Tag Archives: Insurance Fraud

Broward PIP Fraud Scam Leads to Four Arrests

Four Florida residents were arrested on April 1 for participating in a Broward County scheme to defraud insurance companies by filing false PIP claims.

The defendants filed eight claims concerning a Mercedes that belonged to one of them, according to a statement from the Florida Department of Financial Services, Division of Insurance Fraud.

Claims alleged that the Mercedes had been run off the road. It was ultimately determined that only one of the eight claims was lawfully made and that the other seven were filed in furtherance of the defendants’ scam.

According to the statement, the four individuals arrested are:

  • Ermes Falero, Boca Raton
  • Gary Lee, Boca Raton
  • Javier Navarro, Miami
  • Michael Rumain, Point Pleasant

Falero, with Lee’s help, is alleged to have organized a scheme by which he and Lee would falsify documentation and use that false documentation to file fraudulent insurance claims. The remaining two defendants are accused of making fraudulent statements supporting Falero’s and Lee’s false insurance claims.

Falero, the scam’s main organizer, faces 150 years in prison. Lee faces up to 90 years, and the defendants who made the false statements each face 15 years in prison.

Comments Off

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

Tampa PIP Fraud Investigation Results in Seven Arrests

An office manager who acted as a patient broker as well as her six patient recruits were recently arrested on insurance fraud charges by the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) after a two-year investigation uncovered suspicious insurance claims made by the individuals.

According to a story in the Tampa Tribune, Minette St. Fleur, 50, paid individuals to pose as patients injured in car accidents. The complex scheme, which was centered at Integrated Healing Clinic in Tampa, involved these patients filing fraudulent claims to multiple insurance agencies for their bogus injuries. Prices paid for treatments, some of which never occurred, greatly exceeded actual costs and totaled more than $150,000 in fraudulent claims, DIF found.

The scam was directed at GEICO Insurance Company, 21st Century Insurance, Progressive, Safeco Insurance, State Farm Insurance and Liberty Mutual Insurance. GEICO initially noted some patients repeatedly visited the clinic for many different treatments and that some dates on clinic paperwork did not match the dates on the filing of claims. The company brought the suspicious activity to the attention of DIF who began their investigation.

St. Fleur has been charged with insurance fraud and patient brokering, and was released on $2,000 bond

The others who were arrested for their involvement in the scheme included:

  • Sonthonax Ferdinand, 57
  • Marie Jean Gilles Valcin, 42
  • Marie Celestin, 38
  • Josue Auguste, 42
  • Elisena Louissaint, 48
  • Joseph D Pierre, 39

Hillsborough County State Attorney Mark Ober’s office will prosecute the case.

Comments Off

Filed under Insurance Fraud

Sales of Fraudulent Life Insurance Policies Leads to Pompano Beach Arrest

A Pompano Beach woman who sold fraudulent life insurance policies to elderly military veterans and their families has been arrested and charged with insurance fraud, according to an April 1 announcement by Florida’s Chief Financial Officer, Jeff Atwater.

Patrice Sands sold the policies to members of Make-A-Wish Veterans, Inc., a Miami company providing assistance to veterans. According to investigators, Sands sold the policies, collected premiums, and deposited those premiums into a bank account tied to her business, Universal Research Group Insurance Agency. She never actually procured the policies, however.

When her husband died, one 84-year-old victim attempted to collect the death benefits due her under the policy she had purchased from Sands. No benefits were received, however, and Sands told the widow that the insurance company had “gone under.” Sands then sought return of the life insurance certificate and allegedly destroyed it. A check written by Sands to refund the woman’s premiums bounced due to insufficient funds.

If convicted, Sands faces up to 25 years in prison and the suspension of her insurance agent license.

Since July 2014, the Division of Insurance Fraud has arrested 59 insurance agents, bail bond agents, and public adjusters for fraud that has totaled almost $4.5 million dollars.

Comments Off

Filed under Insurance Fraud

Florida CFO Stresses Insurance Fraud Prevention Efforts

As Fraud Prevention Month came to a close, Florida Chief Financial Officer Jeff Atwater announced that the Florida Department of Financial Services remains focused on raising awareness of insurance fraud and its impact on the lives of Floridians. He also reassured citizens that his office will continue to combat this unlawful activity.

Throughout the country, the overall price tag for fraud is more than just a dollar amount in a budget report. The estimated $80 billion annual cost of fraud poses potential fiscal drains not only to insurance companies but to law-abiding insurance customers who in turn have to pay higher premiums.

According to the National Insurance Crime Bureau (NICB), auto insurance fraud, homeowners’ insurance fraud, and workers’ compensation fraud make up the three most prevalent types of insurance fraud. In addition, personal injury protection, or PIP, fraud accounts for nearly 50 percent of all fraud referrals in Florida.

The Florida Legislature passed HB119 in 2012 to reduce PIP fraud and yield savings for consumers. Florida auto policyholders have saved $65 since passage, according to the Atwater release, resulting from a statewide decrease in PIP fraud of 13.6 percent.

Also, the Department of Financial Services’ Division of Insurance Fraud (DIF) has helped bring fraudulent offenders to justice by actively pursuing these criminals through their investigations. Since 2011, when CFO Atwater first took office, DIF personnel have made a significant impact in the fight against fraud:

  • 5,708 insurance fraud arrests made
  • 4,485 fraud convictions stemming from these arrests
  • 96% conviction rate in partnership with local law enforcement and the State Attorney’s Offices

The Department’s Division of Consumer Services also conducts a consumer educational program, notes Atwater, to help Floridians from becoming fraud victims. Consumers who become aware of potential fraud can report it using an Insurance Fraud Hotline at 1-800-378-0445, or on the webpage www.MyFloridaCFO.com/Fraud. An Anti-Fraud Reward Program is in place to award individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

Comments Off

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

Four Arrested in Medicaid Fraud Scam Targeting Orlando Homeless

The Florida Attorney General’s Office announced on March 20, 2015 that four people have been arrested for Medicaid fraud. Homeless people were allegedly recruited to pose as patients in the Orlando fraud scheme, frequently in exchange for gas cards and temporary housing.

The defendants in the case are identified as follows:

  • Christina Benson, arrested in Georgia
  • Demetrious Davis, arrested in Florida
  • Harold Harrison, arrested in North Carolina
  • Dr. Sabiha Khan, arrested in Florida

Each individual faces at least one count of Medicaid Provider Fraud and one count of Organized Scheme to Defraud.

According to the investigation, Christina Benson, owner of Tranquility Healthcare Solutions in Orlando, billed Medicaid up to $3.2 million for psychosocial rehabilitation services that were neither warranted nor provided in a period of just 18 months. The announcement cited fraudulent payments of $215,000.

The company claimed to have worked with a local doctor, Sabiha Khan, as a treating provider, but many recipients said they had never met her. Additionally, untrained personnel—including some with criminal records—were allegedly used to deliver some services.

Click on the link for the Florida Attorney General announcement.

Comments Off

Filed under Insurance Fraud

Tampa Area $40K Tow Truck Fraud Leads to Four Arrests

On March 25, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of four Tampa Bay area men on charges of insurance fraud.  The men reportedly collected more than $40,000 in insurance payments after causing intentional damage to two tow trucks owned by Jimmy’s Towing and Recovery (Jimmy’s).

Leonard Bosi, 50, of Dunedin, Andrew Gentile, 25, of Palm Harbor, Edgar Gentile, 42, of Seminole, and Matthew Gentile, 23, of Dunedin face two charges each of insurance fraud over $25,000.

The first of two events occurred in Clearwater on June 17, 2014 when one of the tow trucks was involved in an accident. After being returned to Jimmy’s, the truck was reportedly hit by another truck multiple times until it was rendered inoperable.  An insurance claim was paid to Jimmy’s and shared among the four suspects.

Several days later on June 20, 2014, a second tow truck from Jimmy’s caught on fire while out on assignment. The flames were extinguished by an onlooker, and the truck was returned to Jimmy’s. Upon its return to the shop, additional damage was reportedly inflicted on the engine to the point that it could not be repaired.  An insurance claim was again paid to Jimmy’s and distributed among the four suspects.

The suspects were released on $10,000 bond each on the same day as their arrest. They face jail terms of up to 15 years.

The case will be prosecuted by the office of the Sixth Judicial Circuit State Attorney.

Comments Off

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.

Comments Off

Filed under Insurance Fraud