Tag Archives: DIF

Miami PIP Fraud Leads to Three Arrests

Three individuals from the Miami-Dade area, who have allegedly been involved in personal injury protection (PIP) fraud schemes, were arrested on June 30, 2015 by the Division of Insurance Fraud (DIF) in separate cases.

The first individual arrested was Mariela Quintana, a licensed massage therapist at D&J Rehabilitation Center in Miami. According to DIF, the 46-year old fraudulently billed for treatments never performed and signed off on treatment forms. Her role in the scheme resulted in more than $10,000 in fraudulent claims and is the second time in less than six months that she has been arrested for similar activities at the same clinic, DIF said. Quintana has been charged with Insurance Fraud, Grand Theft, and Organized Scheme to Defraud.

The second individual arrested, Noel Vazquez Lazo, organized a staged accident and paid for the policy of the at-fault automobile used in the accident. The 44-year old, paid participants in the staged accident to seek treatment for fake injuries. The PIP scheme resulted in filing claims totaling in excess of $89,000, according to DIF. He is charged with Organizing a Staged Accident, Insurance Fraud, and Grand Theft.

Last but not least, Rodney Fabian, 27, was charged with Solicitation, Patient Brokering, Insurance Fraud, and Grand Theft for his role for soliciting an individual of a hit and run accident and offering to pay for their treatment at a specific clinic, DIF reported. Fabian paid the individual $1,000 for seeking treatment at the specific clinic. However, the insurance company suspected the fraud scheme and refused to process the claims, which caused Fabian to demand the money back from the individual.

According to DIF, the three individuals face jail sentences ranging from 5 to 30 years and each case will be prosecuted by the Miami-Dade Office of the State Attorney Katherine Fernandez Rundle.

Click here to read press release from the Florida Department of Financial Services.

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Filed under Insurance Fraud

Operator of Unlicensed Orlando PIP Clinics Arrested

Josue Pierrissaint, 30, was arrested by the Florida Division of Insurance Fraud (DIF) for charges related to operating unlicensed Orlando PIP clinics earlier this year.

A string of three PIP clinics were opened by Pierrissaint from 2010 to 2012, as listed below.

  • Edgewater Chiropractic was first opened in 2010. It was based in Lockhart, Fla., located in Orange County northwest of Orlando. Chiropractor Sham Mohammed was named as the straw owner.
  • Dr. Wilson’s Straight Up Chiropractic was opened several months later by Pierrissaint in association with chiropractor Koteuaisa Wilson, who also served as the straw owner. The same Lockhart, Fla. address was used in the AHCA application. Wilson later left the clinic, which reportedly did not stop Pierrissaint from using her name.
  • Dr. Koteuaisa Chiropractic was next launched by Pierrissaint in 2012. The clinic was opened in Orlando without the knowledge or consent of Dr. Wilson, although her name was listed on the AHCA paperwork.

Collectively, the clinics were paid in excess of $425,000 by 16 insurance companies.

Pierrissaint, who is not a doctor, was also arrested early in 2014 on similar charges.

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Filed under Insurance Fraud

Details Emerge on Unlicensed Clinics Behind $243K in PIP Fraud

The FLPIPGuide previously reported that Dr. Lherisson Domond, 82, was arrested earlier this year for acting as the straw owner of Unity Pain and Injury Center in Orlando. The Florida Division of Insurance Fraud (DIF) recently revealed that Domond also fronted as the straw owner of Blesscare Chiro Center, also in Orlando.

Blesscare, an unlicensed clinic, was operated by Fortunard Dieuveillant Fonrose, 42. Medical billings totaling in excess of $86,000 were generated between May 2012 and November 2014 under Fonrose’s management, according to DIF reports.

Domond was behind the unlicensed Tamarac clinic of J.J. Health & Wellness also, according to DIF. Jonas Fils, 52, and Obinson Louis, 37, were reportedly the real owners of the clinic, which illegally billed almost $72,000 from May to September of 2013.

Keeping with the pattern of interconnections, Louis also operated the unlicensed Oakland Park clinic of Innovative Medical Rehab Center.

Overall, seven individuals were arrested for the fraudulent operation of the four unlicensed medical clinics.

The clinics were behind personal injury protection (PIP) fraud schemes responsible for more than $243,000 in illegal billings. DIF investigations are on-going, and additional arrests are expected.

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Filed under Insurance Fraud

Broward PIP Fraud Scam Leads to Four Arrests

Four Florida residents were arrested on April 1 for participating in a Broward County scheme to defraud insurance companies by filing false PIP claims.

The defendants filed eight claims concerning a Mercedes that belonged to one of them, according to a statement from the Florida Department of Financial Services, Division of Insurance Fraud.

Claims alleged that the Mercedes had been run off the road. It was ultimately determined that only one of the eight claims was lawfully made and that the other seven were filed in furtherance of the defendants’ scam.

According to the statement, the four individuals arrested are:

  • Ermes Falero, Boca Raton
  • Gary Lee, Boca Raton
  • Javier Navarro, Miami
  • Michael Rumain, Point Pleasant

Falero, with Lee’s help, is alleged to have organized a scheme by which he and Lee would falsify documentation and use that false documentation to file fraudulent insurance claims. The remaining two defendants are accused of making fraudulent statements supporting Falero’s and Lee’s false insurance claims.

Falero, the scam’s main organizer, faces 150 years in prison. Lee faces up to 90 years, and the defendants who made the false statements each face 15 years in prison.

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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

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

Staged Accidents and Insurance Fraud Lead to Miami and Orlando Arrests

September was a busy month for the Florida Division of Insurance Fraud (DIF). The agency arrested a massage therapist for fabricating medical forms, as well as four other individuals who organized and recruited participants to be involved in staged accidents.

According to DIF, one arrest occurred in Orlando while the remainder took place in Miami. Those arrested in the five unrelated cases include:

Madelein Marin Aroche. The 41-year old massage therapist worked at New Life Medical Center in Miami. She was charged with insurance fraud after submitting false therapy forms for treatment she never provided to two patients who participated in staged accidents. Her scheme resulted in almost $30,000 in fraudulent billing to GEICO Insurance Co.

Renfroe Lorenz Tyson. The 46-year old recruiter and participant was arrested in Orlando for his role in a 2013 staged accident that resulted in more than $6,600 in fraudulent billings to Allstate and GEICO.

Victor Manuel Hernandez. The 32-year old from Miami conspired with William Tejeda Mayobanex, who was arrested by DIF in August. Hernandez helped recruit participants for a staged accident in 2011. The participants were then referred to A & J Rehabilitation Center and D & J Rehabilitation Center, where more than $64,000 in fraudulent billings were submitted to United Auto and York Services.

Vladimir Caro. The 38-year old organizer staged an accident in 2011. The six participants in the crash were also referred to A & J Rehabilitation Center and D & J Rehabilitation Center. More than $117,000 in fraudulent billings were submitted to Allstate, State Farm, United Auto and Windhaven.

Sandy Morales Castro, 33, was identified as a recruiter and the eighth subject arrested in a staged accident that occurred in 2010. This fake crash resulted in more than $46,000 in fraudulent billings submitted to GEICO, MGA and Progressive.

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Filed under Insurance Fraud