Water-Loss Claims Hurt South Florida Homeowners

According to an August 25, 2015 article in the Sun Sentinel, South Florida Citizens Property Insurance Co. customers will see a rate increase in their homeowners’ insurance rates. The insurance company stated that South Florida policy holders must pay for the increase in water-loss claims in the region. Citizens pointed out that Miami-Dade, Broward, and Palm Beach counties had a “disturbing rise in water claims and litigation,” which leads many to believe that this is a result of fraudulent claims. Citizens CEO, Barry Gilway, stated that “When you take a look at Miami-Dade and you take a look at the rest of the state, there’s really no major differences in age of the home or frankly, virtually any other characteristic,” which concludes that “there is more fraud.”

According to Gilway, “Water losses are the major reason Citizens is seeking rate hikes for the upcoming year, especially in South Florida. Were it not for water loss, even South Florida policy holders would see rate reductions.” Citizens pointed out that the other counties in the state of Florida will see a rate decrease in their Citizens homeowners insurance.

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Filed under Citizens Property Insurance Co.

Broward Health Offers $69.5 Million to Settle Federal Fraud Probe

Broward Health offered to pay $69.5 million to settle a four-year old federal investigation regarding allegations of massive Medicare and Medicaid fraud. According to an August 21, 2015 post by the FloridaBulldog.org, the settlement was offered on August 20, 2015 after a unanimous vote by Broward Commissioners.  The Commissioners offered no public explanation for their decision or how the settlement offer will affect Broward Health’s operations.

The federal investigation into Broward Health began in May 2011, when the U.S. Department of Health and Human Services (HHS) agents subpoenaed Broward Health records regarding a number of doctors, including medical directors associated with the company’s orthopedic, sports medicine and cardiology practices. However, details of the government’s case against Broward Health remain secret. The only known information regarding the case is that the investigation started based on a complaint brought by an unidentified whistleblower.

Broward Health’s settlement offer, if accepted by the government, would be the second largest settlement offered by a large Florida hospital system for a federal probe.

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Filed under Fla. Stat. 627.736 (2008)

Insurance Companies Are Using Drones Instead of Insurance Adjusters

According to a July 24, 2015 article in the Boston Business Journal, the Federal Aviation Administration (FAA) granted Liberty Mutual Insurance permission to use four types of drones of varying sizes with several conditions regarding the use of the drones. The drones cannot ascend more than 400 feet off the ground and travel no more than 100 miles per hour. The FAA stated that the drones are small and do not weigh more than 55 pounds.

Liberty Mutual Insurance plans to use these drones to photograph houses and businesses damaged by fires or natural disasters for some claims, in place of manned planes or adjusters on ladders.  According to spokesman Glenn Greenberg, Liberty Mutual plans to begin using the drones later this year “on a limited basis.” The drones will initially be used to inspect sites damaged in hurricanes and other large-scale natural disasters, which will help adjusters assess a wide area of damage in a relatively short amount of time.

According to Liberty Mutual, the drones will help protect and keep their claims adjusters and contractors safer since they will not have to risk piloting planes or falling off ladders during roof inspections. Greenberg stated that “they are very excited by this technology that helps our claims professionals more safely help our customers after a loss.” The drones will also provide the insurer with higher-quality photos.

State Farm and AIG have recently received FAA approval to use drones as well. The FAA is asking that the insurance companies have both a visual observer and a pilot with a commercial, private, or other flying certificate to monitor the drone’s flight.

Click here for article.


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Filed under Technology

GEICO Sues Medical Providers Over $5.7M In False Claims

According to an August 18, 2015, Law360 article, GEICO General Insurance Co.  has filed suit against several alleged fraudulent medical companies and their owners for over $5.74 million in paid and pending claims for various medical and physical therapy services provided to auto accident victims in New York.

GEICO is claiming that the individuals running the fraudulent scheme bought medical licenses from doctors and used them to make several medical providers appear legitimate. GEICO is asking the court to recover $2.74 million in no-fault insurance claims that the company has already paid into the alleged scheme and is seeking a judgement that the company does not have to pay the $3 million it still owes.

GEICO is arguing that it should not be required to pay the $3 million it still owes because the providers were fraudulently incorporated and illegally owned by nonmedical professionals.  The services provided in scheme were done by unlicensed independent contractors, and the billing codes for the services provided were misrepresented and exaggerated to inflate the submitted charges.

The suit names the following companies:

  • LLJ Therapeutic Services PT PC
  • Dunamis Rehab PT PC
  • Synoptic Physical Therapy PC
  • Rehab Choice Corp.
  • NR Motion PT PC
  • Rehabxpress PT PC
  • Rom Medical PC

Click here for full story (subscription required).


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Filed under auto insurance fraud

Central Florida Personal Injury Protection Fraud Investigation Comes to an End

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.

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Filed under Insurance Fraud, Personal Injury Protection

Undercover Agents Arrest Bradenton Clinic Operators for Insurance Fraud

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.

Click here for the full story.

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Filed under Insurance Fraud

South Florida Men Arrested For Insurance-Billing Fraud

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.

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Filed under auto insurance fraud, Insurance Fraud