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.
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.
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.
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.
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.
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.
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.