed under Florida, Insurance Fraud

Four Sentenced For $126 million Florida Healthcare Fraud

Four individuals were sentenced on October 29, 2015 in Florida Federal court for their roles in a large complex scheme to rip off the city of Miami, Miami-Dade County Public Schools and numerous major companies for approximately $126 million in false healthcare claims.

The four major defendants in the case were Hendris Castillo Morales, 33, of Miami; Maite Garcia, 40, of Hialeah; Osvaldo Marin Medina, 48, of Hialeah; and Alejandro Biart, 40, of Miami. They were among 15 individuals who have pled guilty, out of 18 charged in connection with the scheme, according to the U.S. Department of Justice.

U.S. District Court Judge Robert N. Scola handed down prison terms to Castillo for a total of 121 months and Garcia for 48 months. Prosecutors stated that Castillo and Garcia were among four defendants who owned and controlled 30 companies at the heart of the scheme in the Miami area. According to prosecutors, the two used medical director staging companies to misappropriate doctors’ licensing information, which they used to submit false claims to insurers.

Judge Scola set a requirement for both Castillo and Garcia of three years of supervised release. They were also ordered to pay more than $13.8 million in restitution.

In a separate case, U.S. District Judge Urusla Ungaro sentenced both Biart and Medina to 41 months in prison followed by three years of supervised release.

Biart was accused of accepting kickbacks from other defendants in return for referring Cigna, Blue Cross Blue Shield and United Healthcare beneficiaries to medical clinics controlled by Castillo, Garcia and co-defendants Rynaldo Castillo and Lizbet Castillo Batista.

Medina was accused of accepting payments in return for allowing his name to be used to incorporate clinics, open bank accounts and cash checks received from Cigna, Blue Cross Blue Shield and United Healthcare.

Click here to read article.

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Filed under Miami-Dade Fraud

Broward County Chiropractor Arrested for $1.5 Million Insurance Fraud Scam

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.


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Filed under Insurance Fraud

State Charges Couple with Insurance Fraud Over $15K Engagement Ring

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.


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Filed under Insurance Fraud

Two Men Convicted in Federal Court for Insurance Fraud

On October 13th, Janio and Jharildan “Harold” Vico were convicted of a total of 16 charges including 12 counts of mail fraud, two counts of money-laundering, conspiracy to commit money-laundering, and conspiracy to commit wire fraud. A federal jury deliberated for approximately two hours before finding the brothers guilty, according to a palmbeachpost.com article. The conviction arises out of the brothers’ ownership and operation of the V&V Rehabilitation Center, located on 10th Avenue North, Lake Worth, Florida, from 2009 until 2011. Janio and Jharildan Vico staged traffic accidents and then billed insurance companies for fake injuries, which were treated at their Lake Worth clinic. The scheme brought in approximately $3 million for the two brothers.

Assistant U.S. Attorney Ellen Cohen is seeking for the brothers to forfeit nearly $400,000 and homes they purchased with proceeds received from the fraud. The brothers can face up to a maximum sentence of 20-years for the most serious charges. The sentencing hearing is set for January 8, 2016.

Click here to read article.


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Filed under Insurance