- CFO Jeff Atwater
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Orlando Arrests
2
Prosecutor Award
3
Most Wanted
4 PIP Fraud News
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Statewide Arrests
8
Statewide Contacts
CFO Jeff Atwater announced the arrests of Leonardo
Francisco Marquez Garcia, 63, and Dayleann Marie
Vallejo-Ruiz, 28, of Miami and Orlando respectively, on charges of insurance fraud. An investigation by the
Department of Financial Services’ Division of Insurance
Fraud revealed that Garcia would do supposed ‘initial examinations’ on crash victims and refer them to the
Injury Rehabilitation Center for physical therapy treatments. Vallejo-Ruiz, the owner of the clinic and a licensed massage therapist, had patients sign blank treatment forms that were sent to the insurance company requesting payment for services never provided.
Marquez Garcia
“This kind of deceit and abuse hurts all Floridians in the form of higher premiums,” said CFO Atwater. “I am proud of my team for putting a stop to this fraud and for their continuing success keeping other fraudsters off our streets.”
Allstate insurance company received bills for the alleged medical treatments purportedly provided between February 3 and March 16, 2012, on two crash victims. Marquez Garcia submitted requests for payment for his initial examinations claiming his services were provided on behalf of Global
Rehabilitation Center, a clinic located in Miami Lakes, Florida, which is not an
Area of Critical Need facility and where Marquez Garcia, an Area of Critical
Needs Doctor, was not licensed to practice medicine. Therefore, Garcia was additionally charged with the unlicensed practice of medicine for operating outside the scope of his license.
Marquez Garcia was first licensed as an ACN doctor in Florida in June 2009.
Vallejo-Ruiz was first licensed as a massage therapist in July 2007.
The investigation is ongoing and additional arrests are expected. The case is being prosecuted by the Orange County State Attorney’s Office, and each defendant faces up to 15-20 years in prison if convicted.

Over the last two years, the PIP Source has covered Operation
Sledgehammer, a joint-investigation and prosecution by the Federal
Bureau of Investigation (FBI), the Division of Insurance Fraud (DIF), the Internal Revenue Service (IRS), the United States Secret Service, the National Insurance Crime Bureau (NICB), the United States
Attorney’s Office and the Palm Beach County State Attorney’s Office.
To date, 92 defendants have been charged in state and federal courts.
South Florida prosecutor Ann Marie Villafana was recently presented with the Prosecutor of the Year award by the Coalition Against
Insurance Fraud , for breaking up the major staged-crash ring.
Convicted ringleaders were required to repay more than $18 million.
We congratulate her on a job well done.
As Assistant U.S. Attorney for the Southern District of Florida and lead prosecutor for the highly publicized investigation Operation
Sledgehammer, Villafana charged 101 suspected insurance-fraud ring members. Her ensuing convictions have earned ring members a collective 714 years in prison, with more prosecutions underway.
“Drivers in South Florida should be relieved. Breaking up a significant no-fault crash ring has made the roads of Palm Beach County safer.
Coalition Co-chair Frank Sztuk presents 'Prosecutor of the Year' award to AUSA Ann Marie Villafana.
Villafana has stemmed a large-scale insurance theft that helped make no-fault premiums among the highest in America,” said Dennis Jay, executive director of the Coalition.
Villafana received her award in a ceremony at the Coalition’s annual member meeting in Washington, D.C.
Remarkably, this was Villafana’s first no-fault takedown involving a major staged-crash ring. She normally prosecutes other crimes such as human rights violations.
Villafana thus had to learn about no-fault and insurance fraud from scratch, and under pressure. Still, she built a large volume of complex evidence into such comprehensive cases that were so convincing that dozens of ring members chose to plead guilty rather than face her in court.
The fraud conspirators staged car wrecks throughout Palm Beach County, where street-level ring members maneuvered innocent motorists into crashes. Ring members also lightly bumped their own cars into each other at low speeds and banged their cars with sledgehammers to clumsily mimic crash damage. Hence the name, Operation Sledgehammer.
Bogus car passengers consequently lied to insurers claiming they received painful whiplash injuries.
Chiropractors and other medical providers charged no-fault auto insurers millions of dollars worth of useless or phantom treatment. Most treatments were mere cookie-cutter duplicates. Ring-based lawyers also launched fraudulent lawsuits against auto insurers.
One ring member, Ana Ovando, even used her children as crash passengers, endangering them on the roads. Ovando received 6 1/2 years in federal prison.
The Coalition Against Insurance Fraud is a nonprofit alliance of consumer groups, insurance companies and government agencies combatting all forms of insurance fraud. For further information about this story or the
Coalition, please contact James Quiggle, director of communications at 202-393-7331 or jamesq@InsuranceFraud.org
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Hispanic Male, 43 years old
5’08”, 220 lbs, Brown Eyes, Black Hair
Warrant Information:
Warrant/Case #: W195822263
Felony Warrant Charges: Insurance Fraud / Grand Theft / Staged
Accident / Organized Scheme to Defraud
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud (DIF) is attempting to locate Jose Raspatelly, in reference to an outstanding warrant.
In September 2008, Raspatelly was arrested for organizing a staged accident on 12/26/07 that resulted in more than $28,000 in fraudulent claims. Raspatelly failed to appear in court, and a warrant was issued for his arrest. Raspatelly’s last known address was in Homestead,
Florida.
If you know where Raspatelly 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/
A Collier Circuit jury found chiropractor Esmaeel Samaliazad, 49, guilty of organized scheme to defraud, insurance fraud involving more than $20,000 and insurance fraud involving less than $20,000. He was the first to go to trial.
"It basically was a fraud factory and they paid people to actually be patients," Statewide Prosecutor Michael Anthony
Pica told jurors during his summation Tuesday. "(Patients) were paid, they staged an accident and then they didn't receive treatments. This was a very corrupt clinic."
Prosecutors say the alleged ringleader, Feghen Delva, 44, a chiropractic assistant, set up Cardinal Chiropractic Center in July 2008, giving birth to a fraud scheme that billed for over $100,000 worth of treatment never provided to patients.
Investigators say he paid Samaliazad and another chiropractor a monthly fee to be straw owners to avoid state licensing requirements. Samaliazad worked in Naples two days a week, while also working at Delva's sister clinic, Premier Spine
& Rehab in Fort Myers three days per week, earning $450 daily.
Samaliazad was the first of five defendants to go to trial.
Samaliazad was first licensed in Florida by the Department of Health (DOH) in July 2003.
See the full article by Aisling Swift of the Naples Daily News at http://insurancenewsnet.com/oarticle/2014/01/25/flachiropractor-convicted-of-insurance-fraud-a-450013.html#.UuZE5nr0Bcx
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Staged car accidents are a multibillion-dollar a year illegal scheme and Florida leads the nation. Orange County investigators say they are overloaded with cases. Eyewitness News reporter Myrt Price shows how the scheme can put even you and your family in danger.
In Orange County, an average of 11 phony crashes happen every week, officials said. But investigators are catching on, and arrests are up 27 percent. "We added a second PIP squad, a squad of five detectives just to investigate PIP-related claims," said an official.
See the full story at http://www.wftv.com/news/news/local/wftv-investigates-staged-car-accidents-central-fla/ncS8L/ .
The Division of Insurance Fraud arrested three persons for a staged accident in West Palm Beach. One of the subjects,
Jose Begas, filed a claim with Progressive, but was denied because his policy had lapsed at the time of the crash.
Those charged included Jose Tomas Begas, 37, Donirico Ruiz, 34, and Marilu Rodriguez, 26.
Two others were also charged, Monica Riveron, 34, and Idoleyvis Gutierrez, 37.
See additional coverage at http://www.wptv.com/dpp/news/region_c_palm_beach_county/west_palm_beach/jose-begasdonicio-ruiz-marilu-rodriguez-accused-of-making-fraud-claim-on-lapsed-policy .
Danny Hernandez, Deputy General Counsel with the
Department of Health (DOH) was a guest speaker at the
January NICB task force meeting in Jacksonville.
Included in the presentation were details outlining his office’s Emergency Action Authority against health care providers who pose an immediate and serious danger to the public and/or are guilty of fraud. He also advised that his office would prosecute those persons found practicing without a license or unlicensed activity. Mr.
Hernandez stressed his office efforts are a collaboration of partnerships forged with state law enforcement agencies as well the private sector including insurance carriers and NICB. Hernandez has spoken at multiple
NICB meetings around the state during the last year.
In September 2013, MetLife donated a vehicle to the Collier County Sheriff's Office to be utilized in the ongoing fight against fraud. (Photo bottom left - pictured left to right: Lt. Chad Parker, Collier County Sheriff's Office; Nancy Jensen,
MetLife SIU Supervisor; John Sargent, MetLife SIU Director; George Hodge, MetLife SIU Manager; Sgt. Doug Turner,
Collier County Sheriff's Office; Luis Romaguera, MetLife SIU Investigator.)
In January 2014, MetLife donated another vehicle, this time to the Hialeah Police Department to be utilized in the ongoing fight against fraud. (Photo bottom right - pictured left to right: Detective Oscar Oliveros and Detective Alex
Barrios, Hialeah Police Department; George Hodge, MetLife SIU Manager; Nancy Jensen, MetLife SIU Supervisor; NICB
SSA Tony Fernandez; Lieutenant Joe DeJesus, Hialeah Police Department.)

The Florida Office of Insurance Regulation (Office) released a preliminary analysis of the rates submitted by the top 20 automobile insurance companies writing Personal Injury Protection (PIP) insurance and encompassing more than 75% of the Florida market. PIP insurance accounts for only a small portion (about 25%) of a consumer’s total auto insurance premium cost; therefore, a statewide average decrease of 13.2% in PIP will result in an overall reduction of 3-4% for a policyholder, depending on the coverage purchased.
The analysis, which was compiled to demonstrate the cumulative effect of House Bill 119, passed in 2012 and shows an estimated average statewide savings in PIP premiums of 13.2% since the first required rate filing due in October of
2012. Two rate filings were due to the Office by auto insurers - an initial rate filing on October 1, 2012 and a second rate filing on January 1, 2014. The anticipated cumulative effect of these two rate filings in the legislation was a 25% overall decrease in PIP rates. Most insurers calculated their rates using a Pinnacle study, which projected that reforms contained in HB 119 would generate PIP premium savings ranging from 14% to 24.6%.
The estimated average statewide savings reflect a positive trend in comparison to 2011, when 86% of auto filings were for proposed increases in PIP premiums - the vast majority for double digit increases. Auto insurers that did not decrease
PIP premiums by the combined, cumulative 25% were required to support and justify the reason the company’s savings should vary.
Based on the Office’s analysis, all of the top 20 personal auto insurers accounted for and recognized the projected savings from HB 119 in PIP rates filed with the Office.
For more information on PIP, please visit the Office’s “PIP Insurance (HB 119)” webpage . The public is welcome to review all PIP filings, which are found on the Office’s I-File Forms & Rates Filing Search System: http://www.floir.com/
Office/FilingSearch.aspx
.
To see the full press release and the chart with information on the top 20 auto insurers showing each company’s cumulative total rate change for PIP as well as information on overall auto insurance rate changes for each company, go to http://www.floir.com/PressReleases/viewmediarelease.aspx?id=2050 .
The Florida Bar is moving closer to enacting new restrictions on lawyer referral services. This follows several meetings of a special committee in 2011 on alleged problems with referral services, which had more than doubled to 71 entities that were operating in Florida at that time.
Proposed amendments to the Florida Bar’s rules of professional conduct would ban attorneys from accepting referrals from a service if the client is also referred to another entity. Attorneys will also be “prohibited from referring clients to another person, entity, association, organization or service that the lawyer knows or reasonably should know is owned by the lawyer-referral service or a beneficial owner of the lawyer-referral service.” For example, if you’re hurt in an automobile accident and call “Ask Gary” or 411-PAIN, the service will only be able to refer you to an attorney or a medical service provider, but not to both.
That doesn’t sound like much, but this change has the potential to cost these services millions every year because double-dipping - sending callers to attorneys who pay to subscribe to the lawyer-referral service and to clinics it owns - will no longer be permitted, at least in Florida. (Kompothecras also operates in Minnesota and Kentucky; 411-PAIN operates nationwide.)
In July 2013, State Farm filed a federal lawsuit against Kompothecras, 1-800-Ask-Gary and his clinics, Physicians
Group.
See the full article by Claire Goforth at http://orlandoweekly.com/news/florida-bar-sets-its-sights-on-1-800-ask-gary-411pain-and-other-lawyer-referral-services-1.1620546

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.
Ronald Maurice Grier, 23 - prescription fraud - P
Ronald Maurice Grier, 23 - prescription fraud - P
Jasel Martinez Gonzalez, 38 - staged acct 04/21/12 (recruiter) $23,007 - Indian Rehabilitation Center (Direct General / Peachtree) J
John Najee Fleurival, Jr, 26 - sale of fake ins card (General Auto) T
Felix Avila, 22 - staged acct 11/03/10 (driver) $34,603 - South Florida Medical Health Company / V L Medical Center Corp (United
Auto / Victoria) M
Mahogany Shante Thomas, 29 - sale of fake ins card (General Auto) T
Luis Manuel Baez Santiago, 32 - fake ins card (MGA) T
Luis Manuel Baez Santiago, 32 - fake ins card (MGA) T
Marilu A Rodriguez, 26 - staged acct 05/05/10 (driver) $9,685 - Imperial Medical Center / New York Medical Rehab (Progressive /
Safeco / Security National) W
Donicio Ruiz, 34 - staged acct 05/05/10 (driver) $0 - Imperial Medical Center / New York Medical Rehab (Progressive / Safeco /
Security National) W
Idoleyvis Gutierrez, 37 - staged acct 05/05/10 (passenger) $9,705 - Imperial Medical Center / New York Medical Rehab
(Progressive / Safeco / Security National) W
Monica Riveron, 34 - staged acct 05/05/10 (passenger) $10,465 - Imperial Medical Center / New York Medical Rehab (Progressive /
Safeco / Security National) W
Cameron Lamarr Pike, 22 - staged acct (driver) $30,945 - Gate Parkway Diagnostic Center / Indian Rehabilitation Center (Direct
General / State Farm) J
Jose Tomas Begas, 37 - staged acct 05/05/10 (driver) $0 - Imperial Medical Center / New York Medical Rehab (Progressive /
Safeco / Security National) W
Pamela Joy Byrd, 53 - fake ins card (Geico) W
Samantha Leigh Eades, 26 - staged acct 08/08/12 (driver) - Indian Rehabilitation Center (Direct General) J
Luis Emilio Pagan Arroyo, 28 - staged acct (passenger) $30,945 - Gate Parkway Diagnostic Center / Indian Rehabilitation Center
(Direct General / State Farm) J
Zulmarie Casanova-Cruz, 27 - staged acct (passenger) $30,945 - Gate Parkway Diagnostic Center / Indian Rehabilitation Center
(Direct General / State Farm) J
Edgardimar Torres Castro, 26 - staged acct 05/16/12 (passenger) $45,649 - Indian Rehabilitation Center (Sentry / USAA) J
Angel Sotolongo Sierra, 32 - fake ins card (Progressive) M
Harold John Pompey, 68 - chiropractor - organized scheme to defraud - Gate Parkway Diagnostic Center (Direct / Farmers /
Progressive) J
Sandy Goussaint, 39 - fake ins card (United Auto) O
Ivonne Rivera, 44 - staged acct 02/05/12 (passenger) $10,000 - HR Healthy Rehab / Vity Medical Center (Gainsco / Infinity / USAA)
O
Omar Rivera, 36 - staged acct 02/05/12 (passenger) $10,000 - HR Healthy Rehab / Vity Medical Center (Gainsco / Infinity / USAA)
O
Jameil E Sanders, 29 - sale of fake ins card (Affirmative) T
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)

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.
Carlos Gustavo Morales Lastayo, 27 - staged acct 09/19/12 (recruiter) $69,625 - B & A Diagnostic / Doctors Professional Medical /
Gentle Care Rehab Services / Psychologist Technology / South Florida Medical Health Corp / YH Imaging (Geico / United Auto) M
Angel Manuel Rodriguez-Correa, 25 - staged acct 05/12/12 (passenger) $19,845 - Gate Parkway Diagnostic Center / Health Point
Injury Center (Direct General / State Farm / Windhaven) J
Imylsys Manso, 34 - staged acct 01/23/12 (passenger) $59,046 - B & A Diagnostic / Clarke Medical Services / Emoge Medical
Services / Light Rehab Center / Magic Hands Medical Services / Mcary Medical Services (21st Century / United Auto) M
Joel Morera Estrada, 40 - staged acct 01/23/12 (driver) $59,046 - B & A Diagnostic / Clarke Medical Services / Emoge Medical
Services / Light Rehab Center / Magic Hands Medical Services / Mcary Medical Services (21st Century / United Auto) M
Gertrudis Vargas Batista, 45 - staged acct 08/13/12 (recruiter) $55,610 - Emanuel Therapeutic Massage / Miami Medical Care
Corp / Palmetto West Rehab (Esurance / Windhaven) M
Jose F Banos, 31 - staged acct 08/15/09 (recruiter) $46,483 - (Allstate / Progressive / US Security) M
Joel Ferrer Rodriguez, 48 - staged acct 03/24/12 (driver) $28,368 - Crystal Rehabilitation / Gate Parkway Diagnostic Center / Indian
Rehabilitation Center (Geico / Infinity / Ocean Harbor) J
Roilan Pineiro, 37 - staged acct 01/18/12 (clinic owner / recruiter) $66,744 - B & A Diagnostic / Fontainebleu Rehab Center /
Universal X-Ray Corp / Y & J Chiropractic Center (Geico / United Auto) M
Ynette Auguste, 24 - staged acct 05/03/12 (driver) - Hollywood Pain & Rehab (State Farm) B
Mario Delva, 34 - clinic employee / organized scheme to defraud - $27,693 - Excel Health and Rehabilitation Center () O
Gerald Andre, 36 - staged acct 06/30/11 (recruiter) $27,693 - Excel Health and Rehabilitation Center () O
Luis Lopez, 76 - staged acct 09/16/09 (recruiter) $53,058 (Old Republic / Progressive / State Farm) M
Billy Desrosiers, 24 - staged acct 06/30/11 (passenger) $27,693 - Excel Health and Rehabilitation Center () O
Angela Lashell Jackson, 44 - fake ins card (Geico) T
Aslot Auguste, 31 - staged acct 05/03/12 - Hollywood Pain & Rehab (State Farm) B
Bettyne Auguste, 28 - staged acct 05/03/12 - Hollywood Pain & Rehab (State Farm) B
Julio Jose Perez, 28 - staged acct 05/03/12 - Hollywood Pain & Rehab (State Farm) B
Jennifer Leah Rankin, 43 - office manager / false billing - $320 - Massage First (Travelers) J
Lazaro Elia Rodriguez, 61 - staged acct 03/24/12 (driver) $28,368 - Crystal Rehabilitation / Gate Parkway Diagnostic Center / Indian
Rehabilitation Center (Geico / Infinity / Ocean Harbor) J
Victoria J Gidney, 51 - false claim- $277 - (Geico) O
Terry Randall Robinson, 52 - false claim - $277 - (Geico) O
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)

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
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. John DYGON
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. Rafael DELGADO
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
On page 1, we cover the arrests of an Orlando doctor and clinic owner.
On page 2, we congratulate Ann Marie
Villafana on being named Prosecutor of the
Year by the Coalition Against Insurance Fraud.
On page 3, we feature another fugitive in
Insurance Fraud’s Most Wanted and highlight the conviction of a chiropractor in Ft Myers.
As always, we report on PIP Fraud in the News and the latest PIP-related arrests.
We hope to continue to provide you with information on PIP fraud throughout 2014.