On November 6, 2015, four former employees of the now defunct healthcare provider Health Care Solutions Network Inc. (HCSN) were sentenced for their role in a scheme to fraudulently bill Medicare and Florida Medicaid for approximately $63 million. U.S. District Judge Robert N. Scola of the Southern District of Florida sentenced Roger Rousseau, 73, of Miami, the former medical director of HCSN to192 months in prison: Liliana Marks, 49, of Homestead, former therapist was sentenced for 72 months in prison; therapist Doris Crabtree, 63, of Miami, and Anglea Salafia, 68, of Miami Beach, were each sentenced to 60 months in prison. All four defendants were sentenced to three years of supervised release.
On August 24, 2015, a Miami jury convicted all four defendants of conspiracy to commit healthcare fraud and Rousseau was additionally convicted of two counts of healthcare fraud. To date a total of 22 defendants have been charged and convicted for their roles in the HCSN scheme, which focused on performing services that were not medically necessary and were never provided.
The HCSN scheme provided intensive mental health services to Medicare and Medicaid beneficiaries in Miami and North Carolina from 2004 to 2011. HCSN paid kickbacks to assisted living facilities owners and operators in Miami who, in exchange, referred beneficiaries to HCSN. In order to support the scheme, Rousseau signed, forged, and altered medical records and Crabtree, Salafia, and Mark also falsified medical records. As a result of the scheme, HCSN submitted approximately $63.7 million in false and fraudulent claims to Medicare, and received payments totaling approximately $28 million on those claims.
Please click here to read the U.S. Department of Justice Press release.
Zian Scott Snyder, 29, and Alicia Maria Hill, 26, of Cantonment, Florida have been charged with scheme to defraud, insurance fraud, grand theft, and conspiracy to commit insurance fraud by the Florida Division of Insurance Fraud (DIF) for alleged false claims over a custom-made engagement ring.
According to an article on NorthEscambia.com, the couple filed a false claim on a $15,000 ring that Hill claimed she lost swimming in the Gulf. She was also recorded claiming she lost the ring on a boat in the Gulf. Four days after filing the claim with her insurance company, Hill took the ring to Marks and Morgan Jewelry store in Ft. Walton Beach to have the ring repaired.. The custom-made ring was identified by photographs taken at the Ft. Walton Beach jewelry store.
Around the same time the couple filed the insurance claim, the store manager of the Jewelry store told authorities she witnessed the ring for sale on Craigslist and that she was positive that it was the same ring in question because she was the one who custom made the ring. The couple told her that the ring had not been stolen, but was eaten by a dog and was later recovered.
A month after the couple filed the insurance claim, Hill called the insurance company to report that the ring had been recovered. The insurance company then advised that the ring or the check must be returned. Three days after Hill informed the insurance company of the recovery, she changed her story once again, stating that it was actually a different ring that was recovered.
The insurance company told state investigators that neither the ring nor the insurance proceeds were ever returned by the couple.
On October 13th, Janio and Jharildan “Harold” Vico were convicted of a total of 16 charges including 12 counts of mail fraud, two counts of money-laundering, conspiracy to commit money-laundering, and conspiracy to commit wire fraud. A federal jury deliberated for approximately two hours before finding the brothers guilty, according to a palmbeachpost.com article. The conviction arises out of the brothers’ ownership and operation of the V&V Rehabilitation Center, located on 10th Avenue North, Lake Worth, Florida, from 2009 until 2011. Janio and Jharildan Vico staged traffic accidents and then billed insurance companies for fake injuries, which were treated at their Lake Worth clinic. The scheme brought in approximately $3 million for the two brothers.
Assistant U.S. Attorney Ellen Cohen is seeking for the brothers to forfeit nearly $400,000 and homes they purchased with proceeds received from the fraud. The brothers can face up to a maximum sentence of 20-years for the most serious charges. The sentencing hearing is set for January 8, 2016.
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Residents of Duval County are being advised to remain vigilant for criminals soliciting residents to participate in a scam to defraud insurance companies.
News Channel WJXT of Jacksonville, Florida has reported an increase in the number of residents calling their newsroom to report potential scammers going door-to-door asking for a copy of their insurance policy.
According to the Coalition Against Insurance Fraud, this scam involves windshield repair shops convincing unsuspecting residents to replace their windshield even though little to no damage exists. These repair shops often offer incentives for residents in the form of cash or other gifts.
Insurance professionals have seen a marked increase in the number of windshield replacement claims over the past 5 years. Gil Smith, News Channel WJXT’s crime and safety analyst recommends that if you do have a damaged windshield to contact your insurance company first. Further, he recommends that you only seek a vendor that your insurance company approves.
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On August 13, 2015, The Florida Department of Financial Services Division of Insurance Fraud (DIF) announced multiple arrests related to a large scale personal injury protection fraud scheme across the Central Florida region.
According to the Orlando Business Journal, DIF and the Federal Bureau of Investigation (FBI) partnered to investigate two clinics, First Medical Rehab of Bradenton and Kirkman Family Chiropractic Care in Orlando. Their investigation led to the arrest of five people, arrest warrants issued for three additional people, and three related arrests in the Fort Myers area. Insurance carriers and former patients raised allegations of possible illegal activity happening at these two personal injury clinics.
The Kirkman Family Chiropractic investigation disclosed their plot of bypassing clinic licensure requirements set by the Agency for Health Care Administration. Co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only because licensed health care professionals can operate clinics without the necessity of an additional clinic license. To date, more than $100,000 in fraudulent claims have been paid by multiple insurance carriers.
The charges varied depending on each individual’s alleged role which included: patient brokering, conspiracy to commit patient brokering, false and fraudulent insurance claims, solicitation, grand theft, organized scheme to defraud and conspiracy to commit insurance fraud. All individuals arrested, if convicted can face anywhere from five to 30 years in prison as well as face fines as large as $10,000.
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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.
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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.
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