Tag Archives: Insurance 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

Insurnace Fraud Sweep has resulted in 31 individuals charged

State Attorney Katherine Fernandez Rundle announced today at a press conference the success of “Operation Flames and Flood Two” which charged 31 individuals with insurance fraud.  According to the State Attorney’s Office the operation focused on public adjuster, Jorge Fausto Espinosa, who was hired by policy holders to damage the insured homes for the purpose to collect ill-gotten gains from insurance companies. Jorge Fausto Espinosa, who is already facing charges in a similar fraud case from last year, called “Operation Flames and Flood One”, deliberately staged fire and water damage claims to residential homes in Miami-Dade County, Lehigh Acres, and Naples.

“Operation Flames and Flood Two” focused on the expansion of Espinosa’s fraud activities through his Miami-Dade company, Nationwide Adjusters LLC, into the west coast of Florida into Collier and Lee counties. According to the State Attorney’s Office operation two involved 20 staged fires with loses close to $ 7 million. Several homeowners also face charges for their role in the fraud.

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Century Woman charged with Auto Insurance Fraud

The Florida Department of Financial Services Insurance Fraud Division charged Trisha Michelle Milstead a resident of Century, FL with one felony count of insurance fraud. Assistant State Attorney Greg Marcille stated that on September 8, 2014 Milstead was involved in a vehicle accident, but at the time her vehicle policy had lapsed for non-payment. She then reinstated her insurance policy on September 9, signing a statement that there had been no previous damage during the lapsed time period.  Two days after the policy was reinstated she filed a claim for the accident and damage associated.

Trisha Milstead remains in the Escambia County Jail with bond set at $10,000 and is scheduled for an arraignment hearing next month.

Click here for news article.

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Insurance agent sentenced for 8 years for racketeering

On May 12, State Attorney Bill Eddins announced the arrest of Randall Peterson. Peterson was a Cantonment insurance agent who conducted a fraudulent insurance scheme while operating under multiple business names which involved the theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.

Peterson’s scheme began with him advertising job opportunities on the Internet for his fictitious company, College Consultants of the Gulf Coast. He then had hundreds of applicants provide information for life insurance which  he and his associates expressed to the job applicants as a free job benefit. The prosecutor’s office showed that Peterson used the information from the job applicants to complete life insurance applications that he submitted to the insurance companies in order to receive advanced commissions, which were as much as 130 percent of the first year premiums and bonuses.

Randall Peterson was found guilty of racketeering and money laundering by Circuit Court Judge Ross Goodman.  The state will request at a future hearing that restitution be set at an amount over $500,000.

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Filed under Fla. Stat. 627.736 (2008)

Jacksonville PIP Fraud Scheme Involved Staged Auto Accidents

Roxana Suarez La Rosa was arrested for PIP fraud, according to an April 28 release by the Florida Department of Financial Services’ Division of Insurance Fraud.

Suarez La Rosa owned and operated the Saint Jose Injury Center in Jacksonville that was behind a string of staged auto accidents, according to witnesses. Crash participants were asked to sign for medical services they never received, which were then billed to insurance companies. More than 50 insurance claims were generated in the alleged scam. Billing amounts were not disclosed.

If convicted, Suarez La Rosa faces up to 50 years in prison on racketeering and fraud charges. Additional cases against the medical clinic are pending.

The Office of the State Attorney in the 4th Judicial Circuit of Florida, which covers Duval, Clay and Nassau Counties, is handling the case.

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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