October 2012 Volume 3 - Issue 4 “Bame allegedly allowed the clinics to operate illegally under his name from 20092010...Bame admitted that he did not fully own or have a financial interest in either clinic...” HEADER HERE Arrested in Orlando Chiropractor Unlicensed Clinic Scheme Chiropractor Charles Richard Bame, 75, was arrested in September by the Division of Insurance Fraud (DIF) in Orlando on charges of operating an unlicensed clinic, insurance fraud, grand theft and scheme to defraud. Bame was arrested for falsely obtaining an exemption with the Florida Agency for Health Care Administration (AHCA) for All Family Chiropractic Center, LLC and for filing false documentation to obtain a massage establishment license with the Florida Department of Health (DOH) for Mina Chiropractic & Rehab Center. Both clinics are located in Orlando. Bame allegedly allowed the clinics to operate illegally under his name from 2009-2010. In a letter to AHCA in October 2010, Bame admitted that he did not fully own or have a financial interest in either clinic, and that he agreed to let the clinics use his license because he was in financial need at the time. DIF initiated the investigation following receipt of information from State Farm about the false ownership of the clinics. INSIDE THIS ISSUE 1 Unlicensed Clinics 2 Massage Therapist Convicted by Jury 4 PIP Fraud News 5 Maureen Perez 6 Statewide Arrests 8 Statewide Contacts Gesner Louisius, 51, is believed to be the true owner of All Family Chiropractic Center, LLC, and was arrested in September in Miami-Dade County. Investigation by DIF showed that Louisius had drafted a letter of purchase showing that Bame bought the clinic for $20,000, but in fact never paid any money and his ownership was a scam. Luc Kenty Legerme, 43, believed to be the true owner of Mina Chiropractic & Rehab Center, was arrested in August for his role in the scheme. Investigation by DIF showed that Legerme controlled the operation of the clinic and hired Bame to work as the chiropractor and to pose as the owner in order to obtain the AHCA exemption. Bame was listed on another clinic, Pine Hills Family Chiropractic Center, which is also under investigation. Bame, licensed in Florida as a chiropractor since 1982, has agreed to relinquish his DOH license. All three clinics have closed. October 2012 Page 2 Miami Massage Therapist Convicted of Staging Accidents in Jury Trial Massage therapist Carlos Martinez Hejses, 41, was convicted in September in a jury trial of two counts of staged crash, two counts of patient brokering, five counts of filing false insurance claims and five counts of grand theft 3rd degree. Martinez Hejses was arrested in April 2011 by the Division of Insurance Fraud for two staged accidents that he organized in 2010. Three accident clinics in Miami-Dade County - Psychologist Technology Inc., V & R Medical Group, and Continental Rehabilitation Center - filed claims against Allstate, Progressive and State Farm in excess of $69,000. “Even though insurance fraud is an almost invisible crime, it affects every single hard working American who drives an automobile. In these tough economic times, we are working diligently with law enforcement to identify, investigate and prosecute those health care workers who have become professional scammers in order to make some easy money. I’m very proud of my prosecutors and greatly appreciate the valuable work of DIF Lieutenant Violeta Serrano who helped bring this criminal to justice,” said Miami-Dade State Attorney Katherine Fernandez Rundle. The case was successfully prosecuted by Assistant State Attorneys Juliana Millon and Scott Holtz of the Insurance Fraud Unit of the Miami-Dade State Attorney’s Office. Although most fraud defendants do not go to trial, the actions of these dedicated prosecutors fully demonstrate that the state is prepared to go the distance to fight back against these organized insurance fraud rings. Martinez Hejses has been a licensed massage therapist since September 2010, faces up to 90 years in state prison for his crimes. Each charge of staged crash carries a minimum mandatory penalty of two years in prison. Two other individuals who were charged in the scheme are awaiting trial, and a third defendant is a fugitive having allegedly fled to Cuba. Clinic Owner Arrested For Fake Crashes The Division of Insurance Fraud (DIF) announced the arrests of a clinic owner and a licensed massage therapist in three staged accident cases in Miami-Dade County. Roberto Toledo, 50, owner of Centinel Medical Center, a clinic located in Hialeah, was charged for organizing two of the three staged accidents and paying the participants in the third. Odalys Puri Lorente, 48, a licensed massage therapist since 2007, was charged with insurance fraud and grand theft for fabricating treatment forms for patients she did not treat at Centinel Medical Center. The three staged accidents occurred in March 2009 and June 2010, and resulted in more than $203,000 in fraudulent claims being filed against five insurance carriers by four clinics, $136,000 of which was billed by Toledo’s own Centinel Medical Center. Eight persons were previously arrested related to these cases including organizers and participants as well as another clinic owner. That clinic owner, Daysi Puigros, was arrested by DIF in five cases for organizing staged accidents, operating an unlicensed clinic and using the name of a deceased doctor on billing forms. Puigros owned and operated several clinics including Better Life Medical Center LLC and Quality Life Rehabilitation Center, LLC, both in Hialeah. The insurance companies defrauded in these cases included Allstate, Progressive, RAC, State Farm and United Auto. Centinel Medical Center, which was incorporated in October 2007, is not licensed with the Florida Agency for Health Care Administration (AHCA). Toledo was licensed by the Department of Health (DOH) as a registered chiropractic assistant since September 2009, and it expired in March 2012. Toledo faces a minimum of two years in prison if convicted of the second-degree staged accident felony, and could face a maximum of 110 years if convicted on all counts. The case will be prosecuted by the Insurance Fraud Unit of the Miami-Dade County State Attorney’s Office. This case is part of a continuing crackdown by CFO Atwater’s Division of Insurance Fraud and the National Insurance Crime Bureau in the fight against auto insurance fraud in Florida. The PIP Source Page 3 Most Wanted: Fugitive Dagoberto Milian Lopez Hispanic Male, 56 years old 5’10”, Brown Eyes, Brown Hair Warrant Information: Warrant/Case Number: 209B-MM-113865 Conspiracy to Commit Mail Fraud Details: The Florida Department of Financial Services, Division of Insurance Fraud is attempting to locate Dagoberto Milian Lopez in reference to the outstanding warrant. Lopez was indicted by the U.S. Attorney’s Office in July 2011 as part of Operation Sledgehammer for his involvement in a massive insurance fraud / staged accident ring operating in Palm Beach County. If you know where Lopez can be located, please contact the Division of Insurance Fraud at 800-378-0445. Check out the latest Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/ Seven Arrested in Tampa PIP Fraud Ring Two massage therapists and five participants in a staged accident were arrested by the Division of Insurance Fraud in Tampa. Yarlenis Guanche-Valoy, 30, worked at Relief All Pain Rehabilitation Center, LLC, an accident clinic located at 3104 West Waters Avenue, Suite #105 in Tampa. Guanche-Valoy had been licensed as a massage therapist in Florida less than three months before she allegedly falsified medical treatment records for some of the participants in the staged accident that took place in June 2010. Jose Lopez, 44, a massage therapist licensed in Florida since 2008, worked at Park Place Therapy, LLC, located at 6800 North Dale Mabry Highway, Suite #186 in Tampa. Lopez allegedly falsified medical treatment records for other participants in the same staged crash. Lopez is the sole officer listed on the clinic which incorporated in July 2009. Thais Scharenberg, 19, and Kevin Charles, 24, were participants in the staged crash who allegedly treated at Relief All Pain Rehabilitation Center, LLC. Katherine Martinez, 23, Carlos Luis Azuaje, 30 and Carolina Martinez, 21, were participants who allegedly treated at Park Place Therapy, LLC. Each were charged with staged accident and filing false insurance claims. Scharenberg and Katherine Martinez were arrested in March while the others were arrested in September. Geico, Progressive and State Farm were defrauded in this case with claims in excess of $53,000 filed by the two clinics for treatment as a result of the staged accident. October 2012 Page 4 PIP FRAUD – In The News Clinic Owner Charged in Structuring Case in Tampa The Division of Insurance Fraud arrested clinic owner Hernan P. Rodriguez Hernandez, 50, on charges of structuring transactions to evade reporting or registration requirements in the amount of $707,400 during the period of September 2010 and September 2011. Rodriguez Hernandez withdrew cash in amounts less than $10,000 from the bank account in the name of his clinic, Orthopedic & Radiology Center, in an effort to evade the required CTR reporting. Hernan had allegedly purchased the Tampa clinic, formerly known as Regional Health Care Center, effective October 2010 for $20,000. Hernan is charged with a first degree felony and faces 25 years in prison. Editorial - Hold auto insurers to their deal on PIP reform An editorial in the Palm Beach Post by Randy Schultz called on officials to hold insurance companies to keep their end of the bargain on the new PIP bill. Schultz writes that state legislators and Gov. Scott made a deal with Florida’s auto insurers, passing a law that cracks down on fraud and overbilling in Personal Injury Protection (PIP) cases, and in return, premiums will decrease. House Bill 119 made major changes to the no-fault system that Florida started 40 years ago. The law kept damage limits for emergency cases at $10,000, but reduced the limit to $2,500 in non-emergency cases. PIP no longer will cover acupuncture and massage therapy. Clinics that take PIP cases must be licensed. Lawyers no longer can seek double or triple their fees in PIP cases. Insurance Consumer Advocate Robin Westcott believes because there never was a distinction between emergency and non-emergency cases, the test will come when a lawyer challenges the definition of “emergency.” Since the definition potential loss of life or limb - comes from federal health regulations, Ms. Westcott believes that it will stand up in court. If it doesn’t, such an outcome “has a chance to blow up this bill.” Read the entire editorial at http://www.palmbeachpost.com/news/news/opinion/editorial-hold-auto-insurers-to-their-dealon-pip-/nSHKS/. Lawsuit Filed Against New PIP Statute, Challenges Constitutionality A widely anticipated lawsuit was filed recently by chiropractors, massage therapists and acupuncturists, whose services either were curtailed or eliminated for PIP reimbursement. Chiropractic treatment can be reimbursed under PIP only if referred by a physician, and then only up to $2,500 unless deemed to be emergency treatment. Massage therapy and acupuncture no longer are reimbursable under PIP. The lawsuit says the new law is unconstitutional on several fronts. By restricting reimbursement for their services, the law violates their equal protection rights and denies them due process, these providers say. Pretty standard stuff for such lawsuits. Two provisions in the lawsuit, though, caught my eye. One is the contention that the new law isn’t needed because supporters failed to properly document the extent of fraud and abuse. Not sure what level of proof would satisfy them, but any rational person who reviews the data likely will conclude the state is a cesspool of medical fraud and abuse. You can read the entire article (with a link to the lawsuit) by Executive Director Dennis Jay of the Coalition Against Insurance Fraud at http://www.insurancefraud.org/blog/?p=1866. Division of Insurance Fraud / National Insurance Crime Bureau Provide Training The National Insurance Crime Bureau (NICB), in conjunction with the Division of Insurance Fraud, provided staged accident training to the 122nd Florida Highway Patrol recruit class in Tallahassee last month. Captain Steven Smith and NICB Special Agent Herb Price provided information on types of staged accidents, what to look for when investigating a crash scene, and a general overview of how PIP fraud affects all of Florida’s citizens in one way or another. This is another component in the continuing partnership between the three agencies in fighting insurance fraud in the State of Florida. The PIP Source Page 5 Remembering Maureen Perez On May 10, 2012, the Tampa Division of the FBI dedicated the Special Agent Maureen “Mo” Perez Emergency Operations and Training Center at the Orlando Resident Agency in her memory. We take this time to share the remarkable story of our friend and co-worker, Maureen ‘Mo’ Perez, who passed away on March 24, 2010, following a long battle with a rare form of cancer. Diagnosed in her early teens with Pigmented Villonodular Synovitis (PVNS), she underwent numerous operations, experimental chemotherapy, radiation and an above-the-knee amputation of her left leg in 2005. Though faced with these obstacles, Maureen always held a positive attitude and lived life to the fullest. She brightened any room she entered, and truly placed our own “problems” in the proper perspective. Maureen gave new meaning to the term “Fighting Irish” as she fought against this disease from an early age. It never stopped her from what she wanted, as she played softball and was the only girl on the boys baseball team one year. Inspired to a career in law enforcement by the Adam Walsh case, Maureen started out as a North Miami Police Explorer in 1982. Maureen joined the Florida Marine Patrol at the young age of 18 under her maiden name Murphy. Maureen was then hired at the Division of Insurance Fraud in 1994, when the Miami office added positions following the flood of fraud cases from Hurricane Andrew. Maureen handled numerous hurricane cases, then moved on to PIP fraud and staged accidents. Maureen Perez Former DIF Director John Askins, who hired Maureen, remembers her as one of the sharpest and most dedicated investigators who ever worked for him. "Maureen was an integral part of a very close knit squad in Miami. We all loved her contagious enthusiasm, wonderful sense of humor, and the ever present sparkle in her eyes. At a young age Maureen was a fast-rising star destined for the FBI." Leaving DIF after less than 3 years, Maureen joined the FBI as a special agent at age 26; starting what would be an exciting 13-year career before she retired in 2009. Among her duties during her career with the FBI, Maureen was the Joint Terrorism Task Force Coordinator, a Hostage Negotiator and an Employee Assistance Counselor. Playing Santa at DIF In 2007, Maureen was awarded the William H Webster Award by Society (part of the Former Agents of the FBI Foundation). The award was created in 2001 to recognize and honor an active duty FBI Special Agent for exemplary public or humanitarian service provided outside of their official employment. Upon receiving the honor, Maureen presented the Foundation’s $5,000 cash award to Dr. Douglas Letson, her doctor from Moffitt Cancer Center, to help Moffitt’s ongoing groundbreaking research. Maureen was a dedicated professional to her career and a dedicated volunteer to helping others who suffered with rare forms of cancer, forming the “Dare To Be Rare Foundation,” which raised money and awareness for rare cancer research. The Former Agents of the FBI Foundation proudly presented the award to Maureen, calling her a remarkable and inspirational person. Receiving the William H Webster Award For several years, Maureen worked with the Amandalee Golf Classic, a tournament held in honor of cancer victim Amandalee Weiss, and her own MOving Forward Charity Golf Tournament in Orlando. Money raised at these events went to support research at the Sarcoma Department of H. Lee Moffitt Cancer Center in Tampa. Please check out this link for more information: http://amandaleegolfclassic.com/movingforward.html. Maureen was an outstanding law enforcement officer, a friend and inspiration to everyone she met and a very special person. Maureen was married to the love of her life and a loving mother of two boys. We miss her dearly. Maureen was 39. Please read this story at http://articles.orlandosentinel.com/2010-03-28/news/os-maureenperez-obituary-2-20100328_1_fbi-agent-prosthetic-leg-rare-disease. Maureen’s family at the Operations Center Dedication October 2012 Page 6 Statewide PIP Arrests – September 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. Miguel Groupierre, 43 – staged acct 04/07/10 (passenger) $34,274 - Alpha Medical Rehab Center / Hadera Health Center / We Care Medical Services (Progressive / State Farm / US Security) M Francisco Robles, 28 – staged acct 05/18/11 (recruiter) $62,249 - Absolute Health / Ache Free Body / Atlantic Mobile / B & A Diagnostic (21st Century / State Farm) M Charles Richard Bame, 75 – chiropractor / straw owner – All Family Chiropractic Center, LLC / Mina Chiropractic & Rehab Center (State Farm) O Michael Bradley Little, 32 – sale of fake ins card (State Farm) T Edgardo Jose Velez, 35 – caused acct 10/20/11 (driver) $21,317 – Emergency Physicians of Central Florida / Florida Injury Kissimmee / Regional Chiropractic Group (Liberty Mutual / Progressive) O Sariel Velunza Rodriguez, 37 – staged acct 11/07/10 (driver) $55,595 – Alas Medical Center / East Coast Chiropractic / Sanchez Therapy Center / South Florida Medical (Imperial Fire / State Farm) M Alexander Aroche, 35 – staged acct 12/20/11 (recruiter) $0 - (Allstate / Responsive) M Leon Deon Henderson, 28 – staged acct 03/24/10 (passenger) $60,000 - Florida Pain & Wellness / Injury & Accident Clinic (Direct General / Republic Western) O Yarlenis Guanche-Valoy, 30 – massage therapist - $11,080 - Relief All Pain Rehabilitation Center (Progressive) T Carlos Luis Azuaje, 30 – staged acct 06/25/10 (passenger) $14,787 - Park Place Therapy, LLC (Geico) T Gambino Manuel Delgado, Jr, 44 - pip patient / false claim - $30,654 - 911 Pain Management Group (Farmers / Geico) B Jose Lopez, 44 – massage therapist - $12,826 - Park Place Therapy, LLC (Geico) T Alieska Arce, 23 – staged acct 09/17/11 (driver) $12,100 - All X-Ray Diagnostic Services / Quality Rehabilitation Services (Infinity) M Dora Baquedano, 38 – paper acct 01/20/12 (driver) $8,290 - Miami Star Medical Center (Esurance) M Fednord Badio, 32 – staged acct 06/01/09 (recruiter) $71,979 - Northlake Medical Chiropractic (Gainsco / Republic Western / Sentry) W Samuel L Harrington, Jr, 62 – paper crash 07/26/10 (driver) $0 - Best Medical Health Care Solutions (21st Century / Allstate) T Iris Fontes, 29 – PIP patient - $17,016 - Light Rehabilitation Center (Allstate) W Angel Antonio Matos, 46 – PIP patient - $16,324 - Light Rehabilitation Center (Allstate) W Kevin Charles, 24 – staged acct 06/25/10 (recruiter) $11,080 - Relief All Pain Rehabilitation Center (Progressive) T Robert Toledo, 50 - clinic owner staged accident 06/21/10 (recruiter) $69,608 - Centinel Medical Center (Allstate / Progressive / RAC) M Robert Toledo, 50 – clinic owner staged accident 03/31/09 (recruiter) $84,647 - Centinel Medical Center (Allstate / Progressive / RAC / United Auto) M Robert Toledo, 50 – clinic owner / patient brokering - $49,591 - Centinel Medical Center (State Farm) M Dina Hoffman, 69 – pip patient / false claim - $30,654 - 911 Pain Management Group (Farmers / Geico) B Gesner Louisius, 51 – unlicensed clinic – All Family Chiropractic Center, LLC (State Farm) O Odalys Puri Lorente, 48 – massage therapist - $132,895 – Centinel Medical Center (Allstate / Progressive / State Farm) M Shaviya Latrice May, 24 – jump-in 06/24/12 - $0 (Geico) P Zulmairin Clemente Santiago, 33 – paper acct 10/07/10 (driver) $10,000 - Caleb Health Care / Global Diagnostic Center (Farmers) T Carolina Martinez, 21 – staged acct 06/25/10 (driver) $14,908 - Park Place Therapy, LLC (Geico) 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) The PIP Source Page 7 Statewide PIP Arrests – September 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. Celian Marie Vega Almodovar, 21 – fake ins card (Ocean Harbor) W Steven Leonard Mack, 38 – staged acct 07/21/11 (recruiter) $6,875 – Sunrise Medical Clinic (Enterprise Hertz / Progressive) B Veronica Mallet Masoucos, 26 – staged acct 12/28/11 (driver) $44,436 – B & A Diagnostic / Doctors Professional Medical Center / M & N Rehabilitation Center (Imperial Fire & Casualty) M Stephen H Mattutat, 59 – lost wages - $1,035 (Progressive) P Kyle Daniel Mattutat, 21 – lost wages - $1,035 (Progressive) P Ania Barbarita Almaguer 41 – staged acct 01/19/12 (driver) $32,056 – New Life Rehab Services (United Auto) M Mirlene Pierre Louis, 27 – jump-in - $2,451 - DISA Medical (Assurance America) F Willie D Hatcher, 47 – fake ins card (Seminole Casualty) W Carlos M Sanchez, 24 – staged acct 11/07/10 (driver) $55,595 – Alas Medical Center / East Coast Chiropractic / Sanchez Therapy Center / South Florida Medical (Imperial Fire / State Farm) M Hernan P Rodriguez Hernandez, 50 – structuring transactions - $707,400 – Orthopedic & Radiology Center (Farmers / Geico / MetLife / Safeco / State Farm / Travelers) T Marshall Robin Ward, 49 – application fraud (Titan) P Yahima Crespo, 32 – staged acct 11/07/10 (passenger) $55,595 – Alas Medical Center / East Coast Chiropractic / Sanchez Therapy Center / South Florida Medical (Imperial Fire / State Farm) M Arrested in July 2012 Luc Kenty Legerme, 43 – unlicensed clinic – Mina Chiropractic & Rehab Center (State Farm) O Arrested in Aug 2012 Sang Tran, 40 – staged acct 03/24/10 (recruiter) $60,000 - Florida Pain & Wellness / Injury & Accident Clinic (Direct General / Republic Western) 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) October 2012 Page 8 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 Maj. Buddy HAND 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 one, we cover the arrests of a chiropractor and two clinic owners in Orlando for their role in an unlicensed clinic scheme. On page two, we highlight the arrest of a clinic owner who organized staged accidents and a jury trial conviction of a massage therapist for staging accidents. On page three, we feature the latest fugitive from Insurance Fraud’s Most Wanted and the arrest of a chiropractor in another unlicensed clinic operation. On page five, we remember one of the Division of Insurance Fraud’s finest detectives, Maureen Perez. 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. Jewel CAMERON Lt. Paul MEYERS SOUTH CENTRAL REGION Counties: Broward, Highlands, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie Plantation Field Office - 954.321.2902 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