October 2013
Volume 4 - Issue 4
“I applaud the hard
work of our
investigators who are
able to identify and
shut down these
destructive crime rings,
which hurt Florida
families by driving up
insurance rates for
everyone.”
- CFO Jeff Atwater
INSIDE THIS ISSUE
HERE
Clinic Owners,HEADER
Chiropractor
Arrested
in Fort Myers PIP Fraud Sting
Florida Chief Financial Officer Jeff Atwater announced the arrests of nine
individuals involved in an accident clinic sweep in Fort Myers and Port
Charlotte. The arrests included clinic owners, a chiropractor and a massage
therapist charged with patient brokering and solicitation in support of a large
scale personal injury protection (PIP) fraud ring.
“These arrests are another great win in the
ongoing fight against PIP fraud in Florida,”
said CFO Atwater. “I applaud the hard work
of our investigators who are able to identify
and shut down these destructive crime rings,
which hurt Florida families by driving up
insurance rates for everyone.”
A long-term undercover investigation
DIF executes a search warrant at
conducted by the Florida Department of
Evans Rehab Center in Ft Myers
Financial Services’ Division of Insurance
Fraud (DIF) in partnership with Nationwide Insurance and Titan Insurance
discovered that employees at Evans Rehab Center, in Fort Myers and Charlotte
Wellness and Rehab Center in Port Charlotte, advised patients to sign
documents for rehabilitation services for injuries that supposedly occurred during
auto accidents. It is alleged that these clinics then billed insurance companies for
fraudulent treatments that never occurred. The investigation also revealed that
Charlotte Wellness was allegedly operating without the required license.
1
Fort Myers Arrests
2
PIP Fraud News
Evans Rehab Center opened in June 2012 while Charlotte Wellness and Rehab
Center opened in March 2010. DIF also executed search warrants at the clinics.
3
Most Wanted
4
Statewide Arrests
6
Statewide Contacts
The nine subjects taken into custody include clinic owner Fritz Edouard, 37;
clinic owner Wilson Louis, 35; clinic owner Gerard Jean Stephen Valere, 51;
chiropractor Ronald Woodley, 63; Recruiter Jordany Estimond, 44; massage
therapist Andres Bravo, 52; receptionist Gloria Feliz, 31; William Jean, 36; and
Joe Gevans, 51.
DIF was assisted by the Lee and Charlotte County Sheriff’s offices in this
investigation. Read more at http://www.fox4now.com/features/4inyourcorner/Arrestsin-SWFL-clinic-fraud-sweep-230197281.html.
October 2013
Page 2
PIP FRAUD – In The News
Sledgehammer Clinic Owner Sentenced to Six Years in Federal Prison
Maria Testa Baceiro, 29, was sentenced to six years in prison for operating a wide-ranging car insurance scam out of a
chiropractic clinic she and her longtime boyfriend owned in Palm Beach County. Testa, who was also ordered to pay
$4.2 million in restitution, is the latest to be sentenced as part of Operation Sledgehammer.
Prosecutors said Testa collected millions from Febre’s Medical Center on Forest Hill Boulevard and Universal Rehab
Med Group in Miami. They were also involved in scams operated out of other clinics in Palm Beach and Miami-Dade
counties, said federal prosecutor Ann Marie Villafana.
Testa’s boyfriend, Luis Ivan Hernandez, pled guilty to similar charges and is scheduled to be sentenced in November.
See the entire article by Jane Musgrave of the Palm Beach Post at http://www.palmbeachpost.com/news/news/crimelaw/woman-sentenced-to-six-years-in-car-insurance-scam/nbBqW/.
Appeals Court Lifts Temporary Injunction on Florida PIP Law
A Florida appeals court has cleared the way for the enforcement of the new auto insurance law that the legislature enacted to fight PIP fraud in Florida. The ruling by the 1st District Court of Appeal said the Circuit Court Judge was wrong
when he sided with those who challenged the 2012 law. The appeals court contended that those who sought to block
enforcement of the law had not shown they were actually being harmed by it. The ruling does not end the ongoing
lawsuit challenging the new law.
See these three articles for more information - http://www.bradenton.com/2013/10/23/4788895/fla-appeals-court-liftstemporary.html, http://www.insurancejournal.com/news/southeast/2013/10/25/309242.htm and http://
www.thefloridacurrent.com/article.cfm?id=34990671.
ABC News Highlights DIF Case Operation No Med Services on Nightline
On October 23, 2013, the ABC News show Nightline broadcast an in-depth story on insurance fraud which included the
Division of Insurance Fraud’s (DIF) case known as Operation No Med Services. A camera crew followed Lt. Rafael
Delgado and his squad around Miami for several days as they prepared to arrest nearly 20 subjects in a major PIP fraud
investigation involving staged accident and fraudulent clinics. The investigation by DIF involved five staged accidents
and more than $408,000 in fraudulent claims. The coverage by Nightline is very thorough, and captures the flavor of the
PIP fraud activity that is costing insureds in Florida more than $1 billion a year. Watch the story at http://
abcnews.go.com/US/florida-authorities-battle-lucrative-crime-rings-insurance-fraud/story?id=20659399.
See a related news story from CBS4 for the press conference in May 2013 at the Miami-Dade State Attorney’s office at
http://miami.cbslocal.com/2013/05/01/nearly-two-dozen-people-arrested-for-insurance-fraud/.
Dennis LaRosa Retires From AHCA, Joins Law Firm
After more than 22 years with the State of Florida, Dennis LaRosa has retired. He has joined the defense law firm of
Roig, Tutan, Rosenberg, Martin & Stoller, PA, as their healthcare policy advisor, where his duties will include consulting
on various healthcare regulatory and compliance matters, providing expert testimony and lobbying. LaRosa is probably
best known to readers of the PIP Source for his time with the Agency for Health Care Administration (AHCA) as the
OMC Manager of the Health Care Clinic Unit, Health Quality Assurance, since its inception in 2003 through September,
2013. In this capacity he managed seven operations and management consultants, who oversaw the unit's health care
clinic licensing function. LaRosa wrote all rules for his unit and analyzed both rules and legislative proposals.
LaRosa is a frequent speaker on health care clinic licensure as it relates to PIP and criminal laws, and has also been
approved as an expert witness in state and federal civil and criminal cases dealing with unlicensed activity.
We thank Dennis for his many years of service in the fight against fraud in the state of Florida and wish him well in his
new career. You may contact him at 954-462-0330 or dlarosa@roiglawyers.com.
Former DIF Detective Joins National Insurance Crime Bureau in South Florida
Teresa Grimaldi, former detective with the Division of Insurance Fraud (DIF), has joined the National Insurance Crime
Bureau as it’s newest agent with the South Florida Medical Fraud Task Force. Grimaldi spent 10 years with the Coral
Springs Police Department before joining DIF in 2011, where she was most recently the state agency‘s lead detective for
the Operation Sledgehammer investigation in Palm Beach County.
We thank Teresa for her hard work at DIF and congratulate her on her new endeavor.
The PIP Source
Page 3
Most Wanted: Fugitive
James William Lloyd, Jr.
Black Male, 39 years old
6’03”, 175 lbs, Brown Eyes, Black Hair or Bald
Warrant Information:
Warrant/Case #: F10022494B
Felony Warrant Charge: Insurance Fraud / Staged Accident
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud (DIF) is attempting to locate James William Lloyd, Jr. in reference
to the outstanding warrant.
In April 2007, DIF received a referral concerning a staged accident ring.
Lloyd was identified as the top guy or “RECRUITER of Recruiters”. As
a recruiter, he was the person who finds and coordinates persons willing
to fake accidents for money.
Five persons were arrested in connection with this staged accident ring.
Lloyd has yet to be found since his warrant was issued on August 2,
2010. Lloyd was believed to have been in Bethesda, Maryland.
If you know where Lloyd 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/
Chiropractor / Clinic Owners Arrested in Miami
In September, Florida Chief Financial Officer Jeff Atwater announced the arrests of three individuals in
unrelated but similar PIP fraud investigations in Miami. Chiropractor David Louis Hirschenson, 55, was
arrested for illegally soliciting accident victims and obtaining vehicle crash reports. Nester Sanchez, 39, and
Chakira Vila Puentes, 45, owners of C & N Therapy Center, were arrested for insurance fraud and grand
theft.
“PIP fraud schemes drive up auto insurance rates for all Floridians, so we must do everything we can to put a
stop to them," said CFO Atwater. "I applaud our investigators for their diligence in bringing these fraudsters to
justice.”
An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that
Hirschenson used unauthorized media credentials to obtain crash reports illegally and use them to solicit
accident victims. Hirschenson was charged with 19 counts of obtaining illegal crash reports and one count of
solicitation.
In a separate investigation, detectives determined that husband and wife Nester Sanchez and Chakira Vila
Puentes operated an unlicensed accident clinic named C& N Therapy Center located in Miami. The couple
hired a massage therapist to act as a straw owner of the clinic, which allowed them to bill more than $353,000
in fraudulent PIP claims. The clinic was paid more than $212,000 for these billings.
October 2013
Page 4
Statewide PIP Arrests – September 2013
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.
Jobitza Baine Berberena Soto, 33 – staged acct 07/12/12 (passenger) $44,055 - Advanced MRI Diagnostic / Baymeadows Injury
Center / Wellness Rehabilitation Services (Direct General / Farmers / Sentry) J
Tavaris Denald Turner, 30 – fake ins card (Liberty Mutual) T
Steve Caplan, 38 – staged acct 05/12/10 (driver) $159,631 - Back 2 Life Rehab (FIGA / Progressive / Rental Services) B
Angela Rose Bajorek, 34 – fake ins card (Occidental Fire & Casualty) O
Nieman Arias, 35 – solicitation – Auto Body Max (Star & Shield / State Farm / United Services) M
Marcos Antonio Hernandez, 22 – staged acct 04/09/12 (driver) $60,480 - Integral Medical Rehab Center / Magic Spot Medical
Center (Geico) M
Jean V Cassamajor, 41 – staged acct 05/04/11 (recruiter) $ - KJ Chiropractic / Wellness Pain and Rehab () O
Franklin Leavy Butler, Jr, 32 – staged acct 01/14/13 (driver) $6,881 - (USAA) J
Cornelius Conley, 22 – fake ins card (United Auto) M
Linda Gale McCullough, 57 – application fraud (Workman’s Auto) O
Foufoune Etienne Junior, 43 – jump-in 08/25/11 - $28,895 - Injury Treatment Center (Imperial Fire & Casualty) B
Julie Marie Davis, 32 – jump-in 03/14/11 - $36,346 (Geico / State Farm) T
Audreka Latesha Everett, 35 – staged acct 05/01/12 (driver) $20,000 – Atlas Massage Therapy Corp / Gate Parkway Diagnostic
Center (Geico) J
Audreka Latesha Everett, 35 – staged acct 07/07/12 (driver) $42,426 – One Touch Therapy Center (Direct General / Geico) J
Luis A Recio Rodriguez, 31 – staged acct 10/05/11 (driver) $94,716 - Clarke Medical Services / Emoge Medical Services / New Life
Rehab Services (Allstate / United Auto) M
Vitoria Abranches, 41 – staged acct 06/13/10 (passenger) $37,909 – Back 2 Life Rehab (Progressive / Repwest / Sentry) B
Kendra Yvette Washington, 35 – application fraud (Geico) J
David Louis Hirschenson, 55 - chiropractor - solicitation - Advanced Chiropractic Center / Attorney Michael S. Davis (United Auto) M
Nestor Sanchez, 39 – clinic owner / unlicensed clinic - $353,362 - C & N Therapy Center (Allstate / Bristol West / Geico / Mercury /
Progressive / State Farm / Travelers) M
Mushin Nazal Al Shaibani, 43 – staged acct 09/17/12 (driver) $3,273 - (Progressive / Repwest) J
Chakira Vila Puentes, 45 – clinic owner / unlicensed clinic - $353,362 - C & N Therapy Center (Allstate / Bristol West / Geico /
Mercury / Progressive / State Farm / Travelers) M
Lilnetta Trenise Adkins, 27 – fake ins card (Geico) T
Marino Ramirez, 58 – staged acct 05/31/11 (recruiter) $62,573 – ORD Medical (Geico) M
Melania Del Villar, 51 – staged acct 05/16/12 (passenger) $13,636 – Indian Rehabilitation Center (Direct General) J
Milton Delgado, 31 – solicitation – Auto Body Max (Allstate / OCE) M
Roberto Padron Rivero, 44 – staged acct 01/25/12 (recruiter) $70,791 – Advanced Orthopedics and Pain Management / Angels
Diagnostic Group / Atrium Chiropractic & Rehab / Biscayne Rehab Center / Gentle Care Rehab Services / South Florida Medical
Health Center / YH Imaging (Esurance / Geico / State Farm) M
Raymond Anthony Paponetti, 24 – staged acct 05/12/10 (passenger) $159,631 - Back 2 Life Rehab (FIGA / Progressive / Rental
Services) B
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 – September 2013
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.
Brian Ferreira, 24 – staged acct 11/18/09 (driver) $78,191 – Back 2 Life Rehab / Coconut Creek Rehab (Alamo / Progressive) B
Brian Ferreira, 24 – staged acct 10/2/09 (passenger) $127,739 – Back 2 Life Rehab / Coconut Creek Rehab (Allstate / Esurance /
Progressive / State Farm) B
John Arthur Huggins, II, 21 – staged acct 10/04/10 (passenger) $10,453 - Austin Health Center (Geico / Liberty Mutual / State
Farm / USAA) T
Laura Jo Horm, 34 – false claim (USAA) P
Kyle Harper Hancock, 26 – false claim (Geico) O
Yunier Rodriguez Labrada, 34 – staged acct 04/02/12 (recruiter) $60,938 - Integral Medical Rehab / Well-Care Rehab Services
(Allstate / Geico) M
Mark Alan Lester, 46 – application fraud (Geico) T
Shawn Franklin Mindo Chaco, 35 – massage therapist / false claims - $5,239 - The Islands Therapeutic and Rehabilitative Center,
LLC (Geico) T
Dirsia L Mohedano, 41 – staged acct 08/11/11 (passenger) $91,259 - Sunshine Florida Rehab Center / VM Physical Therapy (21st
Century / Geico) M
Osniel Cuevas Garcia, 33 – staged acct 03/25/10 (recruiter) $46,208 - B & A Diagnostic / Angels Diagnostic Group / Pentacle
Rehabilitation Center / Sunlight Rehabilitation (Geico / MGA / Progressive) M
Jonathan Freitas Gualberto, 24 – staged acct 11/18/09 (recruiter) $78,191 – Back 2 Life Rehab / Coconut Creek Rehab (Alamo /
Progressive) B
Jonathan Freitas Gualberto, 24 – staged acct 10/2/09 (passenger) $127,739 – Back 2 Life Rehab / Coconut Creek Rehab (Allstate /
Esurance / Progressive / State Farm) B
Marquette Antwon Dames, 21 – paper acct 10/26/10 (driver) $17,847 – Personal Medical Center (Farmers) T
Sherie Lashay Henderson, 29 – sale of fake ins card (Affirmative) T
Osniel Morales, 35 – staged acct 03/16/12 (recruiter) $10,271 - CMD Medical Center (State Farm) B
Francisco Barbaro Marrero, 52 – PIP patient - $6,162 - Columbus Rehabilitation Center (Geico) T
Yulian Andino, 37 – PIP patient - $6,162 - Columbus Rehabilitation Center (Geico) T
Andres Cortinas, 72 – staged acct 03/16/12 (passenger) $10,271 - CMD Medical Center (State Farm) B
Brenda Heitzmann, 55 – false claim - $5,800 (Amica) O
Eduardo Suarez, 35 – staged acct 03/16/12 (driver) $10,271 - CMD Medical Center (State Farm) B
Patricia Darlene Miller Phillips, 43 – lost wages - $5,850 (Nationwide) T
Pablo Lazaro Suarez, 23 – staged acct 09/19/12 (driver) $69,625 - Doctors Professional Medical Group / Gentle Care Rehab
Services / Psychologist Technology / South Florida Medical Health Corp / YH Imaging (Geico / United Auto) M
Felix Medina Rodriguez, 39 – staged acct 03/25/10 (recruiter) $46,208 - B & A Diagnostic / Angels Diagnostic Group / Pentacle
Rehabilitation Center / Sunlight Rehabilitation (Geico / MGA / Progressive) M
Lynn Danielle McNeil, 22 – jump-in 01/30/13 - $2,783 - Bay Radiology Associates / Blue Wave Emergency Physicians / Gulf Coast
Medical Center (Allstate) P
Arrested in December 2012
Mathew Anthony Moore, 26 – false statement in support of lost wages - $5,850 (Nationwide) 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)
October 2013
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 arrests of three clinic
owners and a chiropractor, who were among
nine charged in an organized fraud ring that
operated in Lee and Charlotte counties.
On page 3, we feature another fugitive in
Insurance Fraud’s Most Wanted, and cover the
arrests of a chiropractor and two clinic owners
in Miami.
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. 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