November 2011 Volume 2 - Issue 5 The purpose of the discussions was to gather real-life stories from everyday citizens who are affected by the rising costs of auto insurance throughout the state. HEADER HERE CFO Atwater and Governor Scott Meet With Citizens Across The State on PIP This month, Florida Chief Financial Officer Jeff Atwater teamed up with Governor Rick Scott and held a series of scheduled meetings with citizens across the state to discuss the personal injury protection (PIP) fraud crisis. The roundtables kicked off in Tallahassee when CFO Atwater and Governor Scott, along with Insurance Consumer Advocate Robin Westcott, met with several citizens about their personal stories involving auto insurance. On November 1, Insurance Consumer Advocate Robin Westcott gave a presentation to the Governor and Cabinet about the impact auto insurance fraud is having on Florida’s consumers. There is no doubt that rates are going up and Floridians are being taken to the cleaners by the fraud that has infiltrated this system. According to CFO Atwater in his weekly e-newsletter, Dollars & Sense, “One thing is for sure - bold action is needed this legislative session before auto insurance becomes simply unaffordable and Floridians choose to go without - putting us all at risk.” Four more roundtable meetings were held in Ft. Lauderdale, Orlando, Tampa and Miami. The purpose of the discussions was to gather real-life stories from everyday citizens who are affected by the rising costs of auto insurance throughout the state. (See related story on page 4.) INSIDE THIS ISSUE 1 CFO and Governor Meet Florida Consumers 2 Op Brakes on Fakes 3 PIP Fraud in the News 5 Statewide Arrests 7 Statewide Contacts The Department of Financial Services has stated that rates for PIP coverage in several of the areas hardest hit by increases in fraud have nearly doubled in some cases. A report by the National Insurance Crime Bureau (NICB) showed an increase of nearly 500% in staged accidents from 2008-2010 in Tampa. A 40 year old saw their cost for PIP coverage jump 81% from $479 to $867 during that same period. In Orlando, there was a 58% increase from $388 to $615. In Miami, the cost for the same coverage soared from $582 to $1,050, an 80% increase. CFO Jeff Atwater and Gov. Scott, along with Republican lawmakers, are targeting Florida's PIP law for reform in the coming 2012 legislative session. These meetings come on the heels of a series of public hearings by Westcott in Tallahassee over the last two months. While the official report of Westcott’s Personal Injury Protection (PIP) Working Group is still being finalized, she appeared before the Florida Cabinet stating that although the number of drivers in Florida has held steady in recent years and the number of wrecks has decreased, insurance costs have exploded. In an article published by South Florida’s Sun-Sentinel, reporter Aaron Deslatte wrote that the average number of procedures per insurance claim has exploded since 2007 as medical facilities such as massage clinics have increased billings. Suspected staged accidents have also more than doubled since 2008. See the full article at http://weblogs.sun-sentinel.com/news/politics/dcblog/2011/11/florida_cabinet_pip_creates_91.html. November 2011 Page 2 Operation “Brakes on Fakes” The Anti-Fraud Task Force conducted a crack-down on auto insurance fraud in Palm Beach County. The undercover investigation, named OPERATION “BRAKES ON FAKES”, is the culmination of a six month multi-agency effort to combat insurance fraud. Task Force members include the Constitutional Tax Collector, the Palm Beach County Sheriff’s Office, the State Attorney, 15th Judicial Circuit, the Delray Beach Police Department, the Florida Department of Financial Services and the Florida Highway Patrol. To date, authorities have arrested and booked nineteen (19) individuals for charges including False or Fraudulent Motor Vehicle Insurance Card, Sale of Motor Vehicle with Altered Odometer, Title Fraud, Petit Theft and Fraudulent Use of Personal Identification Information ($5,000.00 or more). One of the individuals arrested for False or Fraudulent Motor Vehicle Insurance Card was a juvenile. The Task Force was formed to combat a growing number of fake auto insurance cards detected by Tax Collector employees in the Delray Beach Service Center. Tax Collector Gannon contacted State Attorney Michael McAuliffe to develop a coordinated response. The level of criminal activity was deemed serious and on the increase. A Multi-Agency Anti-Fraud Task Force was created to investigate and charge those committing the fraud. State Attorney Michael McAuliffe stated: “This alleged scam was perpetrated by those who cut corners while putting others at risk. Using fake insurance cards to register a vehicle or presenting fake information to officers when stopped undercuts the process we depend on to know who should be driving and who should not be on the road. Our coordinated law enforcement effort is just what was needed to find the alleged fraud and stop it. I applaud the partnership and coordination reflected in this operation.” Constitutional Tax Collector Anne Gannon stated: “Law enforcement has delivered excellent fraud detection training to our employees. Our joint goal was to form an effective united front to combat this criminal activity. Forming the Task Force elevated our response and we hope this approach can serve as a model to other counties.” The Department of Financial Services, Division of Insurance Fraud, sees the formation of this Task Force as a way to more effectively combat auto insurance fraud. “Fraud like this continues to drive up auto insurance rates for honest, hard-working Floridians,” said CFO Jeff Atwater, who oversees the Department of Financial Services. “This is yet another battle won in the fight against fraud in Florida. My office is proud to be a part of this Anti-Fraud Task Force, and we will continue to work together to keep your hard-earned money in your pocket, where it belongs.” Joshua Robert Darcy was charged with 1 count of Sale of Motor Vehicle with Altered Odometer; Matthew John Darcy was charged with 1 count of Sale of Motor Vehicle with Altered Odometer, 1 count of Title Fraud and 1 count of Petit Theft; and Raymond Rende was charged with 1 count of Fraudulent Use of Personal Identification Information, 1 count of Title Fraud and 1 count of Sale of Motor Vehicle with Altered Odometer. The following subjects were each charged with 1 count of False or Fraudulent Motor Vehicle Insurance Card: Deon Brandon Carswell; Winfred Darville; Michael Stephens Davis, Jr; Christina Lanat Franklin; Quanteria Sequesha Harris; Lavert Herrington; Kashay Jackson; Ariane Lockett; Madonna Odessa March; Juan Pablo Martinez; Kenneith Mary Noel; Dishawn Hakim Reynolds-El; Larissa West Shoecraft; John Dennis Sullivan; and Latoya Nicole Tripp. The PIP Source Page 3 PIP FRAUD – In The News Clinic Owner Who Used Dead Doctor’s Identity Arrested Again The clinic owner who was arrested in August 2011 for filing more than $200,000 in fraudulent insurance claims using the identity of a deceased doctor was arrested again last month. Daysi Puigros, owner of Better Life Medical Center, allegedly organized two staged accidents in 2009, in which the participants went to her clinic for treatment. Puigros, 43, was initially charged in a scheme in which she also operated her clinic without the necessary license issued by the Agency for Health Care Administration (AHCA). Detectives who were investigating the unlicensed clinic scheme and the use of the dead doctor’s identity were shocked when they learned that Puigros was also staging accidents to obtain patients for her clinic. Detectives believe they will uncover additional staged accidents as more interviews are conducted. Update - Florida Bar Article on Lawyer Referral Services Reporter Gary Blankenship updates the most recent hearing by the Florida Bar on Lawyer Referral Services in his article “For-profit referral services draw Bar scrutiny”. The Special Committee on Lawyer Referral Services continues to meet and will prepare recommendations for the Florida Bar’s review early in 2012. You can read the entire article at - http:// www.floridabar.org/DIVCOM/JN/jnnews01.nsf/cb53c80c8fabd49d85256b5900678f6c/dd815a2bfc8fb6e3852578490071e44c! OpenDocument&Highlight=0,lawyer,referral,services* According to information provided to the Special Committee on Lawyer Referral Services, there are now 71 private services registered with the Bar. More than half have registered within the past two years: 20 so far in 2011 and 23 in 2010. Only a handful of the services were in existence prior to 2004. Another article of interest can be found at – http:// www.floridabar.org/DIVCOM/JN/jnnews01.nsf/8c9f13012b96736985256aa900624829/f06ee483e8598d0f8525792200624978!OpenDocument. Update - Lawsuit Filed To Stop Hillsborough County PIP Ordinance Several clinics in Tampa have filed a lawsuit asking the courts to prevent a new county ordinance from taking effect. The providers, Doctor's Pain Management Group and Health West Rehabilitation Group, filed suit against Hillsborough County and Sheriff David Gee. They claim the new ordinance will drive legitimate clinics out of business. According to an article written by the Tampa Tribune’s Michael Sasso, one new requirement, for example, says all PIP medical clinics must be operated by a physician. That rule "immediately puts the plaintiffs out of business," the lawsuit says, because they are not licensed physicians but are licensed to run health care clinics. One clinic apparently excused from the ordinance is Physicians Group, the chain that gets many of its clients from the 1800-ASK-GARY legal and medical referral service, the suit says. The ordinance doesn't pertain to clinic companies accredited by the Joint Commission, a nationwide nonprofit that accredits healthcare companies. Physicians Group is the only outpatient/ambulatory care clinic in Hillsborough County accredited by this commission, the lawsuit says. You can read all of Michael Sasso’s article, “Suit claims 'Ask Gary' is exempt from crackdown” at - http://www2.tbo.com/ news/consumer/2011/oct/26/spbizo1-suit-claims-ask-gary-is-exempt-from-crackd-ar-285201/ . Staged Accident Organizer Arrested For New Fake Accident The Division of Insurance Fraud arrested Roberto Martinez, 27, of Hialeah Gardens, last month for allegedly staging an accident in June 2011. Martinez was arrested in April for staging an accident in 2008 and was out on bond when he allegedly organized the new fake accident. Three participants, including Martinez’ sister, were also charged in the case with the filing of more than $77,000 in fraudulent claims in addition to the staged accident. In a twist that is occurring with more frequency, Martinez allegedly referred the participants to multiple clinics for treatment, including C&C Rehabilitation Center, Dade Wellness Center, MG Therapeutic Rehabilitation Corp., Matanzas System Corp., and ORD Medical Center in Miami, and Brothers Taylor Rehabilitation Center and Viva X-Ray Medical Diagnostic Center, both in Hialeah. Multiple clinics were used to further game the system and maximize the amount of money paid by each participant’s insurance company. One participant, who decided not to continue in the scheme, was assaulted by persons believed to be associated with one of the clinics, as possible retaliation. The investigation continues and additional arrests are expected. The PIP Source Page 4 PIP FRAUD – In The News Florida Looks to Tampa as Leader in Fight Against PIP Fraud The move by one Florida county to crack down on auto insurance fraud by targeting staged accidents and regulating clinics is being seen as a roadmap for state officials looking to reform the state’s no-fault auto insurance law. Gov. Rick Scott and Chief Financial Officer Jeff Atwater, along with other state officials, held a public meeting with local Tampa officials and citizens to discuss the state’s growing personal injury protection (PIP) insurance fraud problem, which officials say is driving up premiums for state drivers by hundreds of dollars. Hillsborough County, which includes Tampa, has become ground zero in the debate over PIP fraud. The Hillsborough sheriff’s department has targeted staged accidents by stepping up patrols and surveillance, while actively asking local drivers to report suspicious accidents. In the last 15 months, the department reported 123 arrests that have resulted in 150 criminal charges due to staged accidents. Atwater praised local officials for targeting the clinics and said it should serve as a model for state lawmakers who are expected to tackle PIP reform when the legislature convenes next January. “Regrettably, you had to go first,” he said. “Let us export the good work of Tampa Bay and get this burden off the back of all Floridians.” View the entire article online: http://www.insurancejournal.com/news/southeast/2011/11/10/223706.htm. House Unveils PIP-Reform Bill With Input From Florida Gov. Scott, CFO Atwater After failing to pass personal-injury-protection reform legislation earlier this year, Florida lawmakers are gearing up to try again, and draft legislation in a key house subcommittee has input from the staffs of Gov. Rick Scott and Chief Financial Officer Jeff Atwater. The draft legislation released by the House Insurance and Banking Subcommittee would cap attorneys' fees and limit treatments by chiropractors and massage therapists. It also has stricter licensing requirements for clinics that derive more than 30% of their gross income from PIP benefits. The legislation also would require insurers to lower rates through a "use and file" filing within 18 months of its July 1, 2012, effective date. It would sunset PIP on July 1, 2015, unless reviewed and re-enacted by state lawmakers. View the entire article online: http://insurancenewsnet.com/article.aspx?id=298043&type=lifehealth 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, and 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 this 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 into 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. November 2011 Page 5 Statewide PIP Arrests – October 2011 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 Captain Smith. Alexander Cid, 45 – staged acct 02/14/09 (recruiter) $87,041 – Fl Wellness & Rehab Center / Miami Neurology & Rehab Specialist / Virtual Imaging SVS (Republic West / State Farm) M Tamara Borroso Manceho, 40 – staged acct 02/19/10 (recruiter) $41,304 – Sunshine Therapy and Medical Center (Responsive / US Security) W Yania Moreira, 36 – staged acct 03/31/09 (driver) $84,647 - C&C Chiropractic Center / Better Life Medical Center, LLC / Centinel Medical Center (Progressive / State Farm) M Eugenia Oday Lorenzo, 54 – jump-in 09/23/08 - $19,660 - PCM Medical Center (Allstate) M April Casino, 32 – jump-in (Geico) W Idalmis Fonseca, 43 – staged acct 03/31/09 (passenger) $84,647 - C&C Chiropractic Center / Better Life Medical Center, LLC / Centinel Medical Center (Progressive / State Farm) M Carmen Myriam Perez, 39 - false statement in support of jump-in 07/20/11 - $4,540 – GNC Rehabilitation Center Corp (Geico) M Jessica Lynn Kriegel, 20 – false claim lost wages - $6,014 (Geico) J Stephanie E Diaz, 22 – fake ins card (State Farm) F Jorge Luis Perez, 46 - false statement in support of jump-in 07/20/11 - $4,540 – GNC Rehabilitation Center Corp (Geico) M Roberto Martinez, 27 – staged acct 06/27/11 (recruiter) $77,438 - Matanzas / ORD Medical / MG Therapeutic / C&C Rehab / Dade Wellness / Viva X-Ray Medical (21st Century / Geico) M Rafael Javier Arroyo, 19 – staged acct 06/27/11 (driver) $77,438 - Matanzas / ORD Medical / MG Therapeutic / C&C Rehab / Dade Wellness / Viva X-Ray Medical (21st Century / Geico) M Benita Ciment, 45 – false receipts transportation reimbursement - $656 (State Farm) J Gonzalo Canada Reyes, 47 - patient brokering – Massage & Healing Center / Best Choice Healthcare Center (21st Century / Geico / GMAC / MetLife) T Eduardo Padron, 49 – clinic employee - $10,824 - Best Choice Healthcare Center (21st Century / Geico / GMAC / MetLife) T Robin Nelson Campanioni, Jr, 23 - staged acct 09/14/10 (recruiter) $82,939 – Doral Center Rehab / Justin Medical Services (Geico / Kingsway Amigo / Progressive / Unitrin Direct) M Mario Chavez - staged acct 09/14/10 (recruiter) $82,939 – Doral Center Rehab / Justin Medical Services (Geico / Kingsway Amigo / Progressive / Unitrin Direct) M Eduardo Figueredo - staged acct 09/14/10 (passenger) $82,939 – Doral Center Rehab / Justin Medical Services (Geico / Kingsway Amigo / Progressive / Unitrin Direct) M Naima Basnueva Lastre - staged acct 09/14/10 (passenger) $82,939 – Doral Center Rehab / Justin Medical Services (Geico / Kingsway Amigo / Progressive / Unitrin Direct) M Israel Jimenez, 43 – patient brokering - Massage & Healing Center / Best Choice Healthcare Center (21st Century / Geico / GMAC / MetLife) T Larissa West Shoecraft, 37 – fake ins card (Geico) W Juan Pablo Martinez, 44 – fake ins card (MGA) W Lisbet Leon, 34 – clinic employee - $28,256 - New York Medical & Rehab Center / Karow Chiropractic Center / Chiropractic Office of South FL, LLC / J & L Transportation () W Nicholas Walters, 29 – staged acct 08/22/09 (passenger) $9,717 – Dr Gregory Moses (Republic Western / Seminole Casualty) W Alina Bello Alonso aka Justa Davila, 63 – identity theft / application fraud / false claim - $23,822 (Progressive / State Farm) M Office Code –B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach) The PIP Source Page 6 Statewide PIP Arrests – October 2011 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 Captain Smith. Yida Bello, 28 – clinic employee - $28,256 - New York Medical & Rehab Center / Karow Chiropractic Center / practic Office of South FL, LLC / J & L Transportation () W Chiro- Gloria Patricia Cintron, 48 - mail fraud conspiracy – $28,256 - New York Medical & Rehab Center / Karow Chiropractic Center / Chiropractic Office of South FL, LLC / J & L Transportation () W Concepcion Olmos Valls, 53 – staged acct 06/27/11 (passenger) $77,438 - Matanzas / ORD Medical / C&C Rehab / MG Therapeutic / Dade Wellness / Viva X-Ray Medical (21st Century / Geico) M Carmen Venegas, 49 – clinic employee - $28,256 - New York Medical & Rehab Center / Karow Chiropractic Center / Chiropractic Office of South FL, LLC / J & L Transportation () W Veronica Riofrio, 44 – mail fraud conspiracy - $28,256 - New York Medical & Rehab Center / Karow Chiropractic Center / Chiropractic Office of South FL, LLC / J & L Transportation () W Alexis Cruz Martinez, 43 – staged acct 03/31/09 (passenger) $84,647 - C&C Chiropractic Center / Better Life Medical Center, LLC / Centinel Medical Center (Progressive / State Farm) M Maradona Pierre, 24 – staged acct 12/14/10 (recruiter) $30,000 – Palm Beach Chiropractic Clinic (Republic Western) W Ariane Lockett, 44 – fake ins card (Victoria) W Winfred Darville, 26 – fake ins card (Ocean Harbor) W Barbara Esther Zimmerman, 64 – jump-in - $4,540 – GNC Rehabilitation Corp (Geico) M Jorge Mota - staged acct 09/14/10 (driver) $82,939 – Doral Center Rehab / Justin Medical Services (Geico / Kingsway Amigo / Progressive / Unitrin Direct) M Robert James Bradley, 27 – clinic employee - $10,824 - Best Choice Healthcare Center (21st Century / Geico / GMAC / MetLife) T Daysi Puigros, 43 - staged acct 03/31/09 (recruiter) $60,567 - C&C Chiropractic Center / Centinel Medical Center (Progressive / State Farm) M Daysi Puigros, 43 – staged acct 04/16/09 (recruiter) $43,522 – Better Life Medical Center, LLC (State Farm) M Yesenia Toscano, 21 - staged acct 06/27/11 (passenger) $77,438 - Matanzas / ORD Medical / MG Therapeutic / C&C Rehab / Dade Wellness / Viva X-Ray Medical (21st Century / Geico) M Ida Perez, 33 – staged acct 08/10/09 (passenger) $29,000 - Therapy and Body Works (Geico) T Christina Franklin, 33 - fake ins card (Ocean Harbor) W Levert Herrington, 36 - fake ins card (Ocean Harbor) W Catrina Waters Rumph, 41 - fake ins card (Ocean Harbor) W Robins Filsaime, 21 – staged acct 12/14/10 (driver) $30,000 – Palm Beach Chiropractic Clinic (Republic Western) W Marie Dulcie Julsaint, 30 – clinic employee - $14,735 – Health Chiropractic Clinic (21st Century / Allstate / Geico / State Farm) O Eriberto Comendador, 39 - staged acct 02/19/10 (driver) $41,304 – Sunshine Therapy and Medical Center (Responsive / US Security) W Arrested in May 2011 Ana Simon-Zepeda, 28 – staged acct 08/10/09 (passenger) $29,000 - Therapy and Body Works (Geico) T Arrested in August 2011 David Perez, 32 – staged acct 08/10/09 (driver) $29,000 - Therapy and Body Works (Geico) T Wisner Jean, 48 – clinic owner - $14,735 – Health Chiropractic Clinic (21st Century / Allstate / Geico / State Farm) O Office Code –B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) 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 Pensacola Field Office - 850.453.7802 Captain 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 Captain 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 Captain Michael BYRNE Lt. Carlos ROSARIO Lt. Darrell WILSON Fort Myers Field Office - 239.278.7527 Lt. Mark FRITZ Copy goes her. Editor’s Corner This month we report on CFO Atwater joining with Governor Scott to tour the state and talk with citizens about their personal stories involving the high cost of auto insurance. We also report on a six-month multi-agency investigation into fake insurance cards in Palm Beach County called “Brakes on Fakes”. We also provide details on a very active month for PIP fraud arrests as 50 defendants are included in this issue. Tired of paying the high price of insurance fraud? Contact your legislators and tell them what you think should be done with the current state of auto insurance in Florida. Get involved, let your voice be heard. 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 Captain 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 Captain 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