May 2014
Volume 4 - Issue 11
In total, the defendants
were convicted on 103
of 104 counts
charged...The
defendants face a
maximum sentence of
20 years in prison on
each count…
Sentencing for all four
defendants is set for
July 3, 2014 before
Judge Marra in West
Palm Beach.
INSIDE THIS ISSUE
1
Chiropractors Trial
2
Clinic Owner Plea
3
PIP Fraud News
4
Statewide Arrests
6
Statewide Contacts
HEADER HERE
Three Chiropractors
Convicted in Latest
Operation Sledgehammer Trial
Following a six-week trial, a federal jury in West Palm Beach convicted
defendants Kenneth Karow, 54, chiropractor, of West Palm Beach, Hermann J.
Diehl, 44, chiropractor, of Miami, Hal Mark Kreitman, 50, former chiropractor, of
Miami Beach, and Joel Antonio Simon Ramirez, 29, staged automobile accident
recruiter, of West Palm Beach, for their participation in a massive staged
automobile accident scheme based in Palm Beach and Miami-Dade Counties.
In total, the defendants were convicted on 103 of 104 counts charged.
According to the evidence presented at trial, the defendants and their coconspirators staged automobile accidents and thereafter submitted false
insurance claims through chiropractic clinics they controlled between October
2006 and December 2012. To execute the scheme, the true owners of the
chiropractic clinics allegedly recruited individuals who had the medical or
chiropractic licenses required by the state to open a clinic to act as “nominee
owners” of the clinics.
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. With these verdicts, 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.
The defendants face a maximum sentence of 20 years in prison on each count
of conspiracy to commit mail fraud, substantive mail fraud, conspiracy to commit
money laundering, and substantive money laundering. Restitution to the victims
of these offenses is mandatory. Sentencing for all four defendants is set for July
3, 2014 before Judge Marra in West Palm Beach.
See the full press release from the US Attorney’s Office at http://
www.justice.gov/usao/fls/PressReleases/140422-02.html.
May 2014
Page 2
Tampa Clinic Owner Enters Plea
In August 2013, the Division of Insurance Fraud (DIF) arrested Dailin Rojas Perez for her
involvement in a major insurance fraud scheme at Medical Therapy Practitioners, a Tampa
accident clinic. Rojas Perez was charged with racketeering and money laundering involving
more than $350,000 in fraudulent proceeds.
The investigation by DIF found that Medical Therapy Practitioners worked in concert with two
straw companies to bill insurance carriers for services not rendered; services procured as a
result of staged automobile crashes; services for patients who had no injuries; and services not
compensable because the business license was obtained fraudulently.
The two straw companies were identified as Global Solutions Plus, owned by Yanely Campillo
Hernandez, and Today’s Medical Marketing, LLC, owned by Rojas Perez.
Dailin Rojas Perez
Massage therapist Devin Sweet, who was arrested at the same time as Rojas Perez, told DIF
detectives that he had only treated 30 patients a total of approximately 50 times during his six weeks of employment, and
estimated he filled out approximately 5,000 fraudulent therapy forms for patients he never saw. Sweet stated he was
surprised he didn’t have carpal tunnel after signing so many fraudulent forms, he sat at his desk and falsified medical
treatment forms all day long, Monday through Friday, 9AM through 6PM.
Rojas Perez has pled guilty to money laundering and conspiracy to commit RICO, and will be sentenced to 24 months of
community control followed by 36 months of probation. Rojas Perez will pay a total of $350,000 in restitution to Allstate,
Farmers, Geico, Infinity, Mercury, National General and Sentry.
“I am proud of our investigators for bringing this fraudster to justice,” said CFO Atwater. “We will not tolerate anyone who
commits insurance fraud and causes the rates of hard-working Floridians to increase.”
Arrest warrants for racketeering conspiracy and money laundering have also been issued for clinic manager Armando
Diaz Tomas, 34, and his wife, billing clerk Yanely Campillo Hernandez, 31. Campillo Hernandez is believed to be in
Cuba. Diaz Tomas was featured as the Most Wanted in the September 2013 issue of the PIP Source.
Division of Insurance Fraud Distributes Restitution
Checks in Sky Imaging Fraud Case
As a result of a plea by the owners of Sky Imaging, the Division of Insurance Fraud (DIF) began distributing
restitution checks to insurance carriers at the May meeting of the National Insurance Crime Bureau (NICB) South
Florida Major Medical Fraud Task Force. A total of $250,000 was ordered paid back to 13 insurance companies.
The father and son owners of Sky Imaging, Nazih
Chamoun and Robbie Chamoun, were arrested in August
2012 for operating an unlicensed clinic. Sky Imaging had
obtained an exemption by the Agency for Health Care
Administration (AHCA) based on fraudulent documents that
showed it was owned by a doctor, Douglas Hornsby. The
plea deal included the above restitution and the withdrawal
of all pending claims by Sky Imaging, Fountain Imaging and
Diagnostic Services Center of North Miami Beach.
Pictured left to right - Front row: DIF Captain Steven Smith;
Yolanda Velasquez (Mercury); Maria Llanos (Progressive);
NICB SA Teresa Grimaldi; Rene Cubas (Geico).
Back row: Lisa Lowe (Imperial); Heidi Engel (State Farm);
Kay Carpenter (Liberty Mutual); Wendy Sassman (United
Auto); Leonard Rodriguez (Gainsco); Sandra Ellinger
(Allstate).
The PIP Source
Page 3
PIP FRAUD – In The News
Chiropractor, Unlicensed Massage Therapist Arrested in Jacksonville
The Division of Insurance Fraud arrested Chiropractor Steven Rhodes, owner of Ocean View Health, in Jacksonville
Beach for fraudulently billing for services and allowing unlicensed staff to perform medical treatments. Also charged was
Rhodes employee, Cynthia Jane Perez, 45, a massage therapist whose license had expired in August 2013. Rhodes
allowed Perez to treat patients despite being aware that she was unlicensed.
“This kind of fraudulent activity places honest, hard-working Floridians at risk not only financially, but also physically,”
said Chief Financial Officer Jeff Atwater. “I am proud of our investigative team for uncovering this scam and holding this
fraudster accountable for his misdeeds.”
In addition to the unlicensed activity, the investigation by DIF revealed that Rhodes was submitting fee slips that
overinflated the number of treatments being provided, as well as fee slips for treatments never performed. Among the
insurance companies affected by this crime are Kemper, State Farm, Nationwide, Esurance, Progressive, United Health,
and Blue Cross Blue Shield.
Rhodes, who has been a licensed chiropractor in Florida since 1981, originally opened Ocean View Health in October
2006.
Allstate Awarded $3.8 million in Fraud Judgment
Based on a six-week jury trial, the United States District Court for the Northern District of Texas has entered a $3.8
million judgment in favor of Allstate Insurance Company. The jury found that Michael Kent Plambeck, D.C., Jennifer
Giessner, Douglas Friedman, Randal Toca, and other persons and entities engaged in a pattern of racketeering
activity in violation of the Federal Racketeering Influenced and Corrupt Organizations Act (RICO) and the Ohio
Corrupt Practices Act. This judgment sets the stage for the company to vigorously fight this type of healthcare fraud,
so it can continue offering competitive products in the involved states.
The RICO complaint filed by Allstate alleged an intricate multi-state scheme involving the operation of chiropractic
clinics, law offices, and telemarketing entities, in Texas, Louisiana, Ohio, Alabama, and other states. Allstate claimed
the organization solicited persons involved in automobile accidents, ran them though unnecessary treatment, and
referred them to associated personal injury law offices in order to make claims against Allstate and its insureds.
See the story at http://insurancenewsnet.com/oarticle/2014/04/21/allstate-awarded-$38-million-in-fraud-judgment-a492536.html#.U1fD6FXdUrU.
Clinic Owner, 3 Others Arrested in PIP Fraud Case by Miami Police Department
Following an investigation that started in July 2013, the City of Miami Police Department Staged Accident Unit,
working with the Federal Bureau of Investigation (FBI), Miami-Dade Police, Hialeah Police and the Department of
Health, arrested Orestes Sanchez, 48, owner of Remed Medical & Rehab Center, in Hialeah.
Also arrested were massage therapist Vicente Manuel Morejon Valdivia, 43, receptionist Maria Ayala, 63, and runner
Rodneys Antonio Gonzalez, 40. Charges included staged accident, insurance fraud, grand theft, patient brokering
and organized fraud.
Pensacola Chiropractor Sentenced to 6 1/2 Years in Prison
Pensacola chiropractor Russell Dominick, 54, was sentenced to 6½ years in prison following his conviction on
racketeering and second degree grand theft charges. The Division of Insurance Fraud (DIF) had arrested Dominick in
January 2013 following an investigation into an allegation that he had urged a patient to stage an automobile accident to
obtain insurance monies.
Working with the Escambia County Sheriff’s Office, DIF sent an officer to Dominick Chiropractic Clinic as an undercover
patient. Dominick urged the officer to exaggerate injuries for purposes of obtaining a large insurance settlement, and
insurance records show that Dominick billed for treatments not provided. During one visit, Dominick delivered a
controlled substance, a narcotic, to the officer.
“Insurance fraud places a financial strain on hard-working Floridians through increased insurance premiums,” said CFO
Atwater. “I am extremely proud of our investigators for working so diligently with our law enforcement partners to put an
end to this illegal operation.”
Also assisting on this case was the Florida Department of Law Enforcement (FDLE), the Florida Department of Health
(DOH), Esurance and MetLife. Dominick has been a licensed chiropractor in Florida since 1998.
May 2014
Page 4
Statewide PIP Arrests – April 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.
Jennifer Aisha Paulino Soto, 25 - staged acct 01/10/13 (passenger) $34,403 - Doctors Professional Medical Center / Psychologist
Technology (Esurance / Windhaven) M
Djuana Maymie Baskin, 26 - jump-in 08/23/13 - $712 - (Allstate) T
Patrick Armond Billings, 23 - staged acct 03/14/13 (vehicle owner) $6,624 - A1 Imaging of Orange Park / Coastal Spine & Pain Center /
First Coast Medical Center / Orange Park Medical Center (Progressive / RepWest) J
Carmel Linot, 24 - staged acct 03/14/13 (passenger) $6,624 - A1 Imaging of Orange Park / Coastal Spine & Pain Center / First Coast
Medical Center / Orange Park Medical Center (Progressive / RepWest) J
Vincent Robert Suhr, 23 - staged acct 09/05/13 (driver) $15,380 - Central Florida Med & Chiro Center (Infinity / Permanent General) O
Clifton Elliot Johnson, 38 - staged acct 09/05/13 (pedestrian) $15,380 - Central Florida Med & Chiro Center (Infinity / Permanent
General) O
Jems P Richemond, 21 - staged acct 03/14/13 (driver) $6,624 - A1 Imaging of Orange Park / Coastal Spine & Pain Center / First Coast
Medical Center / Orange Park Medical Center (Progressive / RepWest) J
Steven Lloyd Rhodes, 62 - chiropractor / insurance fraud - $11,836 - Ocean View Health (Esurance / Kemper / Nationwide /
Progressive / State Farm / United Health Care) J
Cynthia Jane Perez, 45 - unlicensed massage therapist / insurance fraud - $1,925 - Ocean View Health (Esurance / Kemper /
Progressive / State Farm) J
Marcel Arlon Robinson, 33 - staged acct 09/24/11 (recruiter) ) $21,330 - Advanced Medical Associates (Geico / RepWest) B
Tonica Haynes Travelsi-Filali, 43 - fake ins card (Occidental Fire & Casualty) O
Zennith L Walker, 28 - fake ins card (Occidental Fire & Casualty) O
Jose F Banos, 31 - staged acct 06/27/09 (driver) $16,890 - (Progressive) M
Gregory Allen Earles, 41 - lost wages - $7,500 (USAA) P
Susan Gayle Ford, 43 - staged acct 07/22/11 (driver) $40,000 - Saint Jose Injury Center (Geico) J
Susan Gayle Ford, 43 - staged acct 09/01/11 (driver) $40,000 - One Touch Therapy Center (AGIC) J (both cases charged together)
Angel Luis Cruz-Hernandez, 25 - staged acct 03/31/11 (driver) $34,977 - Advanced MRI Diagnostic / Amed Primary Care /
Baymeadows Injury Center / First Coast MD (Farmers) J
Jean Edrice Dorestant, 38 - staged acct 05/17/11 (recruiter) $189,994 - K J Chiropractic / Dr Wilson’s Straight Up Chiropractic (Geico /
Windhaven) O
Margarita Cruz, 52 - staged acct 09/01/11 (passenger) $40,000 - One Touch Therapy Center (AGIC) J
Ricardo Capella Morales, 29 - staged acct 12/13/11 (driver) $6,000 - Therapy Diagnostic Tech Medical (GMAC / Geico) J
Adalberto Acosta Guzman, 36 - staged acct 09/01/11 (passenger) $40,000 - One Touch Therapy Center (AGIC) J
Ambrosia Tarnett Wilson, 26 - fake ins card (Geico) T
Nikita Hosley, 37 - massage therapist - $10,000 - Dr Wilson’s Straight Up Chiropractic (Geico / Windhaven) O
Jessica Marie Jimenez Lopez, 24 - staged acct 12/13/11 (passenger) $6,000 - Therapy Diagnostic Tech Medical (GMAC / Geico) J
Paublo Luvian Rondon Quinones, 23 - staged acct 12/13/11 (passenger) $6,000 - Therapy Diagnostic Tech Medical (GMAC / Geico) J
Lenka Ramos, 30 - staged acct 07/22/11 (passenger) $40,000 - Saint Jose Injury Center (Geico) J
Jimmy Mareus, 33 - staged acct 05/17/11 (driver) $189,994 - K J Chiropractic / Dr Wilson’s Straight Up Chiropractic (Geico / Windhaven)
O
Javier Alberto Ramos, 42 - staged acct 07/22/11 (passenger) $40,000 - Saint Jose Injury Center (Geico) J
Milquiades Ramon Espiritu, 29 - staged acct 09/01/11 (recruiter / driver) $40,000 - One Touch Therapy Center (AGIC) 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)
The PIP Source
Page 5
Statewide PIP Arrests – April 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.
Javier Alberto Ramos, 42 - staged acct 12/13/11 (recruiter) $6,000 - Arlington Rehabilitation Services / Therapy Diagnostic Tech
Medical (GMAC / Geico) J
Queena Renee McRae, 36 - staged acct 05/17/11 (vehicle owner) $189,994 - K J Chiropractic / Dr Wilson’s Straight Up Chiropractic
(Geico / Windhaven) O
Desiree Ramos, 26 - staged acct 09/01/11 (passenger) $40,000 - One Touch Therapy Center (AGIC) J
Chanel Octavia Akins, 28 - staged acct 05/17/11 (driver) $189,994 - K J Chiropractic / Dr Wilson’s Straight Up Chiropractic (Geico /
Windhaven) O
Josue Pierrissaint, 30 - staged acct 05/17/11 (clinic owner / recruiter) $189,994 - K J Chiropractic / Dr Wilson’s Straight Up Chiropractic
(Geico / Windhaven) O
Victor D Bonilla, 25 - staged acct 09/16/11 (passenger) $62,758 - Clarke Medical Services / Emoge Medical Services / New Life Rehab
Services (Geico / United Auto) M
Marie Bernadette Fede, 53 - unlicensed clinic owner / patient brokering - $11,374 - Belco Chiropractic Clinic (Allstate / Geico / State
Farm) O
Josue Pierrissaint, 30 - staged acct 07/03/12 (clinic owner / recruiter) $4,830 - Dr Wilson’s Straight Up Chiropractic (Progressive / State
Farm) O
Nakita Ayanna Coker, 27 - fake ins card (Occidental Fire & Casualty) O
Shanell Jenkins, 44 - fake ins card (Occidental Fire & Casualty) O
Pierre David Berger, 32 - staged acct 10/03/12 (recruiter) $22,197 - High Definition Mobile MRI / Lakes Town Rehab / M & D Mobile
Diagnostic Imaging / Metric Diagnostic / Trust Me Chiropractic Center (State Farm) B
Catherine Ann Bowker, 39 - fake ins card (Geico) T
Milagros Adorno, 31 - jump-in 04/11/12 - $8,121 - Advance Healing Center / Advanced 3D Diagnostics / Digital Radiology Center / HR
Healthy Rehab (Gainsco) O
Dana Ranese Washington, 50 - fake ins card (Occidental Fire & Casualty) O
Yelis Ramos Gomez, 33 - staged acct 07/22/11 (driver) $40,000 - Saint Jose Injury Center (Geico) J
Damocles Daniel, 54 - jump-in 10/11/11 - $15,185 - Hollywood / Diagnostic Center / North Dade Rehab (Imperial Fire) M
Madison Brooke Thayer, 22 - fake ins card (Seminole Casualty) T
Edgardo Javier Diaz Colon, 33 - staged acct 07/22/11 (passenger) $40,000 - Saint Jose Injury Center (Geico) J
Edgardo Javier Diaz Colon, 33 - staged acct 12/13/11 (recruiter) $6,000 - Therapy Diagnostic Tech Medical (GMAC / Geico) J (both
cases charged together)
Alcides Arguelles Fonseca, 25 - staged acct 05/05/09 (driver) $12,251 - New York Medical & Rehab Center (Forest Hill Rehab)
(Assurance America) W
Zuleyka Martinez-Serrano, 23 - staged acct 05/04/12 (driver) $19,749 - Gate Parkway Diagnostic Center / One Touch Therapy Center
(Direct General / Geico / Progressive) J
Mayleen Sepulveda, 44 - staged acct 05/05/09 (passenger) $13,140 - New York Medical & Rehab Center (Forest Hill Rehab) (21st
Century) W
Luis A Miranda, 51 - staged acct 05/05/09 (passenger) $13,732 - New York Medical & Rehab Center (Forest Hill Rehab) (21st Century)
W
Adriel D Rojas, 38 - staged acct 05/05/09 (driver) $12,251 - New York Medical & Rehab Center (Forest Hill Rehab) (Assurance
America) W
Jose R Valdez-Morales, 47 - staged acct 06/07/12 (passenger) $37,469 - One Touch Therapy Center (Direct General / Infinity / Titan) J
Eliezer Vallejo, 24 - staged acct 06/07/12 (driver) $37,469 - One Touch Therapy Center (Direct General / Infinity / Titan) 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)
May 2014
Page 6
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
WEST CENTRAL REGION
Counties: Charlotte, Collier, DeSoto, Glades, Hardee, Hendry,
Hernando, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk,
Sarasota
Tampa Field Office - 813.972.8602
Capt. Michael BYRNE
Lt. Carlos ROSARIO
Fort Myers Field Office - 239.278.7527
Lt. Mark FRITZ
Copy goes her.
Editor’s
Corner
On page 1, we cover the convictions of
three more chiropractors in Operation
Sledgehammer.
On page 2, we cover the plea of a Tampa
clinic owner and restitution payments to
the victims of Sky Imaging.
As always, we report on PIP Fraud in the
News and the latest PIP-related arrests.
EAST CENTRAL REGION
Counties: Brevard, Lake, Orange, Osceola, Seminole, Volusia
Orlando Field Office - 407.835.4402
Capt. Glen HUGHES
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
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. PENDING
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