November 2014
Volume 5 - Issue 5
“I am very proud of
our dedicated
detectives for their
diligent work to hold
these criminals
accountable.”
- CFO Jeff Atwater
INSIDE THIS ISSUE
1
Operation Cold Call
2
Chiros Sentenced
3
PIP Fraud News
4
Most Wanted
5
Statewide Arrests
7
Statewide Contacts
HEADER HERE
Seven Arrested
in Insurance Fraud
Undercover Sting “Operation Cold Call”
Florida Chief Financial Officer Jeff Atwater announced the arrests of attorneys,
chiropractors and clinic employees involved in an organized personal injury protection
(PIP) fraud scheme. The arrests, made in Martin, Miami-Dade and Palm Beach
counties, follow a year-long undercover investigation by the Florida Department of
Financial Services’ Division of Insurance Fraud (DIF).
“These arrests are the culmination of more than a year of extensive and often dangerous
undercover work that has exposed a crime ring responsible for potentially hundreds of
thousands of dollars in fraud,” said CFO Atwater. “I am very proud of our dedicated detectives for their diligent work to hold these criminals accountable.”
During the investigation, multiple undercover detectives were embedded into clinics that
were accepting patients who were illegally solicited. One clinic in particular was billing
for services that were never rendered. On several occasions, patients were also found
being coached to claim they were injured when they were not.
As the investigation progressed, an undercover detective became a patient broker for the
ring. The targets indicated they would compensate the undercover detective for referring
patients under the guise of marketing. During the meeting in which the brokering
agreement was discussed, the principal targets all agreed to pay the undercover
detective for bringing patients to specific clinics. Several times during meetings, the
principal targets mentioned that it was illegal to directly pay for patients and that is why
they disguise it as marketing.
The individuals arrested include attorneys Cory Meltzer, 33, and Brian Neil Greenspoon,
42, Boca Raton; chiropractors Roger Toby Hughes Bell, 44, Hobe Sound, and Ryan
Alexandre Grand, 36, Lake Worth; clinic employee Christina Lee Savoye, 34, Stuart; and
runners Alejandro Jose Marin, 38, Homestead, and Douglas Anthony Santiago, 28,
Boynton Beach. The defendants will be prosecuted by the 15th and 19th Judicial Circuit
State Attorney’s offices.
The clinics involved included Accident Recovery Centers, which opened in 2011 in Port
St. Lucie, and Active Recovery Centers, which opened in 2012 in Stuart. Grand was
licensed as a chiropractor in Florida in 2003 while Bell was licensed in 2012.
Greenspoon was licensed to practice law in Florida in 2003 while Meltzer was licensed in
2007.
DIF was assisted in this investigation and takedown by Geico, MetLife and Progressive
insurance companies; the National Insurance Crime Bureau (NICB); Homestead Police
Department; Martin County Sheriff’s Office (MCSO); and Palm Beach County Sheriff’s
Office (PBSO).
November 2014
Page 2
Three More Chiropractors Sentenced to Federal Prison
in Operation Sledgehammer
Three chiropractors charged as part of Operation Sledgehammer were sentenced to federal prison on
October 10, 2014. Kenneth Karow, 54, of West Palm Beach, Hermann J. Diehl, 44, of Miami, and Hal Mark
Kreitman, 50, of Miami Beach, were sentenced before U.S. District Judge Kenneth A. Marra for their
participation in a massive staged automobile accident scheme based in Palm Beach and Miami-Dade
Counties. Karow was sentenced to 11 years and ordered to pay $6,640,354.07 in restitution; Diehl was
sentenced to nine years and ordered to pay $1,685,345.01; and Kreitman was sentenced to eight years and
ordered to pay $1,634,195.83 in restitution.
After a seven-week trial before Judge Marra, a federal jury in West Palm Beach convicted all of the
defendants of one count of conspiracy to commit mail fraud and one count of conspiracy to commit money
laundering. Karow was convicted of 48 counts of mail fraud and 11 counts of money laundering. Diehl was
convicted of two counts of mail fraud and three counts of money laundering. Kreitman was convicted of 21
counts of mail fraud and two counts of money laundering.
These sentences were the latest in a series of federal and state charges filed as part of a four-year
investigation into a massive staged automobile accident / fraudulent chiropractic clinic scheme. The joint
federal and state law enforcement investigation, dubbed Operation Sledgehammer, has resulted in charges
filed against 93 defendants for their participation in this automobile insurance fraud scheme. Of those 93
defendants, 57 have been charged federally by the U.S. Attorney’s Office, resulting in court-ordered
restitution of more than $11 million to the defrauded insurance companies, and 51 of those 57 defendants
have been convicted by jury or by guilty plea. The remaining six defendants are fugitives. Another thirty-six
defendants have been charged by the Palm Beach County State Attorney’s Office.
This investigation was conducted by the FBI, IRS-CI, the Florida Division of Insurance Fraud, the Palm Beach
County State Attorney’s Office, and the Greater Palm Beach County Health Care Fraud Task Force, and they
were assisted by the National Insurance Crime Bureau (NICB). This case was handled by Assistant U.S.
Attorneys A. Marie Villafaña and E.J. Yera.
See the full press release at http://www.fbi.gov/miami/press-releases/2014/three-chiropractors-sentenced-instaged-automobile-accident-scheme.
Miami Clinic Owner Arrested
The Division of Insurance Fraud (DIF) arrested Marlene Lopez del Castillo, 44, in October on charges of
insurance fraud, grand theft and practicing medicine without a license. Lopez del Castillo is the owner of
Exclusive Health Systems.
Two participants from a staged accident in October 2011 went to Exclusive Health Systems for initial
evaluations. Lopez del Castillo, allegedly acting as if she were the doctor, examined both patients during
their initial clinic visits. Lopez del Castillo also allegedly fabricated follow-up examinations that were later
signed by Dr. Hugo Goldstraj. Lopez del Castillo is not a medical doctor and does not hold a license with the
Department of Health.
Goldstraj, who was arrested by DIF in a separate investigation, provided a statement to investigators that he
did not examine the patients nor did he prepare the reports, but that they were prepared by Lopez del
Castillo. Goldstraj was convicted in May 2014 and has since surrendered his medical license.
Lopez del Castillo opened Exclusive Health Systems in 2000.
The PIP Source
Page 3
PIP FRAUD – In The News
Escambia County Corrections Officer Charged with Application Fraud
Escambia County Corrections Officer Julian Louis Eggleton, 31, was arrested by the Division of Insurance Fraud in
October for application fraud. Eggleton worked at the Escambia County Main Jail when a severe storm dumped more
than two feet of rain in the area. The parking lot at the jail was flooded, and one of the vehicles damaged by water was
owned by Eggleton. Eggleton did not have insurance coverage for his car at the time of the storm, and applied for
coverage after his vehicle had been damaged, and then tried to file a claim.
Miami Clinic Manager Charged With Organized Scheme To Defraud
The Division of Insurance Fraud (DIF) arrested Yalily Clavero Ruiz, 34, on charges of insurance fraud, grand theft and
organized scheme to defraud. Clavero is the office manager for D & J Rehabilitation Center, a clinic located in Miami.
Clavero allegedly instructed patients to sign for treatment that was not provided at the clinic, and also paid $1,000 to the
patient. Video surveillance conducted on behalf of State Farm confirmed that the patient did not receive treatment.
DIF has made numerous arrests this year of staged accident participants who were referred to D & J Rehabilitation.
D & J Rehabilitation Center was incorporated in 2009.
Auto Insurance Scams Dropping In Florida
Of the 12 states with no-fault auto insurance, Florida has seen its share of auto insurance fraud, mainly through scams
involving Personal Injury Protection, or PIP insurance. In 2011, South Florida was second in the nation in PIP fraud,
according to the National Insurance Crime Bureau (NICB) a nonprofit funded by the insurance industry to investigate
fraud. Tampa Bay was number one.
PIP premiums represent roughly 2% of Florida’s collected insurance premium, but accounts for nearly half of fraud
referrals, according to the Florida Office of Insurance Regulation.
Auto insurance fraud has dropped in Florida since a 2012 law reformed PIP. The changes included stronger penalties for
medical providers who commit PIP fraud, and a 14-day, post-accident window for accident victims to seek medical
treatment, and reduced benefits and treatments.
According to the Insurance Information Institute, the Florida Office of Insurance Regulation reported in January 2014 that
the reforms are working and that PIP coverage rates are falling. PIP coverage is expected to drop by an average of
13.2%, based on a review of insurers who provide auto insurance to more than 75% of the Florida market.
Read the full story by Aaron Crowe at http://www.cheapcarinsurance.net/auto-insurance-scams-dropping-in-florida/.
Additional Links for Operation Cold Call
Click the links below to see additional information on the Cold Call arrests.
http://touch.sun-sentinel.com/#section/1099/article/p2p-81828353/
http://www.wpbf.com/news/chiropractors-attorneys-arrested-for-accident-fraud-ring/29434114
http://insurancenewsnet.com/oarticle/2014/10/30/at-least-five-arrested-in-alleged-car-insurance-fraud-ring-a-571162.html
November 2014
Page 4
Most Wanted: Fugitive
Yennier Gutierrez Obregon
Hispanic Male, 26 years old
5’06”, 190 lbs, Brown Eyes, Black Hair
Warrant Information:
Warrant/Case #: 11CF007301
Felony Warrant Charge: Patient Brokering
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud, DIF is attempting to locate Yennier Gutierrez Obregon in
reference to the outstanding warrant.
Gutierrez is charged with soliciting a person after an auto accident and
offering them money to treat at a clinic in Tampa. Gutierrez was paid by
the clinic and in turn paid the person he solicited $1,600.
Gutierrez was arrested by DIF in March 2012 on charges of patient
brokering. Gutierrez may have fled to Cuba and is a fugitive.
If you know where Gutierrez 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/
Division of Insurance Fraud Reorganization
In October, the Division of Insurance Fraud (DIF) reorganized its structure in a manner meant to ensure the continued
high quality services provided by the Division. Deputy Chief Financial Officer (DCFO) Jay Etheridge and DIF Director
Simon Blank announced the following promotions:
Major Tim Cannon was promoted to Assistant Director. Cannon carries with him 30 years of state and local law
enforcement experience.
Major Buddy Hand was promoted to Bureau Chief of the newly formed Bureau of General Fraud. Hand joined DIF in
1994 and has more than 25 years of law enforcement experience. The Bureau of General Fraud consists of 19 squads
throughout the state that will now be reorganized into two districts, District I (North) and District II (South).
Captain Mike Byrne was promoted to Major of District I, and will supervise the squads in Pensacola, Tallahassee,
Jacksonville, Orlando, Tampa and St. Petersburg. Byrne has more than 40 years of military, local and state law
enforcement
experience and another nine years as an insurance SIU investigator.
Captain Glen Hughes was promoted to Major of District II, and will supervise the squads in Miami, Broward, Palm Beach
and Ft. Myers. Hughes joined DIF in 1993 and has 29 years of law enforcement experience.
Captain John Dygon was promoted to Bureau Chief of the Bureau of Workers Compensation. Dygon started with DIF in
1999 and has more than 38 years of law enforcement experience. The Bureau of Workers Compensation has five
squads located in Miami, Broward, Palm Beach, Orlando and Tampa.
Captain Janet Hartman was promoted to Major of the Operational Support Services Unit. This unit is comprised of the
Office of Professional Standards and Planning, the Administrative Unit and Information Technology (IT). Hartman
started with the Bureau of Fire and Arson Investigations in 2009 and has nearly 19 years of law enforcement experience.
Congratulations to all.
The PIP Source
Page 5
Statewide PIP Arrests – October 2014
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.
Kimberly Ann Thompson, 50 - false claim - $4,424 (Travelers) P
Juan Rafae Nazario Tirado, 42 - staged acct 08/29/11 (driver) $45,038 - Sand Lake Rehab and Wellness Center / World
Rehabilitation Care (Allstate / Geico) O
Luis Aniba Orellana, 47 - staged acct 08/29/11 (driver) $45,038 - Sand Lake Rehab and Wellness Center / World Rehabilitation Care
(Allstate / Geico) O
Kyle Terrenzo Liner, 46 - application fraud (Geico) J
Ercilio Alexis Astacio, 26 - fake ins card (Geico) O
Sachina Diane Sapp, 21 - staged acct 03/11/11 (passenger) $4,179 - K J Chiropractic / Metro Chiropractic and Wellness Center
(Geico) O
Julian Louis Eggleton, 31 - application fraud (Progressive) P
Rozaliya R Chelninskaya, 29 - staged acct 05/22/12 (passenger) $16,772 - Gate Parkway Diagnostic Center / Wellness Rehab
Services, LLC (Progressive) J
Antonio Jerode Lewis, 25 - fake ins card (Direct General) T
Lisandra Losada Lamas, 28 - paper acct 02/25/14 (driver) $8,139 - Angels Diagnostic / Golden Health Solutions / The Hope
Rehabilitation (Geico) M
Roberto Gonzalez Broche, 28 - staged acct 08/29/11 (organizer) $45,038 - Sand Lake Rehab and Wellness Center / World
Rehabilitation Care (Allstate / Geico) O
Angel R Martinez, 48 - fake ins card (Occidental Fire & Casualty) O
Marlene Lopez del Castillo, 43 - clinic owner / insurance fraud / practicing medicine w/o license - $1,740 - Exclusive Health Systems
(21st Century) M
Tomas J Abdunes Perales, 47 - staged acct 04/02/12 (driver) $21,130 - Sunshine Rehabilitation (Kingsway Amigo) M
Frederick Lemar Samuels, 27 - fake ins card (MGA) F
Janice Redlefsen Felix, 44 - jump-in 08/01/13 - $2,049 - (State Farm) O
Cindy Enid Lopez, 30 - staged acct 05/22/12 (passenger) $16,772 - Gate Parkway Diagnostic Center / Wellness Rehab Services,
LLC (Progressive) J
Neisy Cedre Lopez, 23 - staged acct 08/10/11 (driver) $117,307 - A & J Rehabilitation Center / D & J Rehabilitation Center (Allstate /
State Farm / United Auto / Windhaven) M
Yalily Clavero Ruiz, 34 - clinic employee - $11,560 - D & J Rehabilitation Center (State Farm) M
Ana Maria Perez Richard, 29 - fake ins card / paper acct 02/25/14 (driver) $10,000 - (Geico) M
Luis O Villegas, 25 - application fraud (Geico) J
Shontell Latoria Carswell, 31 - sale of fake ins card (Geico) T
Yoeny Granado, 31 - staged acct 08/10/11 (passenger) $117,307 - A & J Rehabilitation Center / D & J Rehabilitation Center
(Allstate / State Farm / United Auto / Windhaven) M
Duane Maria Robinson, 35 - sale of fake ins card (Gainsco) W
Sheila Zorima Ramos Maldonado, 44 - staged acct 01/11/12 (driver) $122,885 - Gate Parkway Diagnostic Center / Therapy
Diagnostic Tech Medical (Infinity / Travelers) J
Carlos Alberto Ramos Girald, 66 - staged acct 01/11/12 (passenger) $122,885 - Gate Parkway Diagnostic Center / Therapy
Diagnostic Tech Medical (Infinity / Travelers) 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)
November 2014
Page 6
Statewide PIP Arrests – October 2014
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.
Midna Maria Gomez Aponte, 65 - staged acct 01/11/12 (passenger) $122,885 - Gate Parkway Diagnostic Center / Therapy
Diagnostic Tech Medical (Infinity / Travelers) J
Malquiel Cruz Rodriguez, 44 - fake ins acord (Aequicap / Castle Point Florida) T
Alykhan Karmali, 33 - application fraud (Esurance) B
Richard Gabriel Santiago, 30 - fake ins card (Occidental Fire & Casualty) O
Richard Gabriel Santiago, 30 - fake ins card (Occidental Fire & Casualty) O
Bobby Edward Redmon, III, 22 - jump-in 03/25/14 - $1,436 - Gulf Coast Wellness Centers (National General) F
Paul Arenas, 27 - staged acct 05/05/12 (driver) $28,237 - Gate Parkway Diagnostic Center / One Touch Therapy Center (Allstate /
MetLife) J
Franklin Raymundo Camilo, 63 - false claim - $50,477 (California Casualty / State Farm) M
Elizabeth Marie Romero Diaz, 34 - fake ins card (MGA) W
Gilberto Leon Gonzalez Bonaga, 31 - staged acct 06/08/10 (driver) $156,320 - AB Diagnostic Center / Alberto C Lopez
Chiropractic / Authority Rehab Center / B&A Diagnostic / Doral Care Solutions / Eduardo Jubis, DC PA / YH Imaging (QBE North
America / State Farm) M
Santiago Silva, IV, 21 - fake ins card (Ocean Harbor) W
Eradio Sosa, 36 - staged acct 08/29/11 (recruiter) $45,038 - Sand Lake Rehab and Wellness Center / World Rehabilitation Care
(Allstate / Geico) O
Alejandro Manuel Marrero Gonzalez, 26 - fake ins card (Mercury) T
Julian Andres Moreno, 39 - staged acct 11/03/12 (driver) $76,716 – B & A Diagnostic / Doctor’s Professional Medical Center / LMG
Medical Center / Psychologist Technology (United Auto / York Services FAJUA) M
Weldy Deus, 36 - staged acct 11/30/13 (passenger) $21,926 - Broward Manual Rehab (Geico) B
Linda Mezamour, 32 - staged acct 11/30/13 and 12/03/13 (driver) $21,926 - Broward Manual Rehab (Geico) B
Jason Sadan Douglas, 23 – staged acct 11/30/13 (recruiter) $21,926 - Broward Manual Rehab (Geico) B
Jason Sadan Douglas, 23 – staged acct 12/03/13 (recruiter) $27,018 - Broward Manual Rehab (Geico) B
Jason Sadan Douglas, 23 – application fraud (Geico) B
Cory Matthew Meltzer, 33 - attorney / patient brokering (Geico / MetLife / Progressive ) W
Brian N Greenspoon, 42 - attorney / solicitation (Geico / MetLife / Progressive ) W
Roger Toby Hughes Bell, 44 - chiropractor / patient brokering / insurance fraud (Geico / MetLife / Progressive ) W
Christina Lee Savoye, 34 - clinic employee / insurance fraud (Geico / MetLife / Progressive ) W
Alejandro Jose Marin, 38 - runner / solicitation / patient brokering (Geico / MetLife / Progressive ) W
Douglas Anthony Santiago, 28 - runner / patient brokering / insurance fraud (Geico / MetLife / Progressive ) W
Raul Lester Valdivia Esquivel, 29 - staged acct 01/31/12 (recruiter) $13,549 - Injury Rehabilitation Center (Allstate) O
Olivel Duarte Morejon, 42 - staged acct 01/31/12 (recruiter) $13,549 - Injury Rehabilitation Center (Allstate) O
Arrested Nov 3
Ryan Alexandre Grand, 36 - chiropractor / patient brokering (Geico / MetLife / Progressive ) W
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 7
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: Charlotte, Collier, DeSoto, Glades, Hardee, Hendry,
Hernando, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk,
Sarasota
Tampa Field Office - 813.972.8602
Major Michael BYRNE
Capt. VACANT
Lt. Carlos ROSARIO
Fort Myers Field Office - 239.278.7527
Lt. Mark FRITZ
Copy goes her.
Editor’s
Corner
On page 1, we report on Operation Cold Call,
which resulted in the arrests of attorneys and
chiropractors for solicitation and patient
brokering.
On page 2, we cover the sentences handed
down to three chiropractors in Operation
Sledgehammer and the arrest of a Miami clinic
owner.
On page 4, we feature another fugitive in
Insurance Fraud’s Most Wanted and detail the
reorganization of the Division of Insurance
Fraud.
As always, we report on PIP Fraud in the News
and the latest PIP-related arrests.
NORTH CENTRAL REGION
Counties: Brevard, Lake, Orange, Osceola, Seminole, Volusia
Orlando Field Office - 407.835.4402
Lt. Laquanda GREEN
Lt. John SAVINO
SOUTH CENTRAL REGION
Counties: Broward, Highlands, Indian River, 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
Lt. Evangelina BROOKS
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