September 2011
Volume 2 - Issue 3
“I have no tolerance for
authors of these types of
egregious crimes. We need
to look at tightening laws
and reforming PIP in Florida
so our citizens don’t have to
foot the bill for these
outrageous schemes.”
- CFO Jeff Atwater
HEADER HERE
DIF Arrests Miami
Clinic Owner in
Dead Doctor Fraud
The Division of Insurance Fraud arrested Hialeah accident clinic owner Daysi
Puigros on more than 30 felony counts stemming from allegations that she filed
more than $200,000 in fraudulent Personal Injury Protection (PIP) claims using
the name of a deceased doctor.
Puigros used her clinic, Better Life Medical Center LLC, to submit physical
evaluations by Juan Julio Hernandez Pombo, a doctor who died in December
2008. She is charged with 15 counts of insurance fraud, 15 counts of grand theft
(3rd degree), one count of operating a clinic without a license and one count of
an organized scheme to defraud.
“I have no tolerance for authors of these types of egregious crimes,” said CFO
Jeff Atwater. “We need to look at tightening laws and reforming PIP in Florida so
our citizens don’t have to foot the bill for these outrageous schemes.”
Puigros was filing Personal Injury Protection (PIP) claims with State Farm for
individuals involved in motor vehicle accidents and using the deceased doctor’s
phony evaluations to file claims.
INSIDE THIS ISSUE
1
2
3
Dead Doctor Fraud
5
PIP Fraud Spotlight
on The Coalition
6
7
8
Upcoming Events
Major Fraud Busts
PIP Fraud in the
News
Statewide Arrests
Statewide Contacts
Puigros owned the clinic from September 10, 2007, until it was dissolved on
September 25, 2009. Sworn statements indicate that employees of the clinic
knew the doctor had died, but Puigros continued to use his name for reports and
billing and instructed the employees to do so as well. Employees were also told
to make patients sign blank forms which were then fabricated by Puigros.
Puigros never applied for or received a license to operate the clinic, as indicated
by the Agency for Health Care Administration (AHCA), nor had she applied for a
license with the Department of Health. Chapter 400 of Florida Statutes states in
order to operate a health care facility, it needs to be licensed with AHCA or be
owned by a licensee with the Department of Health. It is a third-degree felony to
operate a clinic without a license.
Puigros is believed to have operated three other clinics in the recent past: Miami
Dade Medical Centers, Florida Best Medical Center, and World Health Medical
Center, all in Hialeah; and may be associated with at least two others in Miami.
A total of $209,656 was billed by Better Life Medical Center for 15 patients to
State Farm, of which $86,883 was paid. The investigation continues and further
arrests are expected.
The PIP Source
Page 2
Major Fraud Cases
Tampa Clinic Owner Charged in Structuring Scheme
The Tampa office of the Division of Insurance Fraud arrested Juan Borras, one of the owners / operators of American Best
Clinic, on charges of intentionally structuring large cash withdrawals to avoid reporting or registration required by Florida
law. This tactic has been linked as a common practice for automobile accident clinics suspected of Personal Injury
Protection (PIP) fraud.
“This type of scheme is often at the heart of a larger PIP fraud ring that costs Florida drivers millions of dollars in higher
insurance premiums,” said CFO Atwater. “My department will continue to crack down on these types of practices and put
these fraudsters behind bars.”
The investigation into American Best Clinic in Tampa revealed that Borras intentionally structured 31 large cash
withdrawals from a clinic bank account in a nine-month period for a total of nearly $260,000, a first-degree felony under
Florida law.
Borras was booked into the Hillsborough County jail and released on bond. If convicted, he faces up to 30 years in prison.
Doe Rivera, 36, a co-conspirator and employee of American Best Clinic, is currently being sought on similar charges,
involving nearly $1.8 million, and a warrant for his arrest has been issued.
Four Arrested in Operation Small Change in West Palm Beach
The Division of Insurance Fraud continued its series of strikes against PIP fraud in Palm Beach County with the arrests of
a massage therapist and three patients in Operation Small Change. To date, 18 patients and three licensed massage
therapists have been arrested in the schemes at three clinics. In this case, the patients were allegedly treated at
Progressive Rehab Treatments Corp, a clinic in Lake Worth. Massage therapist Inge Baumert, who has only been
licensed since May 2010, was arrested for allegedly fabricating documents for treatment she did not provide.
In this case, as it was in Operations Look Out (Universal Rehab Med Group) and Easy Street (Elite Rehabilitation Services
Center,), the patients did not go to the clinic for therapy or only went to the clinic for a few minutes on the dates they
signed for treatment, and provided false testimony to the insurance company about their treatment. Allstate Insurance
Company was instrumental in the success of this investigation. DIF was also assisted by the National Insurance Crime
Bureau (NICB).
Chiropractor, Runner and Two Employees Arrested in Orlando
The Division of Insurance Fraud arrested chiropractor Herdley Dennis Harrison, a runner and two employees for PIP fraud
last month. Harrison, owner of Allied Preferred Healthcare, LLC, a clinic in Orlando, was charged with insurance fraud and
organized scheme to defraud.
Also arrested were Kareen Brown, a licensed CCPA (certified chiropractic physician assistant) and the clinic’s office
manager, Joanes Polynice, who is also licensed as a CCPA with the Department of Health. Brown’s husband, Wayne
Brown, was charged with second degree solicitation, which could carry a two-year minimum prison sentence upon
conviction. Wayne Brown allegedly solicited patients who were not injured to treat at the clinic.
In one of the cases charged, the patients allegedly were treated at the clinic one time, but Allied Preferred Healthcare
billed for more than $8,800 worth of treatment not provided to two patients insured with State Farm. In another case
charged, the clinic billed more than $3,500 for treatment not provided to two patients insured with Direct.
Harrison, who has been a licensed chiropractor since 2004, has operated Allied Preferred Healthcare since 2008.
Clinic Owner Charged with Patient Brokering at Broward Accident Clinic
The Division of Insurance Fraud arrested clinic owner Jean Ronald Virgile for patient brokering. Virgile allegedly paid a
patient $2,000 to get treatment at his clinic, Therapeutic Health Center, located in Tamarac.
The patient had been involved in a car accident with his two children, and was referred to the clinic by a friend. After
treating for several weeks, the patient and his children felt better and did not want to continue with treatment. Virgile
offered the patient $2,000 for treating at his clinic, and another $4,000 if he and his children would continue to get
treatment.
When the patient decided against continuing treatment, a man allegedly sent by the clinic made contact with the patient’s
family and allegedly threatened that the patient needed either to continue with treatment or return the money.
September 2011
Page 3
PIP FRAUD – In The News
Insurance Consumer Advocate Creates PIP Working Group
Florida’s Insurance Consumer Advocate Robin Westcott announced the creation of the Personal Injury Protection (PIP)
Working Group to discuss and develop policy ideas to combat the skyrocketing costs of car insurance. According to
Westcott, PIP fraud is one of the biggest cost drivers for Florida families who are required by law to purchase it.
The Consumer Advocate will invite representatives from the Florida House of Representatives and the Florida Senate,
and various stakeholders in the Personal Injury Protection system. The first meeting is scheduled for September 15.
“My goal is to formulate real solutions in response to the escalating rates burdening Florida’s consumers,” Westcott
said. “Every option should be on the table before car insurance becomes completely unaffordable and Floridians opt to
go without protection.”
Westcott, who was appointed by Florida’s Chief Financial Officer Jeff Atwater in July and indicated her first priority was
to aggressively tackle auto and property insurance challenges to consumers, said her goal is to have the working group
meet through November and to submit the group’s findings to CFO Atwater as well as legislative leaders.
You can learn more about the Insurance Consumer Advocate by visiting the ICA website at http://www.myfloridacfo.com/
ICA/.
CFO Atwater - Legislature Must Target Insurance Fraud
In an article written last month by Michael Sasso of the Tampa Tribune, CFO Jeff Atwater stated that cutting rampant
insurance fraud should be a priority of the Legislature during the upcoming session. He acknowledged that reforming or
eliminating the personal injury protection (PIP) system could be tough, as those who profit from the system would fight to
maintain it.
CFO Atwater spoke to members of the St. Petersburg Area Chamber of Commerce about both PIP fraud and sinkhole
fraud. Regarding PIP, CFO Atwater stated that fraud translates into higher premiums. He cited an example that a 40year-old woman in Tampa who paid about $330 in 2008 for PIP coverage would now pay about $580 this year
(according to the Florida Office of Insurance Regulation).
You can read the full article here - http://www2.tbo.com/news/news/2011/aug/25/menewso4-florida-cfo-legislature-musttarget-insur-ar-252793/.
Man Arrested in Phony Insurance Card Sales Scam in Jasper
Willie Coachman, the operator of Coachman Carwash in Jasper, was arrested in two separate cases for the sale of
fraudulent insurance cards. Coachman had placed an ad selling cheap insurance in the flyer called “America’s Favorite
Coupon Book”. Coachman is not licensed to sell insurance in Florida.
Coachman’s step-daughter, Keaira Tiller, was arrested by DIF in April for selling a fake insurance card. As a result of
that case, the Division had identified multiple victims and continued the investigation. An undercover buy was set up last
month and Coachman was arrested after selling a fake card to a cooperating victim. When arrested, Coachman was
found to be in possession of paperwork that identified dozens of additional fake insurance cards.
GEICO Insurance Donates Vehicle to Cape Coral PD to Help Fight Fraud
Last month, GEICO Insurance Company in conjunction
with NICB presented the Cape Coral Police Department
with a surveillance vehicle to utilize in their Auto Theft
Unit. The presentation took place at the Cape Coral
Police Headquarters.
Pictured left to right: SA Frank Napolitano, NICB; Jay
Carrozza, GEICO SIU Manager; Cape Coral Chief of
Police Jay Murphy; Tony Vetter, GEICO SIU; Captain
Mike Urraro; Detective Sgt. Mike Catania and Detective
Dan Iten.
The PIP Source
Page 4
PIP FRAUD – In The News
Tampa Tribune Editorial - Repair “No-fault” or Junk It
The editorial, published August 28, 2011, starts out with this statement - Chief Financial Officer Jeff Atwater and Gov.
Rick Scott are considering ditching personal injury protection insurance in Florida. The editorial expresses that there are
many who are lining their pockets with ill-gotten gains from the PIP system, including lawyers, physicians, chiropractors,
clinic owners and the con artists who stage accidents and file claims. All drivers pay for these scams, as insurance
companies increase premiums in the wake of fraudulent claims that are filed throughout the state.
The editorial states that hospitals and clinics would be hurt by the demise of PIP, which provides a ready means of
paying for medical treatment for crash victims. But if these medical providers want to keep it, they must be willing to
accept stricter guidelines. Lawmakers must be prepared to tighten the requirements for clinic ownership and to take the
licenses of physicians who abuse the system. Anyone trying to scam the system should face stiff penalties.
The editorial concludes with this - Florida leads the nation in accidents staged to collect PIP benefits, according to the
National Insurance Crime Bureau. The state has one more chance to prove it can manage PIP. Otherwise, it's time to
throw in the towel.
You can read the full editorial here - http://www2.tbo.com/news/opinion/2011/aug/28/vwopino1-repair-no-fault-or-junk-it-ar-253274/.
New Jersey Proposes Major Changes to PIP System for Auto Insurance
The New Jersey Department of Banking and Insurance has proposed dozens of changes to the state's personal injury
protection system for auto insurance including more than 3,000 new codes that further define the list of fees for PIP
claims. Those new codes add to the 1,000 New Jersey already has on the books and would affect fees paid to same-day
surgery centers and alternative providers such as chiropractors. The codes would also change the PIP arbitration system
to help decrease the number of frivolous arbitration claims entering the system.
In the past year, 97% of rate increase requests submitted to New Jersey’s department cited PIP coverage as the reason.
According to a Department of Banking and Insurance spokesman, auto insurance carriers pay benefits of roughly $1.23
for every dollar of PIP premiums collected. Changes in the arbitration system are necessary because the "thousands" of
frivolous arbitrations that are filed each year, attorneys' fees that are awarded dwarf the damages suffered by the
claimant. In one case, a claimant was awarded $17 for an injury but was awarded $1,500 to cover attorneys' fees.
The proposed rule changes have already gained the support of some industry trade organizations. The Property
Casualty Insurers Association of America put out a statement in support of the proposed changes, citing statistics
showing that New Jersey's PIP claims costs have risen more quickly than in other states. Over the past decade, the
average claim has increased 65% from $9,900 per claim in 2001 to $16,400 in 2010, compared to a 36% increase in
other no-fault states, PCI said. (By Jeff Jeffrey, Washington Correspondent: jeff.jeffrey@ambest.com)
IN REMEMBRANCE OF THOSE WHO HAVE FALLEN
We take this moment to honor those who lost their lives in the September 11 attack on
our country 10 years ago. In an instant, our world was forever changed. It is hard to
believe it has been 10 years already. Many of us have gotten on with our own lives
and careers, but for the families of the victims on that darkest of days, it has not been
so easy.
We also remember and thank the men and women serving in our armed services,
especially those who have sacrificed life and limb to protect us and our way of life.
There will be many ceremonies and reviews this month in commemoration of that
tragic day, from New York to Pennsylvania to Washington, DC, and all stops inbetween. Every American was touched by terror on that Tuesday morning, when the
World Trade Center’s Twin Towers and the Pentagon were attacked; and when those
on United Flight 93 prevented another attack. Remember the first responders who
rushed toward the danger and gave their lives trying to save others.
Take a moment from your busy schedule to remember what that day was like.
Honor those who died and never forget.
September 2011
Page 5
PIP FRAUD SPOTLIGHT ON – The Coalition
This month we take a look at the Coalition Against insurance
Fraud. The Division of Insurance Fraud has worked with the
Coalition many times over the last two decades, and they are
an effective partner in the battle against insurance fraud.
Executive Director Dennis Jay adds, "The Coalition enjoys
working with fraud bureaus across the country to help deter fraud and enhance fraud-fighting capabilities. We especially
like working with the Division of Insurance Fraud in Florida because of their dedication and great record of success. We
also look forward to partnering with the CFO's office to enact tougher fraud laws in 2012."
According to the Coalition, they are the nation's only anti-fraud watchdog that speaks for consumers, insurance
companies, legislators, regulators and others. Since their inception in 1993, the Coalition has worked to control insurance
costs, protect the public safety, and “bring this crime wave to its knees.”
Some of the things that the Coalition works to accomplish are to support the enactment of tough new anti-fraud laws and
regulations, promote education of the public about how to fight fraud, and serve as a national clearinghouse of fraud
information. Nineteen states have passed anti-fraud laws based on the Coalition's model insurance fraud bill, the
most-comprehensive model ever drafted for insurance fraud. They also developed model bills making it a crime to recruit
people into fraud schemes and to hire recruiters, creating a state fraud bureau, requiring inspections and photos for used
vehicles before the owner buys auto insurance and guidelines for anti-fraud regulations. They also sponsor national and
state summits that bring together fraud fighters from industry, government and elsewhere to focus on anti-fraud issues,
and help build consensus about ways to fight back.
Their website is rivaled by none, as they provide the most in-depth source of information on insurance fraud in the United
States. They boast of having more than 9,000 pages on the Internet. The Coalition offers important information to
consumers to help them understand the problem, avoid becoming victims, and to encourage them to report fraud.
Materials available include videos, posters and full-color brochures, titled “Fraud: The Crime You Pay For”. They have
revealed scams including bogus health insurance, staged car accidents, swindles against seniors, discount medical
cards, airbag fraud, glass replacement scams, insurance agents stealing money, and more. Their consumer section also
includes the Insurance Fraud Odditorium, which covers the strange and bizarre side of fraud.
The Coalition publishes a weekly insider newsletter called Fraud News Weekly that exposes the newest fraud cases and
trends from around the nation. Thousands of subscribers keep informed about the key issues involving legislation,
regulations, court decisions, public affairs, and recent criminal and civil cases. In addition, their quarterly newsletter,
Journal of Insurance Fraud in America (JIFA), includes more in-depth articles about fraud trends, expert opinions and
other fraud developments.
The Coalition publishes a detailed Annual Report that provides in-depth information about the activities of agencies that
investigate and prosecute insurance fraud, containing the latest data on cases investigated and referred for prosecution,
fraud convictions, and statistical rankings of state fraud bureaus.
Their site also maintains a section called the newsroom, which contains news releases, fraud stats, Fraud of the Month,
and the Insurance Fraud Hall of Shame. The Hall of Shame is always an interesting read. Included in the recent listings
were stories on the murder of a three year old girl for $200,000 life insurance; a building owner turned arsonist whose
actions resulted in the death of a tenant; and a con man who bilked people out of money in a fake health insurance
scheme.
The information in this article was gathered from their website.
www.insurancefraud.org.
Coming Next Month in the Spotlight:
We take a look at the case of a criminal chiropractor at an accident clinic.
For more information, visit them at
The PIP Source
Page 6
Upcoming Events
There are two Auto Insurance Fraud Summits scheduled in the upcoming months for Tampa and Miami.
The first summit will be in Tampa on September 28, 2011, from 6:30 pm to 8:30 pm, at Higgins Hall at St. Lawrence
Catholic Church, 5225 N. Himes Avenue, Tampa, Florida 33614.
The second summit will be in Miami on October 11, 2011, from 6:30 pm to 8:30 pm, and will be held at the University of
Miami’s Fieldhouse Multipurpose Room, 1245 Dauer Drive, Coral Gables, Florida 33146.
At each town hall meeting, residents will be joined by:
- Representatives from the Office of Florida’s Chief Financial Officer
- Members of the Florida Legislature
- Representatives from the Florida Office of Insurance Regulation
- Representatives from the National Insurance Crime Bureau
- Local and state law enforcement officials
- Consumer advocates
- Local elected officials
- Insurance agents and company representatives
For more information, you can contact Kelsey Lehtomaa at (813) 775-6205 or kelsey.lehtomaa@hillandknowlton.com, or
Ron Bartlett at (813) 775-6203 or ron.bartlett@hillandknowlton.com.
September 2011
Page 7
Statewide PIP Arrests – August 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.
Earl Lester Trotman, 68 – PIP patient - $837 – Progressive Rehab Treatments Corp (Allstate) W
Alfredo Perez Peraza, 23 – cashing fraudulent PIP check - $2,154 (State Farm) M
Maira Jaime, 59 – PIP patient - $512 – Progressive Rehab Treatments Corp (Allstate) W
Inge Baumert, 27 – clinic employee - $2,001 – Progressive Rehab Treatments Corp (Allstate) W
Jean Ronald Virgile, 35 – clinic owner patient brokering – Therapeutic Health Center (State Farm) B
Magdalle Pierre Grant, 29 - staged acct 04/28/10 (driver) $62,632 - Marcus Chiropractor Center (Assurance America) B
Ashley M Harris, 27 – clinic employee / staged acct 04/10/07 - Broward Care Chiropractic (State Farm) B
Luis Estrada Gomez, 45 – staged acct 07/17/07 (passenger) $17,853 – Dana Medical Center (21st Century) T
Chanera Davis, 23 – application fraud (Gainsco) B
Terrence Lloyd, 26 – application fraud (Geico) F
Willie James Coachman, 66 – sale of fake ins card (Infinity) T
Willie James Coachman, 66 – sale of fake ins card (Ocean Harbor) T
Ardwens Odne, 26 – jump-in 11/14/10 - $4,790 – Widom Chiropractic Offices (State Farm) F
Betty Cabrera, 21 – staged acct 09/19/08 (passenger) $18,545 - Lopez & Associates – (Mercury) M
Edwina Douge, 28 – staged acct 09/18/08 (passenger) $72,615 – Solution Care Center (Windhaven / Liability Insurance) B
Jose Miguel Reyes, 28 – jump-in -$8,204 – Florida Wellness & Rehabilitation Center of Hialeah / DC Health
Management (Progressive) B
Juan Borras, 55 – structuring - $258,870 – American Best Clinic (various) T
Eduardo Dearmas-Perez, 42 – staged acct 03/24/08 (driver) $17,950 - First Care Solution / MCJ Medical Center
(Geico) M
Raul Scott, 23 – staged acct 09/18/08 (passenger) $68,508 – Solution Care Center (USAA / Rental Insurance) B
Daisy Puigros, 42 – clinic owner - $209,656 - Better Life Medical Center (State Farm) M
Herdley Dennis Harrison, 56 – doctor - $12,219 – Allied Preferred Healthcare, LLC (Direct / State Farm) O
Joanes Polynice, 54 – clinic employee - $12,219 – Allied Preferred Healthcare, LLC (Direct / State Farm) O
Kareen Brown, 34 – clinic employee - $12,219 – Allied Preferred Healthcare, LLC (Direct / State Farm) O
Anthony Williams, 18 – paper acct 10/12/10 (passenger) $30,000 – Personal Medical Center (Sentry) T
Ariel Jones, 19 – paper acct 10/12/10 (driver) $30,000 – Personal Medical Center (Sentry) T
Wayne Brown, 40 – solicitation 2nd degree – Allied Preferred Healthcare, LLC (Direct / State Farm) O
Felix Walker Gonzalez, 32 – staged acct 10/03/09 (passenger) $10,000 - A&C Medical (Republic West / State Farm) F
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 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
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 the arrest of a clinic owner
in Miami who used the name and license of a dead
doctor to commit PIP fraud.
We also cover several major fraud arrests,
including Operation Small Change in Palm Beach
County; a clinic owner in Tampa; a chiropractor in
Orlando, and a clinic owner for patient brokering in
Broward County.
This month’s Spotlight is focused on the Coalition
Against Insurance Fraud, a well respected national
anti-fraud watchdog who is very active in the day to
day fight against insurance fraud.
Finally, we ask everyone to take a moment to
remember the victims who lost their lives 10 years
ago this month on September 11, that tragic day
when our country was attacked.
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