March 2015
Volume 5 - Issue 9
The clinics were part of
personal injury
protection (PIP) fraud
schemes that resulted
in more than $243,000
in illegal billings.
HERE
Seven Arrested HEADER
For Operating
Unlicensed
Clinics in Orlando and Ft. Lauderdale
The Division of Insurance Fraud (DIF) recently arrested seven individuals involved in the
operation of four unlicensed clinics in Orlando and Ft. Lauderdale. The clinics played a
role in personal injury protection (PIP) fraud schemes that resulted in more than
$243,000 in illegal billings.
Lherisson Domond, 82, a licensed medical doctor, was arrested for acting as the straw
owner of two clinics in Orlando, Unity Pain and Injury Center and Blesscare Chiro
Center. In actuality, the clinics were operated by non-licensed individuals who paid
Domond $1,500 / month for use of his name and medical license.
Nesly Loute, 50, Pierre Alex Herisse, 48, and Djoodmy Elie, 44, were arrested for
operating the unlicensed clinic, Unity Pain and Injury Center. Each was charged with
more than $67,000 in illegal billings during March to September 2012.
Fortunard Dieuveillant Fonrose, 42, was arrested for operating Blesscare Chiro Center,
an unlicensed clinic. Fonrose was charged with illegally billing more than $86,000 during
May 2012 to November 2014.
Domond admitted that he entered into an agreement with the true owners to be paid for
the use of his name as a straw owner.
Each Orlando case will be prosecuted by the office of Orange County State Attorney
Jeffrey L. Ashton.
INSIDE THIS ISSUE
1
Clinic Arrests
2
Most Wanted
3
PIP Fraud News
4
FIFEC Update
6
Statewide Arrests
8
Statewide Contacts
In Broward County, DIF arrested two clinic owners, Jonas Fils and Obinson Louis, who
also utilized Domond as a straw owner. Jonas Fils, 52, was arrested for operating J.J.
Health & Wellness, an unlicensed clinic in Tamarac. Fils was charged with illegally
billing nearly $72,000 during May to September 2013.
Obinson Louis, 37, was arrested for operating Innovative Medical Rehab Center, an
unlicensed clinic in Oakland Park. Louis was charged with illegally billing more than
$17,000 during May 2013 to April 2014.
Neither clinic had obtained an exemption from the Agency for Health Care Administration
(AHCA). Both Fils and Louis agreed to pay Domond $1,500 / month to be a straw
owner. Domond had no involvement in the day to day operation of either clinic.
The Broward cases will be prosecuted by the office of Broward County State Attorney
Michael J. Satz.
The investigation continues and additional arrests are anticipated.
March 2015
Page 2
Tampa DIF Detective Nominated For SLECA Officer of the Year
The Division of Insurance Fraud (DIF) nominated Detective Billy Brantley for the State Law Enforcement Chief’s
Association (SLECA) Officer of the Year Award. Brantley has been with the Division since June 2009.
In December 2009, Detective Brantley initiated an investigation involving Tampa clinic Medical Therapy Practitioners.
Brantley gathered evidence that led to the execution of a search warrant. Evidence obtained during the search revealed
that Medical Therapy Practitioners was involved in a scheme to stage accidents, pay individuals to seek treatment at the
clinic and falsely bill insurance carriers for services not rendered. The investigation developed evidence that showed the
clinic was operating with a fraudulent exemption obtained from the Florida Agency for Healthcare Administration (AHCA)
after a chiropractor admitted he submitted the application as the 100% owner of the clinic when in fact he was not.
Detective Brantley conducted numerous interviews and analyzed substantial bank records that provided evidence and
intelligence to document an organized criminal network operating in Hillsborough County. The network involved 42
subjects and 18 clinics with a combined income of over $20 million. The network used straw companies to launder
money in excess of $6 million. Hillsborough County Assistant State Attorney Michael Lennon filed cases against seven
subjects that included charges for RICO and money laundering. Two subjects remain fugitives and are believed to have
fled the country. This investigation had a significant impact in Hillsborough County and is believed to be one of the
contributing factors for a 40% decrease in PIP fraud.
FIFEC is June 10-12, 2015.
See pages 4-5 for updated details.
Robert Charles Brodon
White Male, 69 years old
6’3”, 265 lbs, Green Eyes, Brown Hair or Bald
Warrant Information:
Warrant/Case #: 432012CF000106A
Felony Warrant Charge: Insurance Fraud / Staged Accident
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud, is attempting to locate Robert Charles Brodon in reference to
an outstanding warrant.
In June 2011, Brodon participated in a staged accident that resulted in
more than $13,000 in fraudulent claims. As a participant, Brodon was
paid for damage to his vehicle and also agreed to visit a clinic for
unnecessary treatment.
Brodon has yet to be found since his warrant was issued in January
2012. His warrant is a Florida pick-up only, no extradition.
If you know where Brodon can be located, please contact the Division
of Insurance Fraud at 1-800-378-0445.
Check out the DFS Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/
The PIP Source
Page 3
PIP FRAUD – In The News
Physician Assistant Surrenders License in Operation No-Med Services Plea
Carlos Millan, 76, entered a plea with the Miami-Dade County State Attorney’s Office in which he was sentenced to five
years probation, ordered to pay $11,026 in restitution and surrender his medical license. Millan was arrested in May
2013 as part of Operation No-Med Services, an organized scheme involving four clinics and staged accident claims in
excess of $408,000. Millan worked at Emoge Medical Services, and was charged with falsifying treatment forms for
patients he did not examine.
IRC Estimates Fraud and Buildup Add $7.7 Billion To Auto Injury Claims
A new study from the Insurance Research Council (IRC) estimates that claim fraud and build up added between $5.6
billion and $7.7 billion in excess payments to auto injury claims paid in the United States in 2012. These excess
payments represent between 13 percent and 17 percent of total payments under the five main private passenger auto
injury coverages. Twenty-one percent of bodily injury (BI) claims and 18 percent of personal injury protection (PIP)
claims closed with payment had the appearance of fraud and/or buildup in 2012, according to file reviewers. Claims with
the appearance of fraud and/or buildup were more likely than other claims to involve chiropractic treatment, physical
therapy, alternative medicine, and the use of pain clinics. The study, Fraud and Buildup in Auto Injury Insurance Claims,
is based on continuing IRC research into the causes of increased auto injury claim severity. It is based on more than
35,000 auto injury claims closed with payment under the five principal private passenger coverages. Twelve insurers,
representing 52 percent of the private passenger auto insurance market in the United States, participated in the study.
For more information, see the full story at http://insurancenewsnet.com/oarticle/2015/02/03/fraud-and-buildup-add-up-to%2477b-in-excess-payments-for-auto-injury-claims-a-589705.html#.VNUhzOl0w5s.
Miami Police Department Arrests Clinic Owner In Operation Lake View
The City of Miami Police Department arrested four following
an undercover investigation involving patient brokering and
fraudulent billing at Excellent Care Chiropractic Center.
Those arrested included clinic owner Jose Madruga Sosa,
60, therapist Ariam Angel Gomez Huet, 41, and clinic
employees Maritza Wong, 50, and Mayrelis de la Caridad
Zammora, 36.
Excellent Care Chiropractic Center incorporated in 2003,
and Madruga Sosa has been on the corporate documents
since 2008. Gomez Huet was first licensed in 2009 as a
massage therapist in Florida.
Hialeah Police Conduct Insurance Verification Operation
The City of Hialeah Police Department conducted a proof of insurance operation in February. The results were 389
citations issued and 29 arrests for various criminal violations, including two arrests for fake insurance cards; Henry
Banks, 36 and Eric Reed, 36. The operation was coordinated with the National Insurance Crime Bureau (NICB) and
both Medley and Hialeah Gardens Police Departments participated.
The insurance companies that participated included 21st Century, Allied, Allstate, Ascendant, Assurant, Bristol West,
Dairyland, Depositors, Direct General, Farmers, Geico, Imperial Fire, Infinity, Mapfre, Mercury, MetLife, National
General, Nationwide, Peak, Sentry, State Farm, Titan, Travelers, United Auto, USAA, Victoria and Windhaven.
Check this link for more info - http://miami.cbslocal.com/2015/02/12/police-take-to-the-streets-to-battle-insurance-fraud/.
Division of Insurance Fraud Invites Public Comment on Reaccreditation Process
The Florida Department of Financial Services’ Division of Insurance Fraud is inviting public comment as the division
proceeds through its reaccreditation process. Accreditation is a certification issued by an independent reviewing
authority confirming that an entity has met specific requirements and prescribed standards of excellence. The Division of
Insurance Fraud became accredited in February 2009 and was awarded reaccreditation in June 2012.
Comments about the Division of Insurance Fraud’s compliance with the CFA standards can be sent to The Commission
for Florida Law Enforcement. Letters may be submitted to: CFA, P.O. Box 1489, Tallahassee, Florida, 32302. Email
correspondence may be forwarded to: info@flaccreditation.org. For further information or for a copy of the CFA
standards please contact Lieutenant Tim Hartley, Accreditation Manager at (850) 413-3115.
March 2015
Page 4
PIP FRAUD SPOTLIGHT ON – FIFEC
The Florida Insurance Fraud Education Committee (FIFEC) is pleased to announce the 23rd
Annual Joint (DIF/SIU) Division of Insurance Fraud / Special Investigative Units Conference at the
Caribe Royale Hotel & Convention Center in Orlando, Florida, June 10-12, 2015.
WHAT:
23nd Annual Conference – Insurance FRAUD AWARENESS Conference
WHERE:
Caribe Royale Hotel & Convention Center in Orlando, Florida
WHEN:
June 10-12, 2015
WHY:
The FIFEC Conference is nationally and internationally recognized for creating an
alliance between the Special Investigative Units, the Division of Insurance Fraud
(Florida Department of Financial Services), Federal, State and Local Law Enforcement
and State Prosecutors through educational courses, training and networking.
Please join the Committee, the Florida Special Investigative Units, the Florida
Department of Financial Services, Division of Insurance Fraud, the State of Florida’s
Chief Financial Officer, our sponsors, counsels and exhibitors as we unite in the fight
against insurance fraud in these most difficult financial times.
VISUALS:
The conference is very reasonably priced, as low as $175 with Law Enforcement
Grants available, and there are continuing education credits available for attorneys and
insurance adjusters. Our speakers are hand selected and many have spoken and
presented locally, nationally and some have even spoken internationally.
KEYNOTE: FIFEC has invited Florida Chief Financial Officer, Honorable Jeff Atwater to be the
Keynote speaker. FIFEC has also requested and has initial confirmation that the
Florida (DFS-DIF) Director of the Division of Insurance Fraud, Simon Blank, will
be speaking as we unite in Fraud Awareness and Educational efforts. The all-star
line-up will include an Orange County Sheriff's Office representative and Marilyn
O’Brien, Executive Chairman of FIFEC. The opening ceremonies and conference
will begin sharply at 11 AM with the Orange County Sheriff’s Office HONOR GUARD
and the Pledge of Allegiance. Please join us to at the 23rd Annual FIFEC
Conference.
CONTACTS: Please visit our website @ WWW.FIFEC.ORG
Olimpia Albinson, Allstate Insurance Company
Brett Kelley, Personable Insurance Company
E-MAIL: PUBLICRELATIONS@FIFEC.ORG
The PIP Source
Page 5
PIP FRAUD SPOTLIGHT ON – FIFEC
~ IMPORTANT DATES ~
REGISTRATION:
On-Line Registration: http://fifec.org/registration.html
Thru 4/30/2015 (postmarked):
Early Bird Special $175.00
5/1 – 5/31/2015 (postmarked):
$200
6/1 – 6/11/2015 (postmarked):
$225
Walk In Fee:
$250
WHERE:
CARIBE ROYALE: (800) 537-7737
Mention FIFEC for the special rate of $145.00
(The hotel sold out the past two years, so book early!)
AWARDS:
On-Line Nominations: https://fifec.org/web_forms/award_nomination.php
Nominations Deadline: May 1, 2015
~ Law Enforcement Investigator of the Year
~ Insurance Investigator of the Year
~ Analyst of the Year
~ Law Enforcement Prosecutor of the Year
~ Insurance Attorney of the Year
~ Jerry Zappolo Distinguished Service Award
LAW ENFORCEMENT GRANTS:
Apply On-Line: http://fifec.org/grants.html
Reserved for Law Enforcement, government investigators and prosecutors only!
VOLUNTEERS:
Volunteer On-Line: http://fifec.org/volunteers.html
We encourage attendees to be a part of the conference by volunteering to proctor a class.
FIFEC is an ALL VOLUNTEER organization, and we thank you for your support!!!
March 2015
Page 6
Statewide PIP Arrests – February 2015
Each issue will provide a list of PIP arrests made by the offices throughout the state. Along with each defendant’s name
and age, we will include: the type of scheme involved; the fraud dollar amount; clinic name(s); victim insurance company
name(s); and the arresting office. If you need additional details on any of these arrests, please contact Capt. Smith.
Victor Maure Torres, 25 - staged accident 12/30/11 (passenger) $55,531 - Arlington Rehabilitation Services / Gate Parkway
Diagnostic Center / Roosevelt Rehab Chiropractic / Therapy Diagnostic-Tech Medical (Allstate / Farmers / Sentry / State Farm) J
Camille Miracle, 50 - fake ins card (AIG) O
Houssein de Paz, 40 - paper crash 02/28/14 (passenger) $6,600 - Hope Rehabilitation (Geico) M
Niurka Martinez, 38 - paper crash 02/28/14 (passenger) $6,900 - Hope Rehabilitation (Geico) M
Dominick Maximo Espinal, 23 - staged acct 10/14/12 (jump-in passenger) $12,626 – Advanced 3D / HR Healthy Rehab (Geico) J
Danach Staniclas, 33 - fake ins card (Esurance) O
Latronda Latrece Shelby, 31 - false tow receipt (Geico) M
Iraklis Mallas, 24 - application fraud (Progressive) T
Briselda Hernandez, 41 - fake ins card (Ocean Harbor) W
Randy Fruto Hernandez, 32 - staged acct 08/04/12 (recruiter) $86,152 - CI Medical Center / Doral Health Center / Fiallo Care
Therapy Center / Health Professional Services / YH Imaging (Geico / United Auto / Windhaven) M
Houssein de Paz, 40 - paper crash 02/11/14 (passenger) $6,940 - EM Rehabilitation (Geico) M
Niurka Martinez, 38 - paper crash 02/11/14 (passenger) $5,300 - EM Rehabilitation (Geico) M
Steven Afanador, 54 - false claim / filing false police report (Progressive) O
Laramie J Williams, 30 - application fraud (Assurance America) T
Danilo Antonio Espinal, 43 - staged acct 10/14/12 (driver) $12,626 – Advanced 3D / HR Healthy Rehab (Geico) J
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
Subject Arrested For Operating Unlicensed Clinic in Orlando
The Division of Insurance Fraud (DIF) arrested clinic owner Josue Pierrissaint, 30, for operating several unlicensed
PIP clinics in the Orlando area. In 2010, Pierrissaint originally opened Edgewater Chiropractic in Lockhart, and used
chiropractor Sham Mohammed as the straw owner to obtain an exemption from the Florida Agency for Healthcare
Administration (AHCA).
Pierrissaint then hired another chiropractor, Koteuaisa Wilson, to work at Edgewater. After a few months, Pierrissaint
convinced Koteuaisa to open another clinic, Dr. Wilson’s Straight Up Chiropractic, at the same Lockhart address as
Edgewater. Pierrissaint used Koteuaisa as the straw owner to obtain the AHCA exemption. Wilson eventually left the
clinic, but Pierrissaint continued to use her name to operate for another year.
In 2012, Pierrissaint opened Dr. Koteuaisa Chiropractic in Orlando, without the knowledge or permission of Koteuaisa,
and used her name and license to obtain an exemption from AHCA.
Pierrissaint, who does not hold a medical license, was paid more than $425,000 by 16 different insurance carriers while
operating these unlicensed clinics.
The insurance carriers defrauded by Pierrissaint include AGIC, Allstate, Amica, Assurance America, California Casualty,
Direct General, Farmers, Geico, Infinity, Liberty Mutual, North American, Progressive, Star & Shield, The General,
Travelers and Windhaven.
The PIP Source
Page 7
Statewide PIP Arrests – February 2015
Each issue will provide a list of PIP arrests made by the offices throughout the state. Along with each defendant’s name
and age, we will include: the type of scheme involved; the fraud dollar amount; clinic name(s); victim insurance company
name(s); and the arresting office. If you need additional details on any of these arrests, please contact Capt. Smith.
Susan Marie Rippeon, 56 - lost wages / mileage reimbursement - $2,000 (Geico) O
Kentisha Yaneshea James, 22 - application fraud (Progressive) TL
Dnelia Shanterra Jennings, 34 - jump-in - $8,156 - Mason Injury & Accident Clinic (Progressive) O
Andres Alfonso Gutierrez, 53 – staged acct 12/30/11 (passenger) $57,106 - Arlington Rehabilitation Services / Gate Parkway
Diagnostic Center / Roosevelt Rehab Chiropractic / Therapy Diagnostic-Tech Medical (Allstate / Farmers / Sentry / State Farm) J
Fortunard Dieuveillant Fonrose, 42 - clinic owner / unlicensed clinic - $86,738 - Blesscare Chiro Center (Direct General / Geico /
Kemper / Liberty Mutual / National Liability & Fire) O
Lherisson Domond, 82 - doctor / straw owner - $86,738 - Blesscare Chiro Center (Direct General / Geico / Kemper / Liberty Mutual /
National Fire & Liability) O
Lherisson Domond, 82 - doctor / straw owner - $67,346 - Unity Pain and Injury Center (Geico / Progressive / State Farm / USAA) O
Nesly Loute, 50 - clinic manager - $67,346 - Unity Pain and Injury Center (Geico / Progressive / State Farm / USAA) O
Arlet Mendez Diaz, 25 - PIP patient - $1,242 - Columbus Rehabilitation Center (Progressive) T
Alex Pierre Herisse, 48 - clinic employee - $67,346 - Unity Pain and Injury Center (Geico / Progressive / State Farm / USAA) O
Manuel Iturriaga Espinosa, 39 - staged acct 11/03/12 (recruiter) $74,816 - B & A Diagnostic / Doctors Professional Medical Center /
LMG Medical Center / Psychologist Technology (United Auto / York) M
Jonas Fils, 52 - owner unlicensed clinic - $71,905 - J J Health and Wellness (Liberty Mutual / Progressive / State Farm) B
Crystal L Bolden, 30 - application fraud / false claim (Progressive) B
Josue Pierrissaint, 30 - owner unlicensed clinics - $425,620 - Dr Koteuaisa Chiropractic / Dr Wilson’s Straight Up Chiropractic /
Edgewater Chiropractic (AGIC / Allstate / Amica / Assurance America / California Casualty / Direct General / Farmers / Geico /
Infinity / Liberty Mutual / North American / Progressive / Star & Shield / The General / Travelers / Windhaven) O
Djoodmy Elie, 44 - clinic owner - $67,346 - Unity Pain and Injury Center (Geico / Progressive / State Farm / USAA) O
Edira Nikita Cartwright, 27 - application fraud (Esurance) B
Daisy Lyanne Martinez-Serrano, 23 - staged acct 05/08/12 (passenger) $41,037 - Gate Parkway Diagnostic Center (Direct General /
Geico / State Farm) J
Daysi Martinez, 46 - staged acct 05/08/12 (passenger) $41,037 - Gate Parkway Diagnostic Center (Direct General / Geico / State
Farm) J
Rafael Ruiz, 50 - application fraud (Allstate) M
Clarissa Lynn Schranz, 28 - lost wages - $1,600 (Geico) O
Dolores McClendon, 52 - fake ins card (Direct General) O
Heather Marie Worden, 27 - PIP patient / pedestrian - $13,725 (Geico) M
Obinson Louis, 37 - owner unlicensed clinic - $17,715 - Innovative Medical Rehab Center (Progressive / State Farm) B
Sandra M de la Fuente, 44 - staged acct 01/06/11 (passenger) $47,440 - All Care & Rehab Center / American Therapeutic / D & G
Medical Center / Diagnostic & Radiology of Miami / Excellent Chiropractic / Manuel V Feijoo, MD / YH Imaging (Allstate / Geico /
Kingsway Amigo) M
Zoila Elena Rojas, 54 - staged acct 06/02/14 (passenger?) $69,725 - Angels Diagnostic Group / Golden Health Solution / Imagen
Medical Center (FAJUA) M
Vonel Canga, 26 - fake ins card (United Auto) M
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
March 2015
Page 8
Statewide PIP Contacts
PANHANDLE REGION
Counties: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf,
Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty,
Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton,
Washington
Pensacola Field Office - 850.453.7802
Capt. David LINDSAY
Tallahassee Field Office - 850.413.3115
Lt. Ernie STOLL
NORTH REGION
Counties: Alachua, Baker, Bradford, Citrus, Clay, Columbia,
Dixie, Duval, Flagler, Gilchrist, Hamilton, Levy, Marion,
Nassau, Putnam, St. Johns, Sumter, Suwannee, Union
Jacksonville Field Office - 904.798.5802
Capt. Brian McCOY
Lt. Kevin JONES
NORTH CENTRAL REGION
Counties: Brevard, DeSoto, Hardee, Hernando, Hillsborough,
Lake, Manatee, Orange, Osceola, Pasco, Pinellas, Polk,
Sarasota, Seminole, Volusia
Tampa Field Office - 813.972.8602
Major Michael BYRNE
Lt. Carlos ROSARIO
Orlando Field Office - 407.835.4402
Capt. Evangelina BROOKS
Lt. Laquanda GREEN
Lt. John SAVINO
Copy goes her.
Editor’s
Corner
On page 1, we cover the arrests of seven
individuals for operating four unlicensed
clinics in Orlando and Ft. Lauderdale.
On page 2, we spotlight the nomination of DIF
Detective Brantley for SLECA Officer of the
Year and feature another fugitive in Insurance
Fraud’s Most Wanted.
On page 6, we cover the arrest of an Orlando
man for operating an unlicensed PIP clinic.
As always, we report on PIP Fraud in the News
and the latest PIP-related arrests.
We updated our email list recently. If you were
removed by mistake, let us know. If you are not
currently on the email list and wish to join, just
send your request to:
thepipsource@myfloridacfo.com
SOUTH CENTRAL REGION
Counties: Broward, Charlotte, Collier, Glades, Hendry,
Highlands, Indian River, Lee, Martin, Okeechobee,
Palm Beach, St. Lucie
Plantation Field Office - 954.958.5402
Capt. Rafael DELGAGO
Lt. Bill LEE
West Palm Beach Field Office - 561.837.5601
Major Glen HUGHES
Ft. Myers Field Office - 239.278.7527
Acting Lt. Glen CLASEN
SOUTH REGION
Counties: Dade, Monroe
Miami Field Office - 305.536.0302
Capt. Steven SMITH
Lt. Violeta SERRANO
Lt. Stanley JEAN-FELIX
Lt. Missael DIAZ
South Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt 847.544.7141
Central Florida Major Medical Fraud Task Force
Supervisory Special Agent Jose Olivier 813.558.6387