Tag Archives: Insurance Fraud

Three Jacksonville Residents Charged with PIP fraud

Florida Chief Financial Officer Jeff Atwater recently announced that three Jacksonville residents have been arrested for personal injury protection fraud. The suspects—Yolanda Vargas, Christian Vargas, and Willdelyn Rodgriguez—have each been charged with one count of committing a staged motor vehicle accident and one count of insurance fraud.

A fourth suspect by the name of Felix Vargas, who has not yet been located, is alleged to have recruited the three individuals to participate in the fraud scheme. He is believed to be connected to a New York identity theft ring, as well as to an IRS scam in which he directed payment of others’ tax refunds to himself.

Comments Off

Filed under Insurance Fraud

Chiropractor & Receptionist Connected to Operation Sledgehammer Get Prison Sentences

Convicted for their role in a massive insurance fraud ring involving staged accidents in South Florida, two more people were sentenced in Operation Sledgehammer last week.

Chiropractor Lawrence Schechtman from Parkland, whom we reported about on our FL-PIP Guide on December 19 when he pleaded guilty to mail fraud conspiracy and mail fraud, was sentenced to four years and four months in federal prison. In addition to his sentence, he was ordered by U.S. District Judge Kenneth Marra to pay more than $2.4 million in restitution.

According to federal prosecutors, Schechtman worked at clinics in Palm Springs and Miami, where he signed off on treatments for people who fraudulently claimed they were accident victims as part of the staged-accident ring which operated in several counties.

According to a story in the August 8 Sun-Sentinel, the 45-year old Schechtman, who suffers from heart and back problems, was granted a request to serve his confinement at the Federal Medical Center, a medical prison in North Carolina. Judge Marra gave the chiropractor two months to turn himself in and begin serving his term.

Another co-conspirator from Palm Springs was sentenced for her role in Operation Sledgehammer. Sircy Sacerio, also known as Sisi or Sircy Santos, received four years in federal prison by Judge Marra.

Under the terms of her sentence, the Palm Beach Post reported, the 31-year old reception and office assistant must also repay $1,146,824.26 and will have two years of supervised release following her time in prison.

She originally pleaded guilty to one count of conspiracy to commit mail fraud and five counts of mail fraud.

Part of the fraud activity in Operation Sledgehammer, which was recorded by investigators, included co-conspirators damaging vehicles with sledgehammers to give the appearance of a crash. The participants in the staged accidents would then go to clinics involved in the ring to receive bogus treatment which, according to the U.S. Attorney’s Office, brought in millions of dollar to chiropractors on false and fraudulent insurance claims. The scheme began around October 2006 and continued through December 2012.

Comments Off

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

Disbarred Florida Attorney Gets Prison Sentence in $28.3 Million Medicare Fraud

A disbarred Florida attorney who participated in a $28.3 million Medicare fraud scheme involving false claims for physical and occupational therapy services was recently sentenced in federal court in Tampa to 70 months in prison, the Justice Department announced.

Margarita Grishkoff, formerly of southwest Florida, initially pleaded guilty on January 24 to conspiracy to commit health care fraud. In addition to her prison term, U.S. District Judge Susan C. Bucklew of the Middle District of Florida sentenced the 60-year old to three years of supervised release and ordered her to pay $14,424,856 in restitution, jointly and severally with her co-conspirators.

Grishkoff, who is currently a resident of Charlotte, North Carolina, acknowledged in her guilty plea that approximately $28.3 million in fraudulent claims were submitted to Medicare by her and the scheme’s co-conspirators. Medicare paid approximately $14.4 million of those claims, which were made through physical therapy clinics throughout Florida from 2005 through 2009.

Court documents reveal that Grishkoff, who was disbarred in Florida in 1997, was vice president and director for Ulysses Acquisitions Inc., a Delaware holding company that purchased several comprehensive outpatient rehabilitation clinics and physical therapy providers to gain control of Medicare provider numbers. These clinics included: West Coast Rehab Inc. in Fort Myers; Rehab Dynamics Inc. in Venice; Polk Rehabilitation Inc. in Lake Wales; and Renew Therapy Center of Port St. Lucie LLC in Port St. Lucie.

The Justice Department also said that Grishkoff and her co-conspirators paid kickbacks to patient recruiters and clinic owners to get identifying information of Medicare beneficiaries and physicians. They subsequently took this information to create and submit false claims to Medicare through the clinics Ulysses Acquisitions owned. Claims for reimbursement were made on therapy services that were not legitimately prescribed or actually provided.

But it didn’t end there. Grishkoff and her co-conspirators used the clinics they controlled to submit false reimbursement claims on behalf of other clinics not owned by Ulysses, in exchange for a percentage of the Medicare reimbursement received.

These Miami-based therapy clinics included: Hallandale Rehabilitation Inc., Tropical Physical Therapy Corporation, American Wellness Centers Inc., and West Regional Center Inc. According to court documents, Grishkoff and her co-conspirators kept approximately 20 percent of the fraud proceeds and paid the remaining 80 percent to the co-conspirator clinic owners. Grishkoff further admitted that she arranged sham sales of her clinics to nominee or straw owners to disassociate herself and Ulysses Acquisitions from the fraudulent scheme. Those new owners were recent immigrants with no background or experience in the health care industry.

Comments Off

Filed under Insurance Fraud

Jacksonville Couple Sentenced in “Family & Friends” PIP Insurance Fraud Ring

A married couple convicted of staging car crashes with family members—as we first reported on our FL-PIP Guide on June 23—was recently sentenced for their involvement in an extensive insurance fraud ring in Duval County.

According to a news release issued by the State Attorney’s Office for the Fourth Judicial Circuit, Jose Alberto Velez, 30, received 74 months in prison for three counts of knowingly participating in an intentional motor vehicle crash and five counts of false insurance claims. His wife, April Rosita Wynn, 23, was sentenced to 48 months in prison for two counts of knowingly participating in an intentional motor vehicle crash and four counts of false insurance claims.

A 2012 investigation by the State Attorney’s Office (SAO) and the Division of Insurance Fraud (DIF) found that Velez and Wynn, who are now married, had been recruiting family members and friends to participate in staged car crashes with them. They would then file Personal Injury Protection (PIP) claims through designated rehabilitation clinics, which provided bogus treatment for the participants’ fictional injuries.

Over the past year-and-a-half, almost 100 individuals have been arrested for their involvement in this insurance fraud scheme. Many have already been sentenced, including one of the ringleaders, David Rodriguez Lopez. He received 15 years in prison on charges of schemes to defraud over $50,000, false insurance claims over $100,000, and knowingly participating in an intentional motor vehicle crash.

Other cases are currently pending.

Comments Off

Filed under Insurance Fraud

Allstate to Recover Almost $1 Million in PIP Case against Dr. Sara Vizcay

In a case brought by Allstate in the Florida Middle District, the court ruled on August 1st that the Defendant’s Motion for Declaration of Mistrial was denied, the Plaintiff’s Motion for Declaratory Judgment was granted in part, and the final judgment was ordered.

Dr. Sara C. Vizcay and the seven medical clinics listed below were the Defendants in the case.

  • Best Care Medical Center, Inc.
  • Caleb Health Care, Inc.
  • Florida Rehabilitation Practice, Inc.
  • Global Diagnostic Center, Inc.
  • Personal Medical Center, Inc.
  • P.V.C. Medical Center, Inc.
  • Regional Enterprises for Health Corporation

Fraudulent billing practices and failure to comply with the licensing requirements of the Florida Health Care Clinic Act (HCCA) formed the basis of Plaintiff allegations. In a jury trial earlier this year, the jury found that each Defendant misrepresented material facts.

The court noted that the “jury unanimously found Plaintiffs proved, by a preponderance of evidence, that Dr. Vizcay failed to substantially comply with her statutory medical director duties to systematically review bills … and to ensure those bills were not fraudulent or unlawful.”

The total amount to be recovered by Allstate is $942,883.41, and Plaintiff is not obligated to pay any unpaid amounts.

The case is Allstate v. Sara C. Vizcay, M.D. et al., U.S. District Court for the Middle District of Florida, Case No. 8:11-CV-804-EAK-EAJ. Click on the link to read the August 1, 2014 Order of Judgment.

Comments Off

Filed under Case Law, Insurance Fraud

Fraud Charges Filed in West Palm Beach False Insurance Claim Case

The fact that Frank Assouman was not even in his truck at the time it was hit in a Boca Raton parking lot did not stop him from filing more than $25,000 in false insurance claims.

The crash report and a witness statement taken at the time of the accident indicate that the West Palm Beach resident was not in his parked vehicle when it was struck by another driver. Damage to Assouman’s vehicle was estimated at $1,500.

Days later he sought medical care, including an MRI at Delray Diagnostics and other treatment obtained from Modern Medicine, Inc.

In addition to filing a claim for property damage, Assouman reportedly filed a $21,815 injury claim with State Farm and a $3,035 claim with his own carrier of Windhaven Insurance.  Both claims were denied.

The Florida Division of Insurance Fraud filed a fraud charge against Assouman for less than $20,000.

Comments Off

Filed under Insurance Fraud

Vehicular Arson Cases Climbing Nationwide

The slow economy could be contributing to an increase in claims involving auto fires, according to an official with the Washington, D.C.-based Coalition Against Insurance Fraud.

“Common sense tells you that more desperate people will take more desperate measures to get themselves out of trouble,” said Coalition representative James Quiggle in a News 4 I-Team report.

Cracking the case on vehicular arson is difficult to prove in court, as Maryland officials are discovering. Of more than 2,000 suspected auto arsons in the state during 2013, fewer than 50 cases had sufficient evidence to turn the matter over to prosecutors.

Findings from a 2009 report of the U.S. Fire Administration’s (USFA’s) National Fire Incident Reporting System (NFIRS) reveal the following:

  • Approximately 10 percent of all vehicle fires are intentionally set.
  • Intentional vehicle fires are at their highest during the summer, with a July peak.
  • Matches are the leading heat source (20 percent) of intentionally set vehicle fires.
  • Vehicle seats (34 percent) and uncontained fuel (14 percent) represent the starting point of many intentionally set vehicle fires.

Arson generally has a low clearance rate, according to crime reports from the U.S. Department of Justice. Arson involving motor vehicles, which represent 20 percent of all arson cases, have a particularly low closure rate of approximately 7.4 percent nationwide.

The Florida Department of Law Enforcement statistics indicate that motor vehicle arson may not be a major concern in the state, with fewer than 300 cases of auto arson reported for 2012.

Comments Off

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