Tag Archives: 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

Jacksonville Clinic Owner Arrested for Racketeering and Insurance Fraud

Sandy Morales, who owned and operated Gate Parkway Diagnostic Center, has been arrested for racketeering and insurance fraud charges, as reported in a June 18, 2015 article by the Jacksonville Business Journal.

According to the Florida Department of Financial Services, Sandy Morales organized a complex Personal Injury Protection (PIP) fraud scam that resulted in over $100,000 in fraudulent filing claims for injuries in accidents which did not occur.

Investigators stated that Morales’ arrest is one of 180 arrests since September 2012 that are tied to the fraud network. According to the Division of Insurance Fraud, Morales elaborately staged multiple car accidents, paid people to pose as passengers, and then paid those individuals to seek treatment in his clinic for bogus injuries. Morales is also accused of recruiting other clinic owners to participate in the fraud, and sending patients to those clinics in order to increase the fraud network.

The clinics involved in the PIP scam, now closed, include:

  • Arlington Rehabilitation Services Inc.
  • Baymeadows Injury Center LLC
  • Health Point Injury Center LLC
  • One Touch Therapy Center Inc.
  • Saint Jose Injury Center LLC
  • Therapy Diagnostics Tech Medical Inc.
  • Wellness Rehab Services Inc.
  • Atlas Massage Therapy Corp.

Morales could face a maximum of 45 years in prison, and is currently being held in Duval County Jail with a bond of over $600,000.

Click here to read article.

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Filed under Insurance Fraud

Fort Lauderdale residents arrested for PIP Fraud

The Florida Department of Financial Services’ Division of Insurance Fraud announced on March 19, 2015 the arrest of two Fort Lauderdale Residents for PIP fraud following a staged accident. Kendrick Callins and Lashaunda Gibbs were arrested for staging auto accident, patient brokering and personal injury protection insurance fraud.

The Division of Insurance Fraud, Federal Bureau of Investigation, Broward County Sheriff’s office and the Fort Lauderdale Police Department investigation revealed that Callins and Gibbs organized and participated in a staged accident on September 22, 2012, in Fort Lauderdale. The staged accident involved participants, recruited by Callins and Gibbs, who intentionally drove a rented U-Haul truck into a passenger vehicle occupied by arrestees. The arrestees submitted fraudulent insurance claims which were paid by the insurers. Callins and Gibbs each face a maximum sentence of 25 years.

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Filed under Insurance Fraud

“Operation Never Ends” Leads to Closure of Two Clinics, Multiple Arrests

“Operation Never Ends,” the multi-organizational investigation organized by Miami police, the Secret Service, local and state agencies and insurance companies, has led to the closure of two clinics involved in staging accidents and making fraudulent insurance claims.

The more than one year long operation led to the arrest of, among others, Jorge Felix Felipe Pupo, 49, accused of being the ringleader, and Yanaris Ramirez Paneque, 36, a receptionist at one health clinic, according to authorities.  According to the report from NBC 6:

Police say they went undercover inside a medical building in the 700 block of Northwest 23rd Avenue and at another location near Flagler and the Palmetto Expressway.

Detectives said recruiters would find those willing to participate in the staged accidents, then bring them to medical clinics where paperwork was done to get money back from insurance companies.

Police Sgt. Luis Taborda explained the scheme.

“The clinics are the main,” he said. “They provide the money to a runner and the runner puts together the crash — orchestrates the crash.”

Police said the ring was making big money on the claims.

“I could tell you that in one investigation that we did at the beginning, they were up to $80,000 before we shut them down — in just one crash,” Taborda said.

The article from NBC 6 South Florida is available here.

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Filed under Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012), Insurance Fraud, Licensing