Tag Archives: Insurance Fraud

by | May 17, 2013 · 4:58 pm

92 Accused in Staged Accident Fraud Ring, $20 million in Fraudulent Claims

 

Operation Sledgehammer

According to investigators, charges were brought on Thursday against 33 people allegedly involved in fraudulent insurance claims totaling $20 million.  The Sun-Sentinel reported the following on the three year long investigation:

Operation Sledgehammer, a state and federal investigation, has led to charges being filed against a total of 92 defendants from Palm Beach, Broward and Miami-Dade counties. Those already convicted have been ordered to pay more than $5 million in restitution to insurance companies so far, prosecutors said.

The investigation revealed the ringleaders of the fraud recruited chiropractors Lazaro Rodriguez, 58, of Doral, and Kenneth Karow, 53, of to serve as owners of clinics involved in the ring.

Of the 92 people charged in the ring, five of the defendants, including alleged ringleaders Vladimir Lopez, 38, and Lazaro Vigoa Mauri, 45, have fled to Cuba.  According to authorities, the other defendants who have not yet been caught are considered fugitives.

Also from the Sun-Sentinel report:

[t]he investigation was kicked off by a tip from a member of the public and urged anyone with information to call their local police department.

The participants in the fraud were trained by recruiters on how to make the accidents look realistic, how to file police reports and insurance claims, how to fake injuries and where to go for treatment . . . The ringleaders made sure that insurance checks were deposited into accounts they controlled so they could pay the participants…

The full article from the Sun-Sentinel is available here.

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

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by | May 16, 2013 · 3:57 pm

Fort Myers Chiropractor Arrested, Caught Paying Confidential Informant to Fake Injuries

Fort Myers, FL chiropractor, Dr. David Greydinger, was arrested last week after investigators caught Greydinger submitting fraudulent insurance claims for non-existent auto accidents.  Reports indicate Greydinger, of MYO Health Clinic, paid informants kickbacks to submit claims totaling $6,000 arising out of non-existent accidents.  Reports indicate that MYO Health Clinic remains open for business at this time.

Detective William Quick of the Florida Division of Insurance Fraud stated, “Greed is the primary force behind everything with insurance fraud. It all comes down to money.”

The full report is available here.

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

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by | December 17, 2012 · 7:20 am

“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

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by | November 30, 2012 · 9:43 am

Volusia County Chiropractor, Joseph Wagner, Sentenced to 15 years and $2 million in Restitution

Wednesday, Volusia County chiropractor, Joseph Wagner, was sentenced to 15 years in federal prison and $2 million in restitution as a result of years of healthcare fraud.  Wagner, in addition to billing insurance companies and Medicare for services never rendered, illegally prescribed controlled substances under another doctor’s name.  Patients who were without insurance paid Wagner $100 cash each month for these prescriptions.

According to the Orlando Sentinel article on Wagner’s sentencing:

Senior U.S. District Judge G. Kendall Sharp said Wagner relegated the trust he had as a chiropractor, and now taxpayers will have to pay the price for his fraud.

The full article is available here.

See also: Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud

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Filed under Insurance Fraud, Licensing

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by | November 7, 2012 · 9:10 am

Broward County Chiropractor Pleads Guilty to Insurance Fraud Involving Accident Staging Ring

On Tuesday, Broward county chiropractor Jennifer Adams, 39, of Boca Raton, admitted to one count of conspiring to commit mail fraud and agreed to pay more than $1.92 million in restitution to 10 insurance companies.

Adams permitted her name to be used to create two chiropractic clinics: Ovy Rehabilitation Medical Center, Inc. in West Palm Beach, and Chiropractic Office of South Florida, LLC in Palm Springs. Both clinics submitted fraudulent PIP claims on behalf of individuals involved in staged accidents.

Adams, a chiropractor in Florida since 1999, agreed to relinquish her medical licenses. According to the Sun-Sentinel report:

The maximum punishment is 20 years in prison and a fine of $250,000 though she will likely face a much lesser penalty when she is sentenced by U.S. District Judge Daniel T. K. Hurley in federal court in West Palm Beach in the next several weeks.

The full story is available here.

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

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by | November 6, 2012 · 5:34 pm

Nerber A. Iglesias, 40, and Michael Borkowski, 42 Arrested in Undercover PIP Fraud Sting

Two more arrests were made as a result of a personal injury protection (PIP) fraud scheme in Manatee County involving patient brokering. The arrests of Nerber A. Iglesias, 40, and Michael Borkowski, 42, were the result of an undercover sting, according to an announcement made by Florida Chief Financial Officer Jeff Atwater.

According to the Claims Journal report:

An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Iglesias approached a Sarasota chiropractor about becoming the straw owner of Garden Relief Center, LLC. The chiropractor contacted law enforcement and, under the direction of the department, applied for a clinic exemption certificate to begin operating the facility. The chiropractor, working undercover, was also contacted by a local body shop owner named Michael Borkowski, who made arrangements to provide accident patients to the clinic for a fee. During the course of the investigation, Garden Relief Center submitted almost $40,000 in fraudulent insurance claims to six different insurance companies.

The full article is available here.

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

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by | October 1, 2012 · 9:06 am

Office Manager of Two Chiropractic Clinics, Maria Molina, Pleads Guilty to Mail Fraud Conspiracy, Submitting False Claims for Staged Accidents

Maria “Cary” Molina of West Palm beach plead guilty to one count of “mail fraud conspiracy” in Federal court last Thursday.  Molina was accused of perpetrating an insurance fraud scheme at two chiropractic clinics, OVY Rehabilitation Medical Center and HHR Medical Center, where Molina served as an office manager.  Records indicate Molina submitted bills for individuals known to be involved in staged motor vehicle accidents.  Prosecutors stated that the clinics received $540,000 from PIP insurers as a result of the fraud.

Molina’s co-defendant, Obelio “Ovy” Rodriguez, 43, has been declared a fugitive.

The full report from the Sun-Sentinel is available here.

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

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by | September 5, 2012 · 11:26 am

Eight Arrested for Staging Accidents in Miami-Dade County, Connections to Six Different PIP Fraud Rings

Florida’s Chief Financial Officer, Jeff Atwater, announced Tuesday that eight individuals involved in multiple staged accidents in Miami-Dade County were connected to six different PIP fraud rings.  The press release from the the CFO states:

An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Alexander Cid, 47; Luis Rivero Dominguez, 35; Franklyn Chaviano, 38; Robert E Bayona, 55; Carlos Padron Fernandez, 38; Yosmel Ramos Peraza, 24; Andres Vega Fleites, 61; and Jorge Fernandez Rodriguez, 52, participated in staged accidents in coordination with six fraud rings as organizers or drivers between May 2009 to May 2011.

The staged auto accidents resulted in more than $340,000 in fraudulent auto insurance claims.  If convicted, the eight individuals involved could serve a total of 455 years in prison.

The Division of Insurance Fraud (DIF) recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity.

The full press release is available here.

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

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by | August 29, 2012 · 1:14 pm

Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud

Joseph Wagner, a Volusia County chiropractor accused of prescribing pain killers and muscle relaxers to patients under other doctors’ names, has plead guilty to Federal charges on Tuesday.

Reports indicate that Wagner, who operated Wagner Chiropractic & Acupuncture Clinic on North Ridgewood Avenue, has been under investigation since 2009 when auto insurers began reporting the provider for billing services that were never performed.  Investigators discovered Wagner was committing insurance fraud and illegally distributing drugs by using the Drug Enforcement Administration number and name of another physician.  Wagner was not permitted to prescribe drugs as he was a chiropractor and not a licensed Florida medical doctor.

In July 2010, one of Wagner’s patients overdosed within days of being prescribed painkillers, muscle relaxers and anti-anxiety drugs.  Reports indicate that the patient did survive.   Part of Wagner’s fraud scheme involved submitting fake billings in the names of other, presumably properly licensed, doctors.  Prosecutors say that the the insurance company reimbursements were then split between those doctors and Wagner.  Wagner was indicted on 95 charges and plead guilty to three counts on Tuesday: healthcare fraud, conspiracy to distribute controlled substances and transactional money laundering.

The full article from the Orlando Sentinel is available here.

 

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

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by | August 13, 2012 · 1:58 pm

Owners of Sky Imaging, North Miami Beach Arrested Friday, More Than $1.5mil in Fraudulent PIP Claims

On Friday authorities arrested arrested Robbie N. Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging located in North Miami Beach for alleged PIP fraud.  The two are accused of operating an unlicensed accident clinic and fraudulently billing more than $1.5 million in auto-related claims to insurance companies.

Specifically the owners of Sky Imaging lacked licensing from the Agency of Healthcare Administration (AHCA) and instead enlisted a medical doctor to sign paperwork and pose as the clinic owner to qualify to bill Florida PIP insurers.

The article from the SunSentinel is available here.

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

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