Legislators Unlikely to Change Florida’s No-Fault Auto Insurance Law Right Now

Chief Financial Officer Jeff Atwater wants Florida’s legislators to continue to be patient before considering any rash actions that would change personal injury protection (PIP) coverage in the state. That’s because a recent report released by the state Office of Insurance Regulation (OIR) shows that increases in fraudulent PIP claims have basically been stopped.

The Florida Department of Financial Services is attributing these results to the passage HB 119, effective January 1, 2013, which created some exclusions for coverage under PIP insurance and limited for non-emergency conditions. The amended No-Fault Law excluded PIP reimbursements to massage therapists and acupuncturists, and also required individuals involved in car crashes to seek treatment within 14 days of a motor vehicle accident. PIP allows up to $10,000 in benefits for emergency medical conditions, but places a $2,500 cap on non-emergency conditions. It is mandatory for all Florida drivers to carry PIP.

According to a story in the Sun-Sentinel on January 7, the law set benchmarks for insurance carriers to lower rates. The OIR report showed that from 2011 through September 2014, the average medical cost paid through PIP claims dropped 14 percent statewide.  In South Florida, a hotspot of fraudulent PIP activity, the average payment decreased 28.7 percent, the article reported.

However, it is thought that these numbers are too preliminary and do not show the full impact of the law, yet.

House Insurance & Banking Chairman John Wood, R-Winter Haven, noted in the article that he would be “surprised if there was ‘major’ PIP legislation before the issue is settled in court.”

Senate Banking and Insurance Chairwoman Lizbeth Benacquisto, R-Fort Myers, said that she is still reviewing the OIR report, and likes to ensure that if changes are made, they have “a very positive effect on policyholders and our constituents.”

The annual legislative session begins in March.

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Filed under Fla. Stat. 627.736 (2012), Insurance Fraud

Staged Accident Organizer Arrested in Orlando

A 41-year old from Orlando, who was at the center of an alleged staged vehicle accident which occurred in 2013, was recently apprehended by the Florida Division of Insurance Fraud (DIF).

Jean Severe was arrested in November for organizing the fake crash.  According to DIF, participants were sent to Florida Chiro & Rehab Center for unnecessary medical treatment of their bogus injuries.  The scheme resulted in more than $6,000 in false claims filed with insurers Allstate and GEICO.

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Filed under Insurance Fraud

Separate PIP Fraud Cases Lead to Three Jacksonville Arrests

Three individuals from the Jacksonville area, who have allegedly been involved in personal injury protection (PIP) fraud schemes, have recently been arrested by the Division of Insurance Fraud (DIF) in separate cases.

The first individual apprehended was Walter Juarez Lopez, who owned and operated Therapy Diagnostic Tech Medical.  According to DIF, the 42-year old helped organize staged accidents in 2011, in which participants were sent to his clinic as well as Arlington Rehabilitation Services. His role in the scheme resulted in more than $32,000 in fraudulent claims, DIF said.

Also arrested in November was Jose Burgos who organized a fake crash for insurance money in 2012.  The 40-year old, who sent participants to One Touch Therapy Center, was tied to more than $31,000 in false claims, DIF reported.

Last but not least, Edwin Edgardo Martinez-Rodriguez, 46, was also nabbed for his role as a staged accident organizer.  In 2012, he organized a fake accident that resulted in more than $16,000 in false claims made by Gate Parkway Diagnostic Center and Wellness Rehab Services, LLC, according to DIF.

Fraudulent claims were submitted to several insurance companies including Direct General, Esurance, GEICO, Infinity, Progressive, State Farm and Travelers.

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Filed under Insurance Fraud

Mario Rene Ruiz added to Florida Division of Insurance Fraud’s Most Wanted Fugitive List

A post on our December 1st FL-PIP Guide reported that five individuals were arrested for their roles in an alleged staged accident scam in 2012 that resulted in fraudulent Personal Injury Protection (PIP) claims costing three insurance carriers almost $40,000.  The five cases will be prosecuted by the Broward State Attorney’s Office.

A sixth individual wanted in connection with this crime—Mario Rene Ruiz—has yet to be apprehended and is now considered a “Most Wanted Fugitive” for insurance fraud, the Division of Insurance Fraud (DIF) announced.

According to DIF, Ruiz has lived in Fort Lauderdale but may have returned to Honduras, his native country. The 32-year old reportedly measures 5’6” in height, weighs 152 lbs., and has brown eyes and hair.

Anyone with information regarding Mario Ruiz’s whereabouts is asked to contact DIF at 1-800-378-0445 or the Broward County Sheriff’s Office.  Tipsters can remain anonymous and may be eligible for a reward as part of the Florida Department of Financial Services’ Anti-Fraud Reward Program.

To date, the department has awarded almost $349,000 to nearly 60 citizens as part of its Anti-Fraud Reward Program, which rewards individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

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Filed under Insurance Fraud

DIF Arrests Miami-Dade Staged Accident Organizer

Ismael Govea Morales was detained and arrested in Miami-Dade County for organizing two staged accidents, the Division of Insurance Fraud (DIF) reported. He was booked at the county jail in Miami in November.

DIF’s investigation found that the 49-year old recruited participants for two staged accidents occurring in June and August of 2012. Participants in the scheme were referred to clinics in Miami including Beyond Care Corp, Med Life Medical Services, Union Medical Center, Cedar Valley Medical Group, Intensive Therapy and MS Medical Rehab Corp.

The clinics then billed six different insurance carriers—Geico, Kingsway Amigo, Progressive, State Farm, United Auto, and York Services—totaling more than $167,000 in fraudulent charges as a result.

In addition, 76-year old Manuel Alvarez, one of the participants in the June 2012 fake crash, was arrested in November.

This isn’t the first time Govea has been involved in a fraudulent scheme. In January 2013, DIF arrested him on charges of insurance fraud, grand theft, money laundering, organized scheme to defraud, and making false entries on books of corporation.

At that time, Govea was charged with a total of 363 counts for his role in a sophisticated insurance fraud scheme that involved a clinic in Hialeah. Unbeknownst to the true owners of this clinic, Prudential Diagnostic Center, Govea added his name as an officer to the corporation in 2011. The clinic incorporated in 2008, but later closed in 2009.

Govea used Prudential Diagnostic Center as the conduit for defrauding insurance carriers of more than $726,000 in fraudulent billings, according to DIF. He opened a mail drop to collect insurance checks, and between January and June of 2011, Govea allegedly used the corporation to submit billings to 27 different insurance carriers for MRI services that never took place, resulting in nearly $440,000 in payments.

At first, Govea cashed about $44,000 worth of checks through a bank account he opened under the corporation name, but later switched to a check cashing store in Coral Gables to cash the vast majority of the checks.

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Filed under Insurance Fraud

Boca Raton Medical Billing Company Members Indicted in Ohio Fraud

Seven people and a Florida medical billing company were indicted on December 17, 2014 for their roles in a multi-million dollar health care fraud conspiracy involving a controversial form of chiropractic manipulation, according to a news release by the U.S. Attorney’s Office for the Northern District of Ohio.

Members of the fraud scheme indicted are:

  • Physicians Surgical Group (PSG) of Boca Raton, Fla.
  • Christopher Liva, 36, of Boca Raton
  • Edward Liva, 64, father of Christopher Liva, based in Boca Raton
  • Carolyn Via, 51, of Boca Raton
  • Mark Fritz, age not provided, of Coral Springs
  • Three other medical professionals from Northeast Ohio

The Livas and Via owned PSG and were also part owners of Shaker Heights Surgical Center (SHSC), located in Ohio.  Fritz was chief financial officer at PSG.

The U.S. Attorney for the Northern District of Ohio alleged that, from 2007-2010, the defendants deceived various private insurance companies, bilking them out of millions of dollars on behalf of patients who underwent manipulations under anesthesia, a risky treatment that is normally reserved for those who have not responded to more conservative chiropractic treatment.  The procedure is classified as surgery by the American Medical Association, according to the indictment.

In order to defraud the insurance companies, the defendants disregarded actual diagnoses, created fake diagnoses, submitted false billing claims, and represented that the procedures were performed by medical doctors, when in fact they were performed by chiropractors.

Additionally, the indicted parties marketed SHSC and the experimental manipulation procedure to chiropractors in Ohio. Chiropractors were paid a flat fee of $4,000 for each patient they referred to SHSC, and the clinic waived patients’ co-pays and deductibles.  The clinic then typically submitted three types of claims to the insurance companies—for professional fees, facility fees, and fees for anesthesia services.

The Livas, Fritz, PSG, and the three Ohio medical professionals are charged with one count each of conspiracy, wire fraud, health care fraud, and money laundering.  The Livas and Via each face an additional count of money laundering.

Prosecutors are also seeking to seize property derived from the criminal conspiracy, including two properties in Boca Raton, money, a watch, and 4.18-karat diamond stud earrings.

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Filed under Insurance Fraud

Florida Needs 35 More Judges, Says Florida Supreme Court

The texting while driving law that took effect in October, 2013 is one of several reasons why the Florida judicial system needs 32 additional county court judges and three new circuit court judges, according to an annual Certification of Need for Additional Judges published December 22 by the Florida Supreme Court.

The recent news that Florida has surpassed New York to become the third largest state in the nation, while not cited by the Court, coincides with increasing pressure on the state’s judicial system.

The Florida Supreme Court analysis breaks down judicial needs by county, with the greatest number of county court certified judicial position recommendations as follows:

  • Three judges in the Fourth Circuit of Duval County (Jacksonville area)
  • Eight judges in the Eleventh Circuit of Miami-Dade County
  • Eight judges in the Thirteenth Circuit of Hillsborough County (Tampa area)
  • Five judges in the Fifteenth Circuit of Palm Beach County

A total of three circuit court judges are also suggested. One circuit court certified judicial position is requested for the First Judicial Circuit, which serves Escambia, Santa Rosa, Okaloosa, and Walton counties in northwest Florida. This circuit experiences a heavy criminal workload and a steady number of tobacco cases, according to the court analysis.

Two circuit court judicial positions are recommended for the Fifth Judicial Circuit, which encompasses Citrus, Hernando, Lake, Marion, and Sumter Counties. The Fifth circuit is the ninth most populous circuit with 5.5% of Florida’s population, according to the court.

There is no request for new judges in the District Courts of Appeal at this time

In its analysis, the Court cites recent trends in the volume and type of cases:

  • Six percent increase in probate filings
  • Nine percent increase in dependency filings
  • One percent increase in circuit civil filings (excluding real property)

The Court also reported declines in domestic relations filings (three percent), felony and juvenile delinquency filings (seven percent each).

The Florida Supreme Court request notes that judges across the state continue to bear the burden of increasing workloads after the number of support staff – including case managers, law clerks and magistrates – was reduced in earlier budget cut backs.

Click on the link to read the full annual Certification of Need for Additional Judges published December 22 by the Florida Supreme Court.

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Filed under Case Law, Fla. Stat. 627.736 (2008)