February 2012 Volume 2 - Issue 8 “Phase one of the investigation, called Operation SledgeHammer, resulted in two federal indictments involving 15 subjects.” HEADER HERE Fifteen Fraudsters Charged in WPB Operation SledgeHammer Beginning in June 2010, the Division of Insurance Fraud, as part of a task force working with the Federal Bureau of Investigation, the Internal Revenue Service, the Secret Service and the National Insurance Crime Bureau, initiated an investigation into a massive fraud ring in Palm Beach County involving staged accidents, money laundering and insurance fraud. Phase one of the investigation, called Operation SledgeHammer, resulted in two federal indictments involving 15 subjects. In July 2011, the first two subjects, Oscar Franco Padron and Joaquin Ross Vasquez were arrested. Three months later, six additional defendants, including massage therapists Lisbet Leon and Yida Bello, were arrested for counts ranging from mail fraud to money laundering and structuring. The indictments include more than $1.2 million in laundered assets and fraudulent claims. Last month, five more defendants, including massage therapist Ketty Gonzalez and staged accident organizers Ernesto Miralles and Julio Fernandez Delgado, were charged. INSIDE THIS ISSUE 1 Op SledgeHammer 2 Unlicensed Clinics 3 AHCA Clinic Sweep 4 PIP Fraud in the News 5 NICB Turns 100 7 Statewide Arrests 9 Statewide Contacts The investigation involved clinics and their owners who allegedly staged accidents to obtain patients to send to their clinics and submit fraudulent billings to insurance companies. The fraudulent exposure in this case is estimated at $10 million. The clinics include Florida Mango Massage Therapy, Karow Chiropractic Center, Healthcare R Us and Chiropractic Office of South Florida. The cases are being prosecuted by Assistant U.S. Attorney A. Marie Villafaña. Several defendants have already pled guilty. For more information, see the press release from the US Attorney’s office at http://www.justice.gov/usao/fls/ PressReleases/120111-02.html. The insurance companies defrauded in this case were Allstate, Direct General, Farmers, Geico, GMAC, Hallmark, Hartford, Infinity, Kingsway Amigo, Liberty Mutual, Mercury, Metropolitan, Nationwide, Progressive, Sentry, State Farm, Travelers and United Auto. Two subjects, Vladimir Lopez and Lazaro Vigoa Mauri, are fugitives. They are believed to be hiding in Cuba. February 2012 Page 2 DIF Arrests Medicaid Fugitive For Operating Unlicensed Clinic in Miami Florida Chief Financial Officer Jeff Atwater announced the arrest of a Miami clinic owner for submitting fraudulent Personal Injury Protection (PIP) claims from his unlicensed clinic. Juan M. Dieguez, who also used the false identity Jorge R. Gonzalez, is charged with operating a health care clinic without a license, grand theft and insurance fraud following an investigation by the Department of Financial Services’ Division of Insurance Fraud (DIF). Dieguez has owned and operated Venetian Rehab Center, located at 434 SW 12th Ave., since October 2010, but was arrested while working at another clinic, Therapy-Diagnostic, Tech Medical. Dieguez was booked into the Miami-Dade County Jail on 01/27/12 and is being held on $65,000 bond. If convicted, he faces up to 15 years in prison. “Insurance fraudsters have learned how to game Florida’s PIP system and every honest Floridian with a car in the driveway ends up paying,” Atwater said. “We must put policies in place to stop those who make a career out of stealing our fellow Floridians’ hard-earned dollars.” To demonstrate the increase of insurance fraud in Florida, consider the fact that in 2008, a 40year-old driver in Miami with an unblemished driving record was paying $582 in PIP premium, and in 2010, this same driver paid nearly $1,050 for the same coverage. This is an 80 percent increase. A fingerprint check of Dieguez after his arrest showed that he was using a false identity under the name Gonzalez. He had obtained a driver’s license in 2009 using a fictitious birth certificate from Puerto Rico. DIF’s investigation further revealed that Dieguez absconded from his probation following a conviction for Medicaid fraud in 1999. Further investigation showed that Venetian Rehab was originally opened by Dieguez’s brother in 2003 and Dieguez added his false identity as an officer in 2010. 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. Farmers Insurance, Kingsway Amigo, State Farm and United Auto provided assistance in this investigation. Staged Accident Organizer Charged with $200,000 in Fraudulent Claims The Division of Insurance Fraud arrested Yasser Vega-Martinez, 34, for planning and orchestrating three staged accidents resulting in more than $200,000 in fraudulent claims submitted to Geico and State Farm. “These staged accidents are at the heart of the PIP fraud epidemic that is casting a shadow over Florida’s highways,” said CFO Atwater. “Every Florida family is affected by these fake crashes in the form of the high auto insurance premiums. My office is determined to work toward policy reforms to curb this costly crime.” Vega-Martinez allegedly participated in two of three accidents he organized and staged between November 2009 and June 2010. The participants were referred to several clinics in the Miami-Dade area including GMC Rehabilitation Center, AB Diagnostic Center, The Osteomuscular Rehab Center Corp, Y & H Imaging, Grand Canal Rehab, Justin Medical Services, Florida Health Professionals Group Corp, Angels Diagnostic Group, and C & C Therapy Center Corp. None of the clinics in this case were licensed by the Florida Agency for Health Care Administration (AHCA); however, several of the clinics were issued exemptions. Vega-Martinez is believed to have organized other staged accidents and additional charges are anticipated. This case will be prosecuted by the dedicated prosecutors in the Insurance Fraud Unit in the 11th Judicial Circuit, under the direction of Miami-Dade State Attorney Katherine Fernandez Rundle. “In the battle against insurance scam artists who dip into all of our pockets, I am proud to have the full support of Florida’s Chief Financial Officer Jeff Atwater and his elite force of Insurance Fraud investigators,” commented Fernandez Rundle. “When my prosecutors bring these insurance fraud criminals into court to face justice, we know that we have the facts and the evidence on hand to convict. With this effective team of fraud fighters on their trail, these scammers need to recognize that they should be looking for a new and honest way to earn their living.” 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 AHCA Targets Health Care Clinics A report by the Agency for Health Care Administration (AHCA) revealed irregularities were discovered during a recent three-day sweep by investigators in 43 of 49 Miami-Dade County clinics. In one case, an insurance company providing personal injury protection coverage was charged $19,000 for massage therapy. During those checks, investigators witnessed only 17 patients while employees at some clinics reported they had never seen a patient. At one clinic, staff said they had not seen the owner or medical director in six months. The investigation found that most of the Miami-Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy. Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture. Many clinics also displayed advertisements for law firms and attorneys who specialized in traffic accident litigation while in numerous instances medical professionals at the clinics were employed without the required background screening. One man kept his job despite being deemed ineligible on his background check. AHCA referred this information to the Division of Insurance Fraud (DIF) for potential criminal investigation. Read more in this article at: http://www.ocala.com/article/20120106/WIRE/120109810 . Florida Bar Panel Looks at Limiting Lawyer Referral Services Membership A Bar committee is considering several proposals that would restrict lawyers from participating in a referral service that also handles referrals for nonlegal services, including medical treatment. “I frankly think what we are looking at is a systemic problem,” committee Chair Grier Wells said. The four proposals are: • A lawyer referral service shall not have [any relationship with] [any financial contractual, or ownership interest in] a medical referral service or any person, group of persons, association, organization, or entity that specifically advertises in this state to accident victims or other prospective clients primarily for the purpose of a healthcare provider filing a claim of payment of treatment of an accident or injury victim and that uses a common phone number, universal resource locator (URL), or other form of shared contact. • A lawyer shall not accept client referrals from any person, entity, or service that also refers or attempts to refer clients to any type of medical provider. • A lawyer shall not accept client referrals from any person, entity, or service that refers or attempts to refer clients to any other type of professional service. • A lawyer shall not participate in or accept referrals from a referral service unless the participants in such referral service are members of The Florida Bar or otherwise subject to the Rules Regulating The Florida Bar. Read the entire article by Gary Blankenship at: http://www.floridabar.org/DIVCOM/JN/jnnews01.nsf/cb53c80c8fabd49d85256b5900678f6c/986ff5924518ad0d8525798e0047c971! OpenDocument&Highlight=0,referral*. February 2012 Page 4 PIP FRAUD – In The News CFO Atwater Attends ‘Put the Brakes on Accident Fraud & Abuse’ Event On January 25, CFO Jeff Atwater joined Gov. Rick Scott and a broad coalition of Florida consumers, business leaders, law enforcement officials and concerned citizens to urge the legislature to take immediate action this session to "Put the Brakes on Accident Fraud and Abuse" in the personal injury protection (PIP) system. Tampa Clinic Owner Arrested on Structuring Charges The Division of Insurance Fraud arrested Norge Romero for structuring cash withdrawals in excess of $574,000. Romero owned and operated Global Diagnostic Center, a PIP clinic located in Tampa. Global Diagnostic Center opened in 2008, and was issued a clinic exemption by the Agency for Health Care Administration (AHCA) involving medical doctor Sara Vizcay. Romero was the sole signatory on his personal account and the account for Global Diagnostic Center, and intentionally structured cash withdrawals to avoid currency reporting requirements, in violation of Florida statutes. Romero allegedly intentionally structured cash withdrawals causing his bank to fail to file an applicable report and in doing so avoided the currency reporting requirements. Between 12/15/2009 and 04/13/2011, Romero structured cash withdrawals 86 times at or below $10,000 from both accounts; cash withdrawals from these accounts totaled $574,500. Romero was arrested on first degree felony charges of structuring transactions to evade reporting or registration requirements prohibited. State Targets PIP, Fraud Efforts to reform Florida’s no-fault auto insurance system — which critics say is rife with fraud and soaring attorney fees — are expected to dominate insurance-related issues when the legislative session begins Tuesday. Gov. Rick Scott and Chief Financial Officer Jeff Atwater have said reforms to mandatory no-fault coverage are critical and legislators are committed to the effort, said Sen. Garrett Richter, R-Naples, chairman of the Committee on Banking and Insurance. “It’s important that the legislature address the fraud and runaway legal fees that have become a part of this system,” Richter said. “At the end of the day, the fraud amounts to a huge tax or assessment on Florida motorists.” Randy Duncan, an agent with the Insurance Depot of Lee County in Cape Coral, said the mandatory coverage can account for up to 60 percent of the average auto insurance premium, and that percentage is growing. Even efforts to clamp down on fraud may be difficult as groups like the Florida Medical Association fight to limit restrictions to truly fraudulent clinics and providers. “The FMA believes that the focus of any legislative effort should be on giving law enforcement and the Department of Health the resources and tools they need to stop the fraud, put those who break the law in jail, and revoke the licenses of the health care providers who participate in schemes to defraud the PIP system,” said association spokeswoman Rebecca O’Hara. Read the full article by Tim Engstrom at PIP-fraud?odyssey=nav|head. http://www.news-press.com/article/20120109/NEWS0107/301090021/1121/MOMS/State-targets- The PIP Source Page 5 NICB Celebrates 100 Years In 2012, the National Insurance Crime Bureau (NICB) will celebrate its Centennial. A Century of Service; A Century of Trust. In 1912, when it was started under the leadership of Fred J. Sauter and called the Automobile Protective and Information Bureau (APIB), Woodrow Wilson was president; Jim Thorpe won Olympic gold at Stockholm; and the HMS Titanic came to rest on the floor of the Atlantic Ocean. In 1927, the APIB joined with several other groups to become the National Automobile Theft Bureau (NATB). It operated under that name for 65 years until 1992, when it merged with the Insurance Crime Prevention Institute (ICPI) to form the National Insurance Crime Bureau (NICB). The merger combined the vehicle investigation expertise of the NATB with the insurance fraud prevention knowledge of ICPI and established NICB as the premier not-for-profit insurance crime investigation company. When NICB questionable claims' analysis showed a dramatic increase in medical fraud associated with auto policies, NICB established, in 2002, its first Major Medical Fraud Task Force (MMFTF) operations in south Florida and New York City. Consisting of dedicated NICB special agents and analytical resources, these task forces also work closely with law enforcement and insurance company special investigation unit personnel. The MMFTF model has been so successful that it has been replicated in Houston, Los Angeles, Washington, D.C., Edison, New Jersey (serving the Philadelphia and Delaware areas) and a second Florida task force was recently added in Tampa where Florida's no-fault law enables auto policy medical fraud to thrive. The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations. NICB member companies wrote over $319 billion in insurance premiums in 2010, or approximately 80 percent of the nation's property/casualty insurance. That includes more than 94 percent ($152 billion) of the nation's personal auto insurance. Read the full press release at https://www.nicb.org/newsroom/news-releases/nicb-celebrates-its-centennial. NICB’s Ron Poindexter to Retire After more than 10 years as Director of Operations for Area 5, the National Insurance Crime Bureau’s Ron Poindexter is retiring. During his tenure, Poindexter has overseen the Major Medical Fraud Task Forces located in South Florida and Central Florida, supervising more than a dozen special agents in their work assisting insurance carriers and law enforcement in fighting fraud. Poindexter was featured in the June 2011 issue of The PIP Source. Prior to joining the NICB, Poindexter served as Director of the Florida Department of Insurance’s Division of Insurance Fraud (DIF) from May 1996 until June 2001. At that time the Fraud Division had a staff of 171, of which 121 were sworn law enforcement investigators, located throughout Florida. During his tenure, the Division led the nation in fraud prosecutions and criminal convictions according to a study by NICB. Ron served 27 years with the Hillsborough County Sheriff’s Office in Tampa, Florida. He rose to the rank of Colonel, Chief of Law Enforcement Operations, and retired in March 1996. He served three years in the United States Army as an Intelligence Analyst, and is a graduate of the FBI National Academy. The insurance industry and law enforcement is grateful to Ron Poindexter for his years of leadership at NICB in the fight against fraud, and his many years of dedicated law enforcement service to the State of Florida. We wish him well in his retirement. February 2012 Page 6 Most Wanted: Arrested Check out the latest Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/ How You Can Help Fight Insurance Fraud in Florida This year, the Florida Legislature created a fund to which anyone can contribute to the fight against insurance fraud by making a donation, gift or grant to the Insurance Regulatory Trust Fund. The proceeds will be used by the Division of Insurance Fraud to hire additional dedicated prosecutors and insurance fraud detectives, as well as fund anti-fraud programs around the state. This is an exciting program that we believe will have a substantial impact on insurance fraud in Florida. Payments should be made payable to: The Department of Financial Services The mailing address is: Department of Financial Services Revenue Processing Section P.O. Box 6100 Tallahassee FL, 32314-6100 The donor should include correspondence with the check indicating it is a grant or donation for the Division of Insurance Fraud. The letter should include his / her intent that the grant or donation be deposited to the Insurance Regulatory Trust Fund and used for anti-fraud efforts. Also include a statement that if the donation is to be used for any other purpose, the funding should be withdrawn. If you have any questions, you can contact us at the PIP Source and we will get an answer. Thank you for your help. Join the Fight. Be a part of the Solution. Make a Difference. The PIP Source Page 7 Statewide PIP Arrests – January 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. Daniel Martinez, 41 – massage therapist - $6,555 - LOP Rehabilitation Center (Allstate) W Alex Arnoldo Flores, 30 – PIP patient - mail fraud / conspiracy to commit mail fraud – () W Julio Fernandez Delgado, 42 – runner - mail fraud / conspiracy to commit mail fraud () W Ernesto Miralles, 39 – runner - mail fraud / conspiracy to commit mail fraud () W Josue Santiago Montanez, 35 – staged acct 11/16/09 (passenger) $1,941 - Advance Pain Management (First Acceptance) T Roberto Santiago, 40 – staged acct 12/08/11 (recruiter) $0 - (none) M Hashley Mocombe, 22 – staged acct 05/01/11 (driver) $21,871 - KJ Chiropractic Clinic / Wellness Pain & Rehab (Farmers / Geico) O Yvio Lesperance, 23 – staged acct 05/01/11 (passenger) $21,871 - KJ Chiropractic Clinic / Wellness Pain & Rehab (Farmers / Geico) O Brenda Magaly Vasquez, 25 – fake ins card (MGA Insurance) W Jacquana Lucas, 30 – staged acct 05/30/10 (driver) $802+ - Massage & Healing Center (Hallmark) T Amy Wava McEver, 31 – paper acct 10/05/10 (driver) $0 - Personal Medical Center (Farmers) T Diane Gibson, 52 – false police report (Geico) J Francina Gonzalez, 31 – staged acct 05/30/10 (driver) - Massage & Healing Center () T Marcella Jean Clemmons, 52 – false police report (Geico) J Armando G Espinosa, 38 – PIP patient - $1,930 - LOP Rehabilitation Center (Allstate) W Zachary Keith Stuhler, 28 – PIP patient - mail fraud / conspiracy to commit mail fraud – () W Aida Artiles Rodriguez, 51 – staged acct 05/18/10 (passenger) $78,941 – Absolute Health Center Corp / Ache Free Body / Active Wellness Center / Atlantic Mobile Services / B & A Diagnostic / J & C Imaging / Lianet Rehab Center / Ocean Medical & Diagnostic Services / Omega Medical Diagnostic / Viva X-Ray Diagnostic Center (21st Century / State Farm) M David Dewilton Thomas, 56 – staged acct 06/24/11 (driver) $15,146 - Orthopedic Center of Okeechobee (Repwest / State Farm) F Code –B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach) February 2012 Page 8 Statewide PIP Arrests – January 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. Juan C Romero, 46 – PIP patient - $555 - LOP Rehabilitation Center (Allstate) W Ketty Gonzalez, 39 – massage therapist - mail fraud / conspiracy to commit mail fraud () W Roberto Martinez, 28 – staged acct 05/18/10 (recruiter) $78,941 - Absolute Health Center Corp / Ache Free Body / Active Wellness Center / Atlantic Mobile Services / B & A Diagnostic / J & C Imaging / Lianet Rehab Center / Ocean Medical & Diagnostic Services / Omega Medical Diagnostic / Viva X-Ray Diagnostic Center (21st Century / State Farm)M Norge Romero, 40 – clinic owner / structuring / money laundering - $574,500 - Global Diagnostic Center () T Manuel Madrigal Perez, 49 – staged acct 05/18/10 (passenger) $78,941 - Absolute Health Center Corp / Ache Free Body / Active Wellness Center / Atlantic Mobile Services / B & A Diagnostic / J & C Imaging / Lianet Rehab Center / Ocean Medical & Diagnostic Services / Omega Medical Diagnostic / Viva X-Ray Diagnostic Center (21st Century / State Farm) M Raul Torres Oliva, 29 – staged acct 05/18/10 (recruiter) $78,941 - Absolute Health Center Corp / Ache Free Body / Active Wellness Center / Atlantic Mobile Services / B & A Diagnostic / J & C Imaging / Lianet Rehab Center / Ocean Medical & Diagnostic Services / Omega Medical Diagnostic / Viva X-Ray Diagnostic Center (21st Century / State Farm)M Juan Torres Garcia, 54 - staged acct 05/18/10 (recruiter) $78,941 - Absolute Health Center Corp / Ache Free Body / Active Wellness Center / Atlantic Mobile Services / B & A Diagnostic / J & C Imaging / Lianet Rehab Center / Ocean Medical & Diagnostic Services / Omega Medical Diagnostic / Viva X-Ray Diagnostic Center (21st Century / State Farm) M Alvin Edward Blocker, 58 – application fraud (Esurance) P Jorge Gonzalez aka Juan Dieguez, 41 – unlicensed clinic - $55,646 – Venetian Rehab Center (Farmers / Kingsway Amigo / State Farm / United Auto) M Hirain Valle Delgado, 37 – probation violation M Donna Sue Joseph, 28 – staged acct 11/08/08 (passenger) $21,001 -East Colonial Chiropractic & Rehab (Avis/Budget) O Yasser Vega Martinez, 34 – staged acct 11/11/09 (recruiter) $85,420 – GMC Rehabilitation / AB Diagnostic Center / The Osteomuscular Rehab Center Corp / Y & H Imaging (Geico / State Farm) M Yasser Vega Martinez, 34 – staged acct 04/15/10 (recruiter) $25,365 – Grand Canal Rehab / Angels Diagnostic Group (State Farm) M Yasser Vega Martinez, 34 – staged acct 06/16/10 (recruiter) $93,553 – Justin Medical Services / C&C Therapy Center Corp / Y & H Imaging / Angels Diagnostic Group / Florida Health Professionals Group Corp (Geico) 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) The PIP Source Page 9 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. Buddy HAND 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, Highlands, 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 highlight a major investigation into PIP fraud in Palm Beach County called Operation SledgeHammer. We report the arrest of a fugitive operating an unlicensed clinic in Miami on page two. On page three, we cover the Agency for Health Care Administration’s (AHCA) sweep of MiamiDade County clinics. We join in the celebration of NICB’s 100th Birthday, and announce the retirement of Area 5 Director Ron Poindexter. Happy Valentine’s Day. EAST CENTRAL REGION Counties: Brevard, Indian River, Lake, Martin, Okeechobee, Orange, Osceola, Palm Beach, Seminole, St. Lucie, Volusia West Palm Beach Field Office - 561.837.5601 Major Simon BLANK Capt. Glen HUGHES Lt. Evangelina BROOKS Orlando Field Office - 407.835.4402 Lt. Jewel CAMERON SOUTH REGION Counties: Broward, Dade, Monroe Miami Field Office - 305.536.0302 Capt. Steven SMITH Lt. Violeta SERRANO Lt. John DYGON Lt. Stanley JEAN-FELIX Plantation Field Office - 954.321.2902 Lt. Bill LEE 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 Dennis Russo 863.967.6904