September 2012
Volume 3 - Issue 3
“My office will continue
to crack down on these
unlicensed clinics that
set up shop for the sole
purpose of committing
fraud.”
- CFO Jeff Atwater
INSIDE THIS ISSUE
1
Sky Imaging Arrests
2
Orlando Takedowns
3
Most Wanted
4
PIP Fraud News
5
Statewide Arrests
7
Statewide Contacts
HEADER HERE
Owners of Sky
Imaging Arrested in
$1.5 Million Unlicensed Clinic Scheme
Florida Chief Financial Officer Jeff Atwater announced the arrests of Robbie N.
Chamoun, 30, and Nazih Boulos Chamoun, 74, owners of Sky Imaging in North Miami
Beach, for operating an unlicensed clinic and grand theft stemming from the fraudulent
billing of more than $1.5 million in claims to multiple insurance carriers.
“It never ceases to amaze me the great lengths fraudsters will go to circumvent the law
and steal the hard-earned money of honest Floridians,” CFO Atwater said. “My office
will continue to crack down on these unlicensed clinics that set up shop for the sole
purpose of committing fraud.”
A joint investigation by the Florida Department of Financial Services, Division of
Insurance Fraud, and the National Insurance Crime Bureau (NICB) determined that
between January 2011 and March 2012, the Chamouns owned and operated Sky
Imaging without the appropriate licensure from the Agency of Health Care
Administration (AHCA). The investigation alleged that the Chamouns enlisted a
licensed medical doctor to sign AHCA paperwork and pose as the straw owner of
the clinic, fraudulently exempting it from the AHCA licensure requirements and
concealing the true ownership of the clinic.
During this time, the Chamouns
submitted billings to 17 insurance
carriers resulting in illegal claim
payments
totaling
over
$1.5
million. The bills submitted were for
the
alleged
completion
and
interpretation of MRIs relating to
Personal Injury Protection (PIP) claims. Sky Imaging was the operating name for
Diagnostic Service Center of North Miami Beach, LLC, which was originally
incorporated in 2007.
The Chamouns were booked into Miami-Dade County Jail. The Insurance Fraud
Unit under Miami-Dade County State Attorney Katherine Fernandez Rundle will be
prosecuting this case.
Sky Imaging had operated at the location of Fountain Imaging which still bears the
old name on the building. The Chamouns also had three additional corporations that
allegedly operated in the same area including USA Medical LLC, Sky Surgical of
North Miami Beach, LLC and Fair Lady Wellness, LLC.
September 2012
Page 2
Former Hospital Employee Arrested in Orlando
Patient Brokering Scheme
After a 10-month investigation into a major security breach at Florida Hospital Celebration, a former hospital employee
has been arrested and charged with unlawfully disclosing patients’ healthcare information. The investigation was
conducted by the Federal Bureau of Investigation (FBI) and the Division of Insurance Fraud (DIF).
Dale Munroe is accused of accessing more than 700,000 patient records in two years and then selling them. Munroe's
job was to help register patients in the emergency room.
Investigators said Munroe helped himself to information mostly from car accident victims, and sold it to someone who
passed it on to chiropractors and attorneys.
Federal agents said the patients whose information he sold usually received a call within a week from an attorney or
chiropractor hoping to drum up business.
Munroe's wife and another employee were also fired, but so far no one else has been arrested.
Read the full article at http://www.wftv.com/news/news/local/former-employee-arrested-after-fbi-investigation-h/nRD34/.
The Orlando Sentinel first reported on the breach in September 2011 - http://articles.orlandosentinel.com/2011-09-30/
news/os-florida-hospital-privacy-breach-20110930_1_identity-theft-patients-access.
See more from Orlando on page 4 - PIP Fraud in the News.
Chiropractor Pleads Guilty in Federal Fraud Case
United States Attorney Robert E. O'Neill announced that Joseph Wagner (62, Daytona Beach) has pleaded guilty to
health care fraud, conspiracy to illegally distribute prescription drugs, and money laundering. Wagner faces a maximum
penalty of 30 years in federal prison. He was indicted on June 13, 2012.
According to the plea agreement, Wagner was a licensed chiropractor and owner of Wagner Chiropractic and
Acupuncture Clinic (WCAC) in Volusia County, Florida. He operated WCAC as a facility that purported to provide
chiropractic and other medical services to customers. On occasion, Wagner did provide chiropractic services to
customers of WCAC. However, he also submitted inflated bills to public and private health care beneficiary programs,
including Medicare. Wagner charged those programs at the higher rates for services rendered by medical doctors,
instead of the rates appropriate for chiropractors. In addition, Wagner systematically submitted claims for reimbursement
for services not rendered.
As part of the fraud scheme, Wagner submitted fraudulent billings in the names of medical doctors. By doing so, the
health care beneficiary programs would make payments directly to those medical doctors. The doctors accepted those
payments and would often split the fraudulently obtained insurance payments with Wagner. In the case of at least one
medical doctor participating in the fraudulent scheme, Wagner received payments from the health care beneficiary
programs by check and then deposited those checks into the medical doctor’s bank account.
Wagner also provided customers of WCAC with prescriptions for prescription drugs, often in return for cash
payments. Since he could not prescribe controlled substances, Wagner provided prescriptions for controlled substances
to customers of WCAC using the names of medical doctors who were aware that Wagner was using their names
illegally. Many of the patients who obtained prescriptions for controlled substances through Wagner used their Medicaid
coverage at pharmacies to pay for those controlled substances.
This case was investigated by the Federal Bureau of Investigation, Food and Drug Administration, Department of Health
and Human Services Office of Inspector General, Florida Department of Financial Services, Florida Department of
Health, and the Florida Department of Law Enforcement. It is being prosecuted by Assistant United States Attorney
Daniel C. Irick.
Find the press release from the United States Attorney’s Office at http://www.justice.gov/usao/flm/press/2012/
aug/20120828_Wagner.html. See a related story at http://www.news-journalonline.com/breakingnews/2012/05/daytonabeach-chiropractor-joseph-wagner-charged-by-federal-government.html.
The PIP Source
Page 3
Most Wanted: Fugitive
Obelio Rodriguez
Hispanic Male, 43 years old
5’7”, 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 Obelio Rodriguez in reference to the
outstanding warrant.
Rodriguez 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 Rodriguez 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/
DIF Arrests More Crash Organizers in Miami
Florida Chief Financial Officer Jeff Atwater announced the arrests of eight individuals involved in multiple staged
accidents in Miami-Dade County connected to six PIP fraud rings. “I am proud of the fight we won this past legislative
session to reform Florida’s personal injury protection system, but this does not mean we can rest,” CFO Atwater said.
“We must continue to remain diligent in our efforts to stop this type of fraud so that Florida drivers are protected.”
An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Alexander
Cid, 47; Luis Rivero Dominguez, 35; Franklyn Chaviano, 38; Robert E Bayona, 55; Carlos Padron Fernandez, 38;
Yosmel Ramos Peraza, 24; Andres Vega Fleites, 61; and Jorge Fernandez Rodriguez, 52, participated in staged
accidents in coordination with six fraud rings as organizers or drivers between May 2009 and May 2011. These staged
auto accidents resulted in more than $340,000 in fraudulent auto insurance claims.
The charges will be prosecuted by the Miami-Dade County State Attorney Katherine Fernandez Rundle’s Office. If
convicted on all charges, they collectively face up to 455 years in prison. 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 Division recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment
of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity. The
FHP also recently launched a website, in collaboration with DIF and the National Insurance Crime Bureau (NICB), to
help educate the public on ways to protect themselves from staged crashes. Visit http://www.flhsmv.gov/fhp/misc/
StagedCrashes.htm for more information.
September 2012
Page 4
PIP FRAUD – In The News
CFO Atwater Appoints Jay Etheridge As Deputy CFO Over Law Enforcement
Florida Chief Financial Officer Jeff Atwater announced the appointment of veteran law enforcement officer and Florida
Department of Law Enforcement Chief of Investigations Jay Etheridge as Deputy CFO over Law Enforcement. Mr.
Etheridge will oversee the Department of Financial Services’ Division of Insurance Fraud, which enforces the criminal
laws related to insurance transactions; Division of State Fire Marshal, which is responsible for conducting fire, arson and
explosives investigations; and the Division of Public Assistance Fraud, which investigates cases of fraud within federal
and state public assistance programs.
“With more than 30 years of law enforcement experience serving his fellow Floridians, Jay has the experience and
proven dedication to lead our team of law enforcement officers and work closely with our partners across the state to
combat fraud, waste and abuse,” CFO Jeff Atwater said. “I am honored that he agreed to join our team and know that
he will be an asset to Floridians.”
Mr. Etheridge began his career as an officer with the Tallahassee Police Department. His service with the Florida
Department of Law Enforcement began in 1990 as a Special Agent rising to Chief of Domestic Security in 2010 and
serving most recently as Chief of Investigations. Etheridge has a proven track record as a budget watchdog, strategic
planner and a goal-oriented manager. Etheridge has a Bachelor of Science Degree in Criminology from Florida State
University and graduated from the FBI National Academy in 2009.
“It is an honor and the highlight of my law enforcement career to join CFO Atwater’s team serving the citizens of the
State of Florida,” Mr. Etheridge said.
Combating fraud is one of CFO Atwater’s top priorities. Fraud of all types, including insurance, financial and public
assistance programs, compound the financial burden on Floridians.
Subjects Charged in Orlando Staged Accident Scheme
The Division of Insurance Fraud arrested three subjects in a staged accident scheme last month in Orlando. The facts of
this case show that it is no ordinary case. Charged in the March 24, 2010 fake crash were David Pollock, 33, Leon Deon
Henderson, 28, Eddie J. Cook, Jr, 51, and Cook’s son, Antonio DeWayne Cook, 26, who helped organize the crime.
Also arrested in Texas on a warrant issued in the same case was Sang Van Tran, 40. Tran is the ex-husband of the
owner of Injury & Accident Clinic, the clinic where the staged accident participants allegedly went for treatment. Tran
owned Accident & Injury Attorney Hotline, a Florida corporation which was dissolved in September 2010. The
investigation also identified Tran as a marketer for another Orlando clinic, Florida Pain & Wellness Center. The
participants in the staged accidents were taken to Injury & Accident Clinic and Florida Pain & Wellness Center for
alleged treatment. Tran allegedly paid some of the participants with a check from Injury & Accident Clinic.
An arrest warrant was also issued for one more participant, Shasta White, 31. The Division of Insurance Fraud is
currently attempting to locate her. If you have any information about White’s whereabouts, please call Lt. Cameron at
407-835-4402.
Orlando Doctor Enters Plea, Sentenced to 10 Years in Prison
Medical Doctor Mladen Antolic, 57, entered into a plea in Orange County and was sentenced to 10 years in prison
related to charges that included racketeering. Antolic was investigated by the Metropolitan Bureau of Investigation
(MBI), the Florida Department of Law Enforcement (FDLE) and the Division of Insurance Fraud (DIF) in a crackdown
against pill mill doctors as well as PIP fraud. Antolic owned and operated Injury Mid-Florida Rehab, LLC and Physical
Medicine Group, LLC, both located in Orlando. Antolic had been licensed as a doctor in Florida since 1986.
Antolic was first arrested in October 2010, and charged several more times as the investigations continued.
Physical Therapist Surrenders License in Plea Agreement
Physical Therapist Andres Lupiano, PT6737, has agreed to surrender his license to the Department of Health as part of
a plea agreement reached with the Miami-Dade State Attorney’s office. Lupiano was ordered to pay $2,600 in restitution
and given 5 years probation.
Lupiano was originally arrested in June 2009 and again in July 2009 pursuant to an investigation into two staged
accidents where the participants allegedly treated at Amedicare Rehab Center, a clinic in Miami. The participants did not
treat, but only signed for treatment, and Lupiano was arrested for fabricating physical therapy reports as if they were
treated. Lupiano was licensed with the Department of Health since December 1990.
The PIP Source
Page 5
Statewide PIP Arrests – August 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.
Amanda Maria Ruz, 68 – illegal sale of international drivers license - W
Robbie Chamoun, 30 – unlicensed clinic – Sky Imaging - M
Vivian Gomez, 49 – jump-in 09/09/11 - $17,500 - TS Medical Health (State Farm) M
Tameika Edgecomb, 30 - fake ins card (Geico / Liberty Ins Corp) W
David Jabari Mahon, 24 – staged acct 08/01/10 (passenger) $45,400 - St Jude Rehab (Geico / State Farm) M
Davilma Pierre-Charles, 50 – staged acct 01/28/10 (driver) $11,180 - Alliance Chiropractic (American Bankers / State
Farm) O
Eslyn Dhaiti, 29 – fake ins card (Mapfre) W
Eddie J Cook, Jr, 51 - staged acct 03/24/10 (passenger) $60,000 - Florida Pain & Wellness / Injury & Accident Clinic
(Direct General / Republic Western) O
Nazih Boulos Chamoun, 74 - unlicensed clinic – Sky Imaging () M
Antonio Dewayne Cook, 26 - staged acct 03/24/10 (recruiter) $60,000 - Florida Pain & Wellness / Injury & Accident
Clinic (Direct General / Republic Western) O
David Pollock, 33 - staged acct 03/24/10 (passenger) $60,000 - Florida Pain & Wellness / Injury & Accident Clinic
(Direct General / Republic Western) O
Aundra Dexter Lowe, 41 – fake ins card (Mendota) W
Dale Munroe II, 35 – patient brokering related crime – identity theft - O
Fednel Charles, 28 – staged acct 12/01/11 (driver) $2,262 - Gold Chiropractic, PA (Farmers / Kingsway Amigo) W
Annique Adrian Williams, 25 – application fraud (Nationwide) F
Yosmel Ramos Peraza, 24 – staged acct 05/18/11 (recruiter) $78,941 – Absolute Health / Ache Free Body / Active
Wellness / Atlantic Mobile / B & A Diagnostic / J & C Imaging / Lianet Rehabilitation / Ocean Med / Omega Diagnostics /
Viva X-Ray (21st Century / State Farm) M
Carlos Padron Fernandez, 38 – staged acct 04/27/11 (driver) $72,869 - AZJ Medical Center / Diagnostic & Radiology
of Miami / La Maison Medical Practice / YH Imaging (Allstate / Geico / State Farm) M
Franklyn Chaviano, 38 – staged acct 05/08/10 (driver) $49,934 - Angel Rehabilitation Medical Center / Absolute Health
Center Corp / Dade Health Care / RT Diagnostic (State Farm) M
Andres Vega Fleites, 61 – staged acct 05/18/11 (recruiter) $9,199 – Active Wellness / J & C Imaging / Lianet Rehabilitation / Ocean Med / Omega Diagnostics / Viva X-Ray (21st Century) M
Alexander Cid, 47 – staged acct 06/19/10 (recruiter) $32,132 – A & I Rehabilitation Center / Medical Diagnostic Center /
Therapium Health Corp (National Indemnity) M
Yurien Medina, 32 - staged acct 08/15/09 (driver) $45,713 - (Allstate / Progressive / US Security) M
Robert E Bayona, 55 – staged acct 05/19/10 (recruiter) $71,163 - G & O Rehabilitation Center / ORD Medical Center
(Geico / State Farm) M
Luis Rivero Dominguez, 35 – staged acct 06/26/09 (recruiter) $43,758 - (Allstate / US Security) M
Alexander Cid, 47 – staged acct 05/02/09 (recruiter) - $11,098 (Allstate) M
September 2012
Page 6
Statewide PIP Arrests – August 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.
Jorge Fernandez Rodriguez, 52 – staged acct 11/07/10 (driver) $55,684 – Alas Medical / East Coast Chiro / Sanchez
Therapy / South Florida Medical (Imperial Fire / State Farm) M
Osmel Ramirez Perruc, 43 - staged acct 12/02/10 (recruiter) $32,458 - Bird Road Physical Therapy (Geico) M
Arrested in June 2012
Yenky Sanchez, 25 – staged acct 06/09/10 (recruiter) $44,900 – Advance Quality Medical Center / GA Therapy Service
(Allstate / Progressive) M
Yenky Sanchez, 25 – staged acct 11/11/10 (recruiter) $30,200 – Selem Medical Center Corp (State Farm) M
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
Protect Yourself Against Staged Crashes - http://www.flhsmv.gov/fhp/misc/StagedCrashes.htm
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
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 the owners of
Sky Imaging in a $1.5 million unlicensed clinic
scheme.
On page two, we cover two big cases in Orlando; a
chiropractor pleads guilty to federal charges and
an arrest is made in a patient brokering case
involving hospital patients.
On page three, we feature another fugitive in
Insurance Fraud’s Most Wanted.
On page four, we welcome new Deputy CFO Jay
Etheridge to the Department of Financial Services.
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
Okeechobee, Palm Beach, St. Lucie
River,
Martin,
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