January 2013 Volume 3 - Issue 7 HEADER HERE CFO Atwater Announces 19 Arrests in Jacksonville Accident Clinic Sting Florida Chief Financial Officer Jeff Atwater announced the arrest of Valerie Marshal, 24, a licensed massage therapist and owner of Indian Rehabilitation Center, Inc. (IRCI), and 18 others for insurance fraud for alleged involvement in a fraudulent accident clinic ring. “These large-scale accident clinics are at the root of the PIP fraud problem in Florida. We will continue to take out these PIP fraud rings so that Florida drivers are protected and safe on the roads .” - CFO Jeff Atwater INSIDE THIS ISSUE 1 Jacksonville Arrests 2 Op Never Ends 3 PIP Fraud News 4 Most Wanted 5 Statewide Arrests 7 Statewide Contacts “These large-scale accident clinics are at the root of the PIP fraud problem in Florida,” CFO Atwater said. “We must stay one step ahead of the ring leaders who are orchestrating these schemes. We will continue to take out these PIP fraud rings so that Florida drivers are protected and safe on the roads.” An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) and the Duval State Attorney’s Office alleges that in September 2011, Marshal opened IRCI and conspired with several individuals to stage auto accidents and submit fraudulent therapy reports for patients who never received treatment from her clinic. These reports were used to file fraudulent Personal Injury Protection (PIP) claims with several insurance companies. Also arrested in the sting were various clinic employees, recruiters, and staged accident participants; Yokayra Ramos, Roscoe Sawyer, Jr., Edgard Fernandez-Romans, David Arteaga Torres, Kenneth Carrerro, Jonathan Robinson, Calvin Grier, Tara Buck, Niko Semedo, Tawaub Zahir, Samantha Daniels, Kathy Adams, Yilan Espinosa, Connor Certo, Lester Lopez, Craig Graves, Julio Angel Figueroa and Ernando Valentin. At least 19 claims were reported to the National Insurance Crime Bureau (NICB) from 11 insurance carriers. IRCI had approximately 80 patients during this time and over $228,000 was paid out to IRCI from the insurance providers. Additional arrests are expected. Marshal, as well as the 18 other individuals arrested in connection with the fraud ring, were booked into the Duval County Jail. If convicted, she faces up to 35 years in prison and each of the 18 individuals face up to 15 years in prison. The Office of Duval State Attorney Angela Cory will be prosecuting the charges in this case. CFO Atwater championed legislative reforms that addressed cost drivers and fraud in Florida’s personal injury protection (PIP) system. These reforms, passed during the 2012 Legislative Session, went into effect January 1, 2013. Anyone with information of 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 almost $275,000 to more than 40 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 2013 Page 2 Miami PD Arrests 10 in Operation Never Ends The City of Miami Police Department (MPD) and the Miami-Dade State Attorney’s Office announced 10 arrests involving insurance fraud, staged accident and patient brokering in Operation Never Ends. The arrests involved unrelated investigations of two clinics in Miami, Miami Medical Care Center and Continental Rehab Center. The year-long undercover investigations also involved the US Secret Service, West Miami Police Department, Hialeah Police Department, Florida Department of Health and the National Insurance Crime Bureau (NICB). “Every incident is different because every clinic is different in the size and scope in the amount of money we have. In one clinic that we had, I can tell you that one investigation we did in the beginning, they were up to $80,000 before we shut them down in just one crash,” explained Luis Taborda from the Miami Police Department. Those arrested in the Miami Medical Care Center case included alleged owner Jorge Felix Felipe Pupo, 50; massage therapist Daniel Garcia, 25; clinic employees Yanris de Regla Ramirez Paneque, 37 and Joyce Camacho, 26; runners Gustavo Echemendia, 73, and Roberto Rosquete Sr, 58. Police are seeking to arrest two additional defendants. Those arrested in the Continental Rehab Center case included owner Ivonne A. Sau, 57, chiropractor Maria D. Quintero, 50, massage therapist Elizabeth Rios-Suarez, 47 and runner Richard Guerra, 55. State Farm, United Auto, Direct General and Nationwide also assisted in the investigation. See more of this story at http://miami.cbslocal.com/2012/12/14/mpd-teams-up-with-secret-service-to-tame-insurancefraud// and http://www.nbcmiami.com/news/Several-Arrests-Made-in-South-Florida-Insurance-Fraud-Crackdown183513471.html. FIFEC Prosecutor of the Year Leaves State Attorney’s Office Juliana Millon, the 2012 FIFEC Law Enforcement Prosecutor of the Year, is leaving the Miami-Dade State Attorney’s office to join an insurance company. Millon, who joined the Miami dedicated prosecutor unit in August 2010, will miss working with the law enforcement officers in the fight against insurance fraud. "This is a bitter sweet move for me, I will miss working with great Detectives fighting a crime that is silent to us all. It's a crime that affects the community as a whole and only all of us together can put an end to it." The unit also recently saw the departure of prosecutor Nneka Uzodinma, who left in 2012. The Division of Insurance Fraud’s Captain Steven Smith stated “Juliana is one of the hardest working and dedicated prosecutors our office has ever worked with, and we will miss her expertise and aggressive prosecution of our fraud cases. We wish her the best in her future endeavors.” Veterans Suzanne Bell and Kerri Crockett of the Miami-Dade unit welcome three new prosecutors to the team. Scott Holtz, who came to the unit on a temporary basis last year, signed on for an 18-month extension. He is joined by Johanna Garcia Benedi, who started with the unit in November, and Maggie Gerson, who starts this month. The PIP Source Page 3 PIP FRAUD – In The News Federal Judge Denies Motion For Temporary Injunction Against New PIP Law A federal court judge has denied a motion brought forward by some medical providers who claimed that Florida’s new no-fault auto law unfairly prevented them from making a living, on the basis it is unlikely they will prevail in court. Florida lawmakers earlier this year enacted the law that made numerous changes in benefits including $10,000 for emergency injuries and a cap of $2,500 for non-emergency medical services. The law also eliminated massage therapists and acupuncturists as medical providers who could be paid under a PIP policy. Under a case filed in U.S. District Court [Myers, et al v. McCarty Case No. 8:12] several chiropractors claimed the restriction on non-emergency benefits infringed on their ability to make a living. It was a claim echoed by the massage therapists and acupuncturists. Federal Judge Richard Lazzara, however, denied their motion to block the law saying they failed to show how they would be irreparably harmed under the new law or how their request for an injunction would serve the public. “The plaintiffs have not met their burden of establishing the essential element necessary for the issuance of a preliminary injunction - a substantial likelihood they will prevail on the merits,” wrote Lazzara. See the article at http://www.insurancejournal.com/news/southeast/2012/12/13/273917.htm. Tampa Clinic Owner Sentenced to 15 Years in Prison On December 19, 2012, Ibrahim Cueto Bernardo, 53, was sentenced to fifteen (15) years in Florida prison and fined $360,000.00 by Judge Battles in Hillsborough County's Thirteenth District. Cueto Bernardo, who absconded to Cuba in October 2012 during his trial, was not present for his sentencing. He was the owner of Underwood Healthcare Services in Tampa and was arrested by the Division of Insurance Fraud in November 2011. Cueto Bernardo was the featured Most Wanted subject in the November 2012 PIP Source. Three Arrested in Orlando For Operating Unlicensed Clinic The Division of Insurance Fraud (DIF) announced the arrests of three subjects following an investigation into the ownership and operation of Selective Chiropractic Health Care, a PIP clinic in Orlando. Lakisha Williams, 31, Elize Verty, 34, and Carmita Etienne, 34, were each charged with unlicensed clinic, scheme to defraud, money laundering and grand theft. Verty, who is the owner of Princess Auto Sales, A1 Wrecker Service and Princess Limousine, was identified as the true owner of Selective Chiropractic Health Care. The three allegedly conspired to operate the clinic through a scheme using chiropractors as straw owners to conceal the true ownership. Selective Chiropractic Health Care was originally opened in 2008. Florida Men Found Guilty of Billing For Fake Whiplash A federal jury last month found Cape Coral residents Francisco Huici Fernandez, 40 and Adrian Perez, 22, guilty of conspiracy to commit health care fraud and mail fraud. Perez was also found guilty of five counts of health care fraud and two counts of mail fraud. The maximum penalty for each conspiracy count and each mail fraud count is 20 years in federal prison and the maximum penalty for each health care fraud count is 10 years. Sentencing is scheduled for March. The investigation of C & A Family Rehab Center was associated with "Operation Whiplash", a thirteen month investigation conducted by the Cape Coral Police Department, United States Secret Service, Internal Revenue Service Criminal Investigation, National Insurance Crime Bureau, and the Division of Insurance Fraud. The case is prosecuted by Assistant United States Attorney Jesus M. Casas. See the story at http://www.winknews.com/Local-Florida/2012-12-12/Cape-Coral-men-are-found-guilty-in-Operation-Whiplash-case. Naples Clinic Owner Charged For Operating Unlicensed Clinic As a result of an eight-month investigation by the Division of Insurance Fraud into criminal activities at The Collier Chiropractic Center, search warrants were executed in November at the clinic and the home of the alleged owner, Wilhem Vilbon. Less than a week later, Vilbon, 48, was arrested and taken to the Collier County Jail. The investigation started after information regarding staged accidents was provided by Allstate. DIF soon began to uncover a case of straw ownership. A podiatrist from Broward County filed for an exemption with the Agency for Health Care Administration (AHCA), claiming to be the owner of the clinic. However, DIF found that the ownership and control of the clinic all led back to Vilbon. The Collier Chiropractic Center is a fictitious name filed with the state, owned by Sunshine Medical, which was registered to the podiatrist. The checks from insurance companies for treatment of patients at the clinic were being deposited into a bank account controlled solely by Vilbon. DIF investigation revealed that over the last five years, more than $1.4 million had been billed to two insurance carriers by Vilbon’s unlicensed clinic. January 2013 Page 4 Most Wanted: Fugitive Joseph J. Beckford Black, Male, 25 years old 5’11”, 190 lbs, Brown Eyes, Black Hair Warrant Information: Warrant/Case #: 09009516CF10B Felony Warrant Charge: Insurance Fraud Details: The Florida Department of Financial Services, Division of Insurance Fraud is actively seeking the whereabouts of Joseph J. Beckford. The insurance fraud investigation revealed that Beckford recruited participants to engage in staged accidents in order to file fraudulent automobile insurance claims. If you know where Beckford 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/ Clinic Manager Sentenced in Sledgehammer Case Maria Molina, a/k/a Cary, 41, of West Palm Beach, was sentenced to 48 months in prison, to be followed by two years of supervised release. Molina had been arrested in June 2012 as part of Operation Sledgehammer for her involvement in the staged accident insurance fraud scheme. Court documents state that Molina worked as the receptionist, office manager, and billing specialist at OVY Rehabilitation Medical Center (OVY) and HHR Rehab Medical Center (HHR). Molina and other co-conspirator employees and recruiters advised the staged accident participants on how to fill out the paperwork and what to say if an insurance investigator interviewed them about their injuries or treatment. The participants were instructed to sign numerous blank treatment forms that would later be submitted indicating that they had visited the clinic on a number of separate occasions for treatment, although they may have visited the clinic only once or twice. Molina admitted that she was aware that patients would sign blank therapy forms for days when they did not receive treatment. Molina also advised a co-conspirator on how to set up a clinic to perform PIP fraud. Molina described how the patients would come from “pre-arranged accidents” and that the clinic would have to pay the patients upfront. When the coconspirator asked how Molina would keep receipts for the cash payments to the “patients,” Molina responded that there would be nothing to show for those payments because “this is illegal, it is fraud, and this is what people are doing.” Operation Sledgehammer is a joint investigation by the FBI, IRS-CID, DIF, NICB and members of the Greater Palm Beach Health Care Fraud Task Force. The case is being prosecuted by Assistant U.S. Attorney A. Marie Villafaña. See the entire press release at http://www.fbi.gov/miami/press-releases/2012/west-palm-beach-residentsentenced-for-role-in-staged-accident-scheme?utm_campaign=emailImmediate&utm_medium=email&utm_source=miami-press-releases&utm_content=162939. The PIP Source Page 5 Statewide PIP Arrests – December 2012 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. Yoannel Arias, 20 - staged acct 12/30/11 (driver) $40,000 - Medical Center of The Palm Beaches / Poinciana Chiropractic Center (Republic Western / State Farm) W Arlene D Agurcia, 25 - staged acct 12/30/11 (passenger) $40,000 - Medical Center of The Palm Beaches / Poinciana Chiropractic Center (Republic Western / State Farm) W Alfredo Pita Hernandez, 29 - staged acct 06/18/11 (recruiter) $88,041 - Flamingo Health Corp / Florida Mammogram & Imaging Services / Rainbow Rehabilitation / Roig Ortho & Rehab Center / YH Imaging (State Farm) M Junior Orozco, 23 - staged acct 12/02/11 (passenger) $1,791 - Fontainebleau Rehabilitation Center (Assurance America) T Livan Hernandez, 27 - staged acct 12/30/11 (driver) $40,000 - Medical Center of The Palm Beaches / Poinciana Chiropractic Center (Republic Western / State Farm) W Justin Michael Ragozino, 30 - jump-in - $13,260 - Complete Care Chiropractic (Progressive) B Francis Alexander Hernandez, 33 - staged acct 04/23/11 (driver) $77,827 - Active Wellness Center / Doral Imaging / Ultimate Diagnostics / Unique Relief (Allstate / Old Republic / Progressive) M Juan A Cruz Rey, 57 - staged acct 12/02/11 (driver) $1,791 - Fontainebleau Rehabilitation Center (Assurance America) T Caridad Abreu, 35 – patient brokering / insurance fraud - $36,672 - Excellent Rehabiltation Center / Sunset Physiotherapy Center (Geico / State Farm) B Carla Maria Erazo, 34 - staged acct 04/23/11 (passenger) $77,827 - Active Wellness Center / Doral Imaging / Ultimate Diagnostics / Unique Relief (Allstate / Progressive) M Denys Castellanos, 40 - staged acct 02/05/12 (recruiter) $64,708 - JS Rehab Center / RCR Rehabilitation Center Corp (21st Century / Geico) M Lucia Elena Rodriguez Fernandez, 46 - clinic employee - $11,000 - Personal Outreach Rehabilitation (Liberty) T Ana M Maiato, 39 - false claim - $55,000 - (Encompass) J Jean Grady Vil, 24 - staged acct 04/25/12 (driver) $8,939 - Modern Medicine (Geico) W Noel Jose Pineda, 31 - staged acct 02/05/12 (driver) $64,708 - JS Rehab / RC Rehab (21st Century / Geico) M Stanley Beauchamp, 21 - staged acct 04/25/12 (driver) $7,047 - Delray Chiropractic and Wellness (Permanent General) W Andrew Douglas Whiffen, 23 - staged acct 09/13/11 (driver) $13,647 - Excellent Rehab / Sunset Physiotherapy (Allstate / Geico) B Elize Verty, 34 - unlicensed clinic / scheme to defraud - $50,559 - Selective Chiropractic Health (Allstate / Assurance America / Direct General / Geico / Liberty Mutual / Progressive / Seminole Casualty / State Farm) O Stacy Benita Simmons, 35 - PIP patient – $2,586 - Tree of Life Medical Center (USAA) T Esteban Hernandez, 66 - staged acct 05/07/10 (recruiter) $73,261 - AB Diagnostic Center / B&A Diagnostic / Francos Medical Center / Medical Professional Health / YH Imaging (Gainsco / State Farm) M Carmita Etienne, 34 - unlicensed clinic / scheme to defraud - $50,559 - Selective Chiropractic Health (Allstate / Assurance America / Direct General / Geico / Liberty Mutual / Progressive / Seminole Casualty / State Farm) O Yanisley Villalobos Franco, 28 - staged acct 11/03/10 (passenger) $34,215 - South Florida Medical Health Company / VL Medical Center (Victoria Select) M Trish Marie Cordero, 27 - staged acct 02/05/12 (passenger) $64,708 - JS Rehab / RC Rehab (21st Century / Geico) M Abigail Pinhas, 31 - staged acct 09/13/11 (recruiter) $13,647 - Excellent Rehab / Sunset Physiotherapy (Allstate / Geico) B Yosmany Rodriguez, 25 - staged acct 04/23/11 (driver) $77,827 - Active Wellness Center / Doral Imaging / Ultimate Diagnostics / Unique Relief / (Allstate / Old Republic / Progressive) M Michelle Eden Padilla, 25 - staged acct 04/23/11 (driver) $77,827 - Active Wellness Center / Doral Imaging / Ultimate Diagnostics / Unique Relief / (Allstate / Old Republic / Progressive) M Allen Pierre Cinor, 23 - staged acct 09/13/11 (driver) $13,647 - Excellent Rehab / Sunset Physiotherapy (Allstate / Geico) B Deeanna N Mercado, 26 - fake ins card (Geico) 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) January 2013 Page 6 Statewide PIP Arrests – December 2012 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. Arrested in Nov 2012 Wilhem Vilbon, 48 - unlicensed clinic - The Collier Chiropractic Center (Allstate) F Jacksonville Arrests (from page 1) Arrested in Sept 2012 Kathy Michele Adams, 35 - staged acct 06/26/12 (driver) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Calvin Grier, III, 19 - staged acct 06/26/12 (passenger) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Jonathan Jay Robinson, 22 - staged acct 06/26/12 (passenger) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Connor Duane Certo, 19 - staged acct 06/26/12 (driver) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Tara Jannelle Buck, 26 - staged acct 06/26/12 (passenger) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J David Arteaga Torres, 21 - staged acct 06/26/12 (recruiter) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Arrested in Oct 2012 Roscoe Sawyer, Jr, 29 - staged acct 06/26/12 (recruiter) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Yokayra Magdalena Cruz Ramos, 25 - clinic employee - $13,000 - Indian Rehabilitation Center (Geico) J Arrested in Nov 2012 Niko Jordan Semedo, 19 - staged acct 06/05/12 (recruiter) $65,000 - Indian Rehabilitation Center (Geico) J Samantha K Daniel, 21 - staged acct 06/05/12 (passenger) $65,000 - Indian Rehabilitation Center (USAA) J Julio Angel Figueroa, 20 - staged acct 06/05/12 (passenger) $65,000 - Indian Rehabilitation Center (Geico) J Edgard Manuel Fernandez Roman, 33 - staged acct 06/26/12 (recruiter) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Tawaub Ahmad Zahir, 21 - staged acct 06/05/12 (driver) $65,000 - Indian Rehabilitation Center (Geico / USAA) J Arrested in Dec 2012 Kenneth Dwayn Vega Carrero, 22 - staged acct 06/26/12 (recruiter) $14,136 - Baymeadows Injury Center / Gate Parkway Diagnostic Center (Allstate / Direct / Geico / Sentry / State Farm) J Yilan Espinosa, 28 - staged acct 05/07/12 (passenger) $13,000 - Indian Rehabilitation Center (Peachtree Casualty) J Lester Lopez, 37 - staged acct 05/07/12 (driver) $27,000 - Indian Rehabilitation Center (Peachtree Casualty) J Valerie Deneen Marshall, 24 - massage therapist / straw owner - $109,013 - Indian Rehabilitation Center (Allstate / Direct / Geico / Mendota / MGA / Ocean Harbor / Peachtree / Sentry) J Ernando Ariel Valentin, 21 - staged acct 05/18/12 (passenger) $10,067 - Indian Rehabilitation Center (Progressive) J Craig Derek Graves, 26 - staged acct 05/18/12 (driver) $6,628 - Indian Rehabilitation Center (Allstate) 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 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 Tallahassee Field Office - 850.413.3115 Capt. David LINDSAY Pensacola Field Office - 850.453.7802 Lt. Joseph HOLOKAN 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 Lt. Darrell WILSON Fort Myers Field Office - 239.278.7527 Lt. Mark FRITZ Copy goes her. Editor’s Corner On page 1, we cover the takedown of a major staged accident ring in Jacksonville involving 19 arrests. On page 2, we cover Operation Never Ends by the City of Miami Police Department, and say goodbye to Miami prosecutor Juliana Millon. On page 4, we feature the latest fugitive in Insurance Fraud’s Most Wanted and another sentencing in Operation Sledgehammer. As always, we report on PIP Fraud in the News and the latest PIP-related arrests. Happy New Year to all our readers! EAST CENTRAL REGION Counties: Brevard, Lake, Orange, Osceola, Seminole, Volusia Orlando Field Office - 407.835.4402 Capt. Glen HUGHES Lt. Jewel CAMERON Lt. Paul MEYERS 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 954.329.7427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Jose Olivier 813.558.6387