February 2015
Volume 5 - Issue 8
“While their injuries may
have been fake, PIP fraud
is real and is not a
victimless crime. When
insurance carriers absorb
such high-dollar losses to
fraud, we all pay in the
form of higher insurance
premiums. I’m thankful to
our dedicated
investigative team for
shutting down this fraud
ring.”
- CFO Jeff Atwater
INSIDE THIS ISSUE
1
Miami PIP Arrests
2
Most Wanted
3
PIP Fraud News
4
FIFEC Is Coming
7
Statewide Arrests
8
Statewide Contacts
HEADER HERE
Nine Arrested in Miami PIP Fraud Cases
Chief Financial Officer Jeff Atwater announced the arrests of nine individuals in
January for personal injury protection (PIP) fraud in Miami. Charged in eight
separate cases involving seven staged accidents, these individuals were arrested
and charged for their involvement in the filing of more than $242,000 in fraudulent
billings submitted to 11 insurance carriers. Five of those arrested were organizers of
the staged accidents.
“While their injuries may have been fake, PIP fraud is real and it is not a victimless
crime,” said CFO Atwater. “When insurance carriers absorb such high-dollar losses
to fraud, we all pay in the form of higher insurance premiums. I’m thankful to our
dedicated investigative team for shutting down this fraud ring.”
Most PIP fraud rings involve several components that are each monetarily driven –
the organizer, who recruits and arranges for individuals to stage, or intentionally
cause, motor vehicle accidents; the patient broker, who convinces the participants to
seek post-accident medical treatments for non-existent injuries; and sometimes
licensed medical providers, who agree to sign off on falsified medical treatment
documents in exchange for payments billed under the participants’ personal injury
protection benefits as part of their automobile insurance policies.
Included among those arrested were massage therapist Lazaro Luis Rosabal
Barcelo, 24, who worked at LMG Medical Center and Yalily Clavero Ruiz, 34, who
was the clinic manager at D & J Rehabilitation Center.
Participants in these staged accidents were referred to at least 13 different South
Florida medical clinics. This case remains ongoing and additional arrests are
expected.
The insurance carriers defrauded in these cases include Gainsco, Infinity, Kingsway
Amigo, Liberty Mutual, Mercury, Progressive, RepWest, State Farm, United Auto,
York and Windhaven.
These cases are part of a continuing crackdown by CFO Atwater’s Division of
Insurance Fraud and the National Insurance Crime Bureau in the fight against auto
insurance fraud in Florida. Anyone with information about suspected insurance
fraud is asked to call 1-800-378-0445. Citizens who provide tips can remain
anonymous. The Department of Financial Services to date has awarded nearly
$350,000 to nearly 60 citizens as part of its Anti-Fraud Reward Program. The
program rewards individuals up to $25,000 for information that directly leads to an
arrest and conviction in an insurance fraud scheme.
January 2015
Page 2
Four Arrested in Jacksonville Staged Accidents
In January, the Jacksonville office of the Division of Insurance Fraud (DIF) arrested four individuals involved in staged
accidents.
Randy Hernandez, 43, was charged in two separate staged accidents that occurred in December 2011. Hernandez was
the driver in a December 3 staged crash and then organized another crash on December 30. Nearly $58,000 in
fraudulent claims were filed against four insurance carriers for the bogus treatment by four clinics. Six participants from
the two crashes were allegedly treated by various clinics, including Arlington Rehabilitation Services, Gate Parkway
Diagnostic Center, Roosevelt Rehab Chiropractic and Therapy Diagnostic-Tech Medical. Danny Lamont Chester, 30,
was arrested as a participant in the December 30, 2011 staged accident.
Roberto Folch Ramos, 43, was arrested as a participant in a May 2012 staged crash which resulted in nearly $20,000 in
fraudulent billings to Direct General, Geico and Progressive.
Rosa Linda Colon-Maldonado, 46, was arrested as a driver in a November 2011 staged crash which resulted in more
than $76,000 in fraudulent billings to Gainsco.
Additional arrests are anticipated for participants in these staged accidents.
FIFEC is Coming - June 10-12, 2015.
See pages 4-5 for details.
Harley Santana-Fernandez
White Male, 34 years old
5’11”, 180 lbs, Brown Eyes, Brown Hair or Bald
Warrant Information:
Warrant/Case #: 130410010043D
Felony Warrant Charge: Insurance Fraud / Staged Accident
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud, DIF is attempting to locate Harley Santana-Fernandez in
reference to the outstanding warrant.
In May 2010, Santana-Fernandez organized a staged accident that
resulted in more than $71,000 in fraudulent claims. As the
organizer, he directed the participants to both clinics and attorneys.
Seven persons were arrested in connection with this staged
accident. Santana-Fernandez has yet to be found since his warrant
was issued in June 2012.
If you know where Santana-Fernandez 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
CFO Atwater Hopes Lawmakers Allow Law To Continue to Reduce PIP Fraud
Florida Chief Financial Officer Jeff Atwater hopes lawmakers continue to show patience with a 2012 law designed to
reduce fraud in the state's "no-fault" auto insurance system.
And he may get his wish, as legislators don't appear ready to change the system just yet.
While the law continues to be challenged in court, Atwater said the 2012 plan to improve the system is backed by a
report released Monday by the state Office of Insurance Regulation. The report indicated that the growth of fraud in
personal-injury protection, or PIP, claims has been halted.
"The Legislature, I'm hoping, will give this time and see how this is progressing, and that we would continue to see more
of these players with less claims do what is the right thing and bring rates down for Floridians," Atwater said.
See the full article by Jim Turner of the News Service of Florida at http://www.news4jax.com/news/pip-insurance-couldcontinue-to-receive-green-light/30578550.
Office of Insurance Regulation Issues Report on PIP Insurance Data Review
The Florida Office of Insurance Regulation (Office) has released a comprehensive Report on the review of the Motor
Vehicle Personal Injury Protection (PIP) Insurance data call as required by House Bill 119, which passed in 2012. The
Report provides data to help evaluate market conditions relating to the Florida Motor Vehicle No-Fault Law and the
impact on the market from reforms made as a result of this law.
The findings showed a general decrease in the per claim costs and the overall number of claims (frequency and severity)
for PIP since the implementation of HB 119 on January 1, 2013. The regional analysis concludes that South Florida and
the Tampa/St. Petersburg regions experienced the most significant decreases in Florida. However, the data also
exposed that other coverages, such as Bodily Injury (BI) and Uninsured Motorists (UM), experienced increases in both
frequency and severity when some benefits covered under PIP moved to these coverages. These trends are expected to
continue over the next year.
Prior to 2012 and the passage of this law, the pervasive nature of PIP fraud and staged auto accidents created an
unsustainable cost trajectory of PIP claims. The Division of Insurance Fraud (DIF), within the Department of Financial
Services (DFS), is responsible for investigating this type of fraud. According to the DIF, there has been a substantial
decline in PIP fraud since the implementation of HB 119 with a projected 16% decrease during Fiscal Year 2013-2014
from Fiscal Year 2011-2012.
Overall, there was limited data available to determine the true impact of HB 119; however, the data call analysis reveals
the law has had a major impact on the personal auto market and changed the trajectory of trends being seen prior to its
enactment.
See the official press release and the report at http://www.floir.com/PressReleases/viewmediarelease.aspx?id=2094.
NICB Posts New Fraud Files Story on Staged Accidents in New York
Check out this latest edition of NICB’s Fraud Files, a video story on a New York staged accident ring involving rental
trucks - https://www.youtube.com/watch?v=N6wDU3ukQtU&app=desktop.
The PIP Source
Page 4
PIP FRAUD SPOTLIGHT ON – FIFEC
This year the Florida Insurance Fraud Education Committee (FIFEC) 23rd Annual Conference will take place June 1012, 2015, in Orlando. The conference is attended by law enforcement, insurance investigators and professionals,
members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional
Insurance Investigators).
The Florida Insurance Fraud Education Committee began as the DIF/SIU Annual Training Seminar representing the
Florida Department of Insurance’s Division of Insurance Fraud and the Special Investigations Unit (SIU) community in
1992. DIF hosted this first seminar, which was actually a one-day, open forum-type workshop held in Altamonte Springs,
with no agenda other than to foster a favorable working environment between the public and private sectors involved in
the fight against insurance fraud.
This year's conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center, located
at 8101 World Center Drive in Orlando, where it has been hosted since 2004. Expected to return this year as speakers
are Florida Chief Financial Officer Jeff Atwater and Division of Insurance Fraud Director Simon Blank and Marilyn
O’Brien, Executive Chairman of FIFEC.
Included among this year’s 60 course offerings are the following PIP-related courses:
The Price is Not Right
Beaches to Bluegrass
PIP Fraud and Organized Crime
Biomechanical Analysis of Injury
Clinic Inspection and Provider Fraud
The Anatomy of an Affirmative Lawsuit
Combating Low Impact Insurance Claims
Understanding Chiropractic Provider Fraud
Vehicular Accident Analysis – The Big Picture
An Introduction to Adjusting No-Fault SIU Claims
High Quality IMEs & FCEs – Get What You Pay For
How To Lose Both a Criminal and a Civil Fraud Case
SIU Data Analytics: Sword and Shield for Florida Law
Communications with Claimants on First Party Claims
A Strategic Approach to Attacking Medical Provider Fraud
Criminal Prosecution of Automobile and PIP Fraud Claims
Fraudulent Uninsured Motorist Claims: The Proof is in The Damage
The Who, What, Where, When and Why of Examination Under Oath
Strategies to Defend Against Attorney’s Fee Claims in Insurance Cases
The Role of the Florida Department of Health in PIP Fraud Investigations
The Application of Social Media in the Injury and Medical Claims Process
Defending Against Fraud: Pre-Suit Investigations and Litigation Strategies
Collaboration With The Department of Health to Combat Health Care Fraud
Developing & Utilizing Evidence: From Clinic Investigations to EUO to Litigation
Vehicle Accident Event Data Recorders, History, Coverage, Capabilities and Future
Mechanisms Available to Adjusters During Review for Regulatory and Compliance Issues
A Comprehensive Radiology Review and CPT Coding Modalities & Therapeutic Procedures
The Florida Motor Vehicle No-Fault (PIP) Law and Current Trends and Issues 2015 Updates
Advances and Changes in the Field of Accident Investigation, Reconstruction and Biomechanics
Understanding the Diagnosis, Documentation and Proper Billing for Spinal Treatment and Procedures
Florida Law and Examinations Under Oath: A Practical Approach to Eliciting Relevant Claim Information
Go to www.fifec.org and register today and join the fight against insurance fraud in Florida.
The PIP Source
Page 5
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 or email us at PUBLICRELATIONS@FIFEC.ORG
Olimpia Albinson, Allstate Insurance Company and Brett Kelley, Personable Insurance Company
AWARDS:
On-Line Nominations: https://fifec.org/web_forms/award_nomination.php Deadline: May 1, 2015
Categories include: 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
Important Dates
On-Line Registration: http://fifec.org/registration.html
Thru 4/30/2015 (postmarked): $175.00 Early Bird Special
5/1 – 5/31/2015 (postmarked): $200
6/1 – 6/11/2015 (postmarked): $225
Walk In Fee:
$250
Mention FIFEC for the special room rate of $145.00 at Caribe Royale (Hotel sold out the past few years, so book early!)
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
FIFEC is an ALL VOLUNTEER organization, and we thank you for your support!!!
The PIP Source
Page 6
DFS Policy on Reporting of Multiple Suspected
Fraudulent Acts in a Single On-line Submission
Recently there has been an increase in multiple fraud referrals for the same suspect entity. In order to streamline the
process and avoid unnecessary work by all parties, the Department of Financial Services, Division of Insurance Fraud
has instituted the below guidelines for reporting multiple suspected fraudulent acts in a single on-line submission.
If you have any questions, please contact Bureau Chief Buddy Hand at 850-413-4020.
January 2015
Page 7
Statewide PIP Arrests – January 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.
Dora Maria de Hoyos Muniz, 37 - fake ins card (Occidental Fire & Casualty) O
Trevor Anthony Desousa, 36 - false tow receipts - $285 (Amica) T
Jacques Jean Baptiste, 49 - PIP patient / false claims - $67,816 - Optimal Chiropractic (Amica) O
Sonia Pierre, 40 - PIP patient / false claims - $67,816 - Optimal Chiropractic (Amica) O
Elvis Lazaro Ferrera, 42 - staged acct 07/06/11 (recruiter) $56,721 - EPM Therapeutic Center / Fast Rehabilitation Center (State
Farm / United Auto) M
Jose Raul Escobedo Espinosa, 41 - staged acct 12/05/12 (driver) $39,774 - 86 Medical & Rehab Center / Blue Village Medical
Center, Corp / Florida Superior Imaging / Intermas Medical Center Corp (Kingsway Amigo / Liberty Mutual) M
Roberto Folch Ramos, 43 - staged acct 05/04/12 (passenger) $19,749 - Gate Parkway Diagnostic Center / One Touch Therapy
Center (Direct General / Geico / Progressive) J
Dionne Rene Preston, 48 - fake ins card (Windhaven) T
Lazaro Luis Rosabal Barcelo, 24 - massage therapist / false claims - $41,356 - LMG Medical Center (York) M
Jenniet Reyes, 30 - staged acct 05/05/14 (passenger) $8,432 - EM Rehabilitation Center Corp (Windhaven) M
Ronnie Thompson, Jr, 30 - jump-in / patient brokering - $3,502 - Unity Pain Injury Center, LLC (Geico / Mercury) O
Luis Angel Maldonado, 42 - false statement in support of jump-in - $11,084 (State Farm) O
Filomena Ruiz, 30 - jump-in - $1,705 (State Farm) O
Yalily Clavero Ruiz, 34 - clinic manager / patient brokering - $9,606 - D & J Rehabilitation Center (Gainsco) M
Rosa Linda Colon-Maldonado, 46 - staged acct 11/10/11 (driver) $76,159 - Emed Primary Care & Walk In Clinic / Gate Parkway
Diagnostic Center / Physicians Medical Centers / Saint Jose Injury Center / Wellness Rehab Service (Gainsco) J
Lazaro Felix Villadonga, 24 - staged acct 05/05/14 (recruiter / passenger) $8,432 - EM Rehabilitation Center Corp (Windhaven) M
Britney Shunquil Sutton, 28 - jump-in (Direct General) T
Yasiel Rodriguez, 35 - staged acct 01/15/14 (recruiter) $29,959 - Excellent Care Chiropractic Center / Palmetto Lakes Therapy &
Rehabilitation Center dba Lakes Rehab / Prime Medical & Rehab Services (Infinity / Mercury) M
Mevett J Wooley, 35 - fake ins card (Geico) O
Julian Manrique, 38 - staged acct 09/07/11 (recruiter) $37,701 - Community Medical Clinic / Fast Rehabilitation Center (Kingsway
Amigo / Progressive / State Farm) M
Yunior Delgado, 27 - staged acct 10/09/10 (recruiter) $19,241 - Angels Diagnostic Center / Millennium Medical Center (Progressive /
RepWest) M
Andrew Williams, 26 - fake ins card (Peak Property) T
Tonya L Sexton, 33 - application fraud (Esurance) T
Bekir Onur Keskiner, 33 - application fraud (Progressive) B
Bekir Onur Keskiner, 33 - application fraud / false tow receipt - $167 (Direct General) B
Danny Lamont Chester, 30 - staged accident 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
Randy Hernandez, 43 - staged accident 12/30/11 (organizer) $57,106 - Arlington Rehabilitation Services / Gate Parkway Diagnostic
Center / Roosevelt Rehab Chiropractic / Therapy Diagnostic-Tech Medical (Allstate / Farmers / Sentry / State Farm) J
Randy Hernandez, 43 - staged accident 12/03/11 (driver) $824 - Arlington Rehabilitation Services / Gate
Center (State Farm) J
Parkway Diagnostic
Breterrica Shauntea White, 24 - application fraud (Permanent General Assurance) TL
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
The PIP Source
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
Lt. Sandra FITZSIMONS
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 nine
individuals for PIP fraud in Miami, including a
massage therapist and clinic manager.
On page 2, we report on the arrests of four
persons for staged accidents in Jacksonville
and feature another fugitive in Insurance
Fraud’s Most Wanted.
On pages 4 and 5, we announce the 2015
FIFEC Conference to be held June 10-12 in
Orlando. Hope to see you there.
On page 6, DIF provides guidance for making
multiple fraudulent claim referrals.
As always, we report on PIP Fraud in the News
and the latest PIP-related arrests.
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
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