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 Insurance Fraud, auto insurance fraud

Roig Lawyers Attorneys Present on Regulatory Compliance

Roig Lawyers, a minority-owned, multi-practice litigation law firm dedicated to serving clients across six offices throughout Florida, is pleased to announce that Jessica Z. Martin, Partner (Deerfield Beach), and Dennis LaRosa, Healthcare Policy Advisor (Tallahassee), will present a program on August 11, 2015 to a national insurance carrier’s SIU Team in Orlando covering regulatory compliance as it relates to insurance defense.

“At Roig Lawyers we believe that continually updating and educating our lawyers is one of the most important aspects of a comprehensive PIP defense.  It is even more important that SIU’s stay on the cutting edge of new and innovative issues so that cases that come to defense counsel utilize the most current thought in the industry,” said Martin.

The presentation will cover specific topics such as medical director responsibilities and the implications of clinic licensing, and exemptions under current and newly enacted legislation together with innovative ideas in defending insurance law suits.  In recent years, regulatory compliance has become a significant tool for auto insurers in fighting personal injury protection fraud and abuse. It will also cover recent case law regarding Section 627.736(6)(b) requests for pre-suit discovery, and other investigative tools to obtain information regarding whether a clinic is operating lawfully.

Martin has been practicing since 2006 defending Personal Injury Protection (PIP)/No-Fault, bodily injury and uninsured/underinsured litigation and aiding insurance carriers with fraud (SIU) investigations, through Examinations Under Oath (EUO), Section 627.736(6)(c) Petitions/Motions for Discovery, and leading affirmative litigation against fraudulent medical providers. Martin is a skilled trial attorney and is also experienced in the use of alternative dispute resolution techniques, including mediation and arbitration, as a means of litigation avoidance. Martin joined the firm in 2002, became a licensed attorney in 2006, and the first female partner in the firm in 2009.

LaRosa has over 40 years experience in state licensing, including 10 years as a supervisor at the Agency for Health Care Administration implementing and overseeing health care clinic licensure and exemptions. LaRosa is a sought after speaker in discussing the relationship between state licensing and automobile insurance having made presentations to the Florida Bar, National Insurance Crime Bureau, the International Association of Special Investigative Units, attorneys and judges and has been a witness in numerous federal criminal and civil cases dealing with this subject.  While a practicing attorney, he prosecuted scores of administrative law cases, appeals, and represented the State of Florida in both state and federal courts on diverse issues ranging from taxation, state licensing, and environmental law to admiralty.  He has been a healthcare policy advisor with Roig Lawyers for the past two years.

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, community association law, corporate law, real estate, banking and finance, immigration, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

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Filed under Health care, insurance defense, PIP/No Fault

Drones Used to Detect Insurance Fraud

On August 4, 2015, WFLA News Channel 8 showcased private investigator Paul Colbert’s methods of hunting down workers compensation fraud suspects through the use of the most cutting-edge technology of our time, remote robotic cameras and drones.

According to WFLA, Colbert has witnessed first hand how beneficial this technology has proven to be. These built-in “hidden cameras” have the ability to detect motion, follow targets and even zoom in without the touch of a button. Colbert showed live video clip feeds of “disabled” workers throwing footballs, doing yard work, walking around without assistance and even lifting heavy loads after claiming they were far too “disabled” to attempt such things. According to Colbert, these false claims are sheer examples of incidents that these machines are aimed at eradicating. Every year workers compensation fraud costs each of us $1,000 to promote as a deterrent to such fraudulent acts per industry statistics.

Colbert understands that his surveillance approach can seem very unconventional, but believes this breakthrough technology can have the capacity to save companies thousands of dollars on fake or exaggerated workers compensation injury claims.

Please click here for the full story.

www.roiglawyers.com

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Filed under Insurance Fraud

Roig Lawyers Tampa Attorney to Present “Emerging Trends in PIP SIU”

Roig Lawyers attorney Miguel R. Roura will present “Emerging Trends in PIP SIU” to a national insurance carrier in Tampa on August 5, 2015.

The presentation will educate adjusters on recent SIU trends, help identify fraud, and discuss various investigative tools used to fight fraud. Also, the presentation will review caselaw which will aid adjusters in determining what issues and facts create a solid or weak defense.

Miguel concentrates his practice in the areas of Personal Injury Protection (PIP)/No-Fault litigation and fraud (SIU) investigations. He also defends clients in cases involving bodily injury, uninsured motorist, property damage, and general liability litigation. The identification and investigation of fraudulent claims represents a significant portion of Miguel’s practice.

Miguel is a graduate of Stetson University College of Law (J.D., 2008) and the University of Florida (B.A., 2004).

About Roig Lawyers

Roig Lawyers is a multi-practice Florida Litigation firm with an unfaltering growing presence in the legal market celebrating 15 years of service, with more than 100 attorneys in 6 offices in Deerfield Beach, Miami, Orlando, West Palm Beach, Tampa, and Tallahassee. Roig Lawyers offers unparalleled legal representation in the areas of commercial litigation, construction, corporate law, real estate, banking and finance, labor and employment, and all phases of insurance defense litigation.

For more information about Roig Lawyers, visit www.roiglawyers.com.

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Filed under Insurance Fraud, Personal Injury Protection, PIP/No Fault

Insurance Agent Arrested for Fraudulent Polices

Insurance Agent Arrested for Fraudulent Polices

On July 27, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced the arrest of insurance agent Julia Shurdom, 67, for conducting insurance related business with a suspended insurance license, scheming to defraud, and uttering a forged document.

Shurdom was allegedly working for Absolute Insurance Services in Orlando, Florida with a suspended license when the fraud was committed. According to the press release, DIF received a complaint in regards to Ms. Shurdom, after a client who purchased homeowners’ insurance in 2013 and 2014 discovered that her home had remained uninsured. After the complaint, DIF began an investigation which found, per Ms. Shurdom bank records, that she collected two homeowners’ insurance premium payments and used the money for personal profit.

According to the investigation, DIF conducted a license search for the accused agent and found that the Department’s Division of Agent & Agency Services (A&A) had already begun investigating Ms. Shurdom for a number of unrelated events. The investigation also revealed that A&A had suspended Julia Shurdom’s license to conduct insurance related business.

A follow up audit by A&A and the ongoing investigation by DIF revealed that Ms. Shurdom continued to sell insurance polices without the proper licensing from the Department of Financial Services, and that the transactions were fraudulent, according to DIF.

Shurdom was booked into Orange County Correctional Facility with a bond of $6,500 on charges which include scheme to defraud, uttering a forged instrument, and violation of a suspension order. Shurdom’s faces up to 15 years in prison.

Click here for the press release.

www.roiglawyers.com

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Filed under Insurance Fraud

U.S. Court of Appeals Agrees to Hear Florida PIP Case

The U.S Court of Appeals for the 11th Circuit in Atlanta has agreed to consider an appeal of a lower-court decision in Florida on whether drivers in Palm Beach County and across Florida should be granted class-action status in their claim against Hospital Corporation of America (HCA) Hospitals who are allegedly grossly overcharging for services under the state’s PIP/No-Fault insurance system.

According to a recent blog post on PalmBeachPost.com, the lower court decision in Florida stated the drivers could pursue cases individually against HCA Hospitals but not as a group. The plaintiffs in the case allege that the hospitals are draining Personal Injury Protection (PIP) benefits by charging up to 65 times what Medicare pays.

Click here to read the blog post.

www.roiglawyers.com

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Filed under Personal Injury Protection, PIP/No Fault