May 2011
Volume 1 - Issue 11
“All of the patients signed
for treatment they did not
receive. Each of the
patients also provided
false statements to
Allstate in support of the
treatment billed by the
clinic.”
HEADER HERE
DIF Arrests 8 in Operation Look Out
The Division of Insurance Fraud arrested eight patients of a Palm Beach County
accident clinic for insurance fraud and grand theft. Working on information provided
by Allstate Insurance and with assistance of the National Insurance Crime Bureau
(NICB), DIF rounded up the patients for their participation in a scheme to defraud.
All of the patients signed for treatment they did not receive. Each of the patients
also provided false statements to Allstate in support of the treatment billed by the
clinic, Universal Rehab Med Group, located in Lake Worth, which totaled nearly
$98,000.
No employees of the clinic have been charged at this time; however, DIF anticipates
additional arrests in this case.
HEADERRing
HERE Dismantled
Staged Accident
in Miami
The Division of Insurance Fraud Miami office busted a long-time operating staged
accident ring that included recruiting participants from a bingo hall in Hialeah.
INSIDE THIS ISSUE
1
2
Operation Arrests
3
PIP Fraud in the
News
4
PIP Fraud Spotlight
on Outreach Program
6
7
Statewide Arrests
CFO Atwater Fights
PIP Fraud
Statewide Contacts
To date, eight defendants have been charged as participants and/or recruiters
involving more than $119,000 in fraudulent claims.
Some of the unusual aspects of this ring included the purchase of insurance policies
over the internet, using false information and at times stolen credit cards, known in
some circles as the Roxy3434 group. One of the subjects involved in the internet
purchase of insurance was arrested in July 2010, while another died before she
could be charged.
The ring evolved from doing actual staged crashes to creating paper accidents,
which they then used to sell themselves to multiple clinics for each claim. Many of
these clinics were not paid by the insurance companies because of the duplicate
billings for the same crash by different providers. At least four accident clinics,
including Lorena de Jesus Rehab, Specialty Care Therapy, Oasis Diagnostic Center,
and Healing Mental Care, were duped by the ring.
Additional arrests are pending. NICB also provided assistance in this case.
The PIP Source
Page 2
Florida CFO Jeff Atwater Fights PIP Fraud
CFO Jeff Atwater started a busy April by holding a PIP Fraud Twitter Town Hall
meeting from his office on April 5. In his weekly newsletter eViews (available at http://
www.myfloridacfo.com/PressOffice/Newsletter/), CFO Atwater wrote - “This week I
had the opportunity to engage with Floridians on Twitter in my first Twitter Town Hall
meeting on auto insurance fraud. The town hall was scheduled for 6-6:30 pm, but due
to the constant stream of questions received I stayed on longer to answer as many as
I could. Out of all who engaged in the town hall, I was able to answer 87 percent of
participants' questions.”
“I found the town hall to be extremely valuable as I was able to address concerns from
my fellow Floridians all over the state, answer questions from both sides of the issue,
and receive important feedback. Twitter is an important platform we can use as public
servants to disseminate information and engage those we serve. Through social
media tools, we can promote transparency and remove the barrier that separates
Floridians from their elected representatives. It also allows for everyone to share their
opinions and influence public policy.”
On April 7, CFO Atwater participated in a staged accident demonstration in Tampa on
Thursday. The event showcased several types of staged auto accidents used in
insurance fraud scams. Florida currently has three of the top five cities nationally for
questionable medical claims associated with staged accidents –Tampa, Miami and
Orlando. Tampa now ranks number one. With the hard work and dedication of State
Attorney Mark Ober and his team in the Tampa Bay area, Florida can successfully
fight fraud and work towards eliminating it.
CFO Atwater also met with two individuals who recently received rewards from the
Division of Insurance Fraud for providing information that directly led to arrests and
convictions in two insurance fraud schemes.
Anyone with information about suspected insurance fraud is asked to call 1-800-3780445. Individuals who provide tips can remain anonymous and are eligible for a
reward of up to $25,000 for information that directly leads to an arrest and conviction
in an insurance fraud scheme.
The PIP Source
Page 3
PIP FRAUD – In The News
DIF Arrests Runner For Third Time in Six Months
For the third time in six months, the Division of Insurance Fraud arrested the same runner for patient brokering. Albert
Potel was charged in Palm Beach County last October as a result of illegal solicitation in two separate cases.
Apparently, those arrests did not deter him from his chosen vocation. In December 2010, Potel approached a
chiropractor in Fort Pierce and offered to provide patients to his clinic at the rate of $1,500 each. Investigation revealed
that Potel claimed he would obtain patients through crash reports. Potel also claimed to be working with an attorney,
who had an office in Fort Lauderdale, which was different than who he claimed to work with when arrested last year.
Hialeah PD Arrests 2 Clinic Owners in Operation Busted Wings
Two clinic owners and four others were arrested by the Hialeah Police Organized Fraud Unit following a staged accident
on March 15, 2011. Gilberto Trujillo, 27, owner of GLL Medical Center, and Yosniel Garcia, 38, owner of Garcia Medical
& Rehabilitation Center, both in Virginia Gardens. Also arrested were accident participants Fernando Fernandez, 34,
Jacqueline Sanchez, 44, Amparo Montenegro, 53, and Suhail Abdel-Rahman, 21. Each were charged with staged
accident and filing a false police report.
Florida’s Office of Insurance Regulation Report on PIP Data
Several interesting notes from the Office of Insurance Regulation report for the year 2010:
More than $1 billion was paid on PIP claims in South Florida (Miami, Broward, Palm Beach). That’s a load of PIP...
While having 27% of the state’s drivers, South Florida is responsible for 55% of the PIP benefits paid out in the state.
The pure direct loss ratio for PIP was 97.4%, meaning for every dollar of premium collected, 97 cents was paid in losses.
The full Florida Office of Insurance Regulation report can be seen at http://www.floir.com/pdf/PIP_04-08-2011.pdf.
In a continuing effort to implement new strategies to combat insurance fraud, Florida Chief Financial Officer Jeff Atwater
launched the “Most Wanted” insurance fraud website, http://www.myfloridacfo.com/pressoffice/mostwanted, to engage
Floridians in the search for scammers who have eluded law enforcement. The website will feature three individuals per
quarter who are wanted by the CFO’s Division of Insurance Fraud or State Fire Marshal.
“Insurance fraud costs the average Florida family between $400 and $700 a year in increased premiums, and I want
your help bringing the ‘most wanted’ insurance fraud scammers to justice,” said CFO Jeff Atwater. “Together we can get
these crooks off the street, decrease your insurance premiums and put money back in your pocket through our
insurance fraud reward program.”
Included in the initial group of fugitives is the first clinic owner charged under the staged accident law.
Osvadi Marrero, owner of Yosuni Medical Center Corporation, allegedly crashed his Humvee
into two other cars in November 2003. Witnesses called police to report a road rage incident in
which the driver had fled the scene. The drivers of the other cars told police that only their two
cars were involved in the accident. It was later learned the participants were promised between
$700 and $800 to be in the accident and pretend to be injured. In December 2003, Marrero and
five others were the first persons arrested under the new staged accident law. In January 2005,
while pending trial in the above case, Marrero was arrested for paying a runner to provide
accident patients and was charged with two counts of patient brokering, two counts of insurance
fraud, and two counts of grand theft. In March 2005, Marrero failed to report to Court and
became a fugitive. Help us find this fraudster and bring him to Justice.
May 2011
Page 4
PIP FRAUD SPOTLIGHT ON – Outreach Program
The Division of Insurance Fraud, under the guidance of CFO Jeff Atwater, unveiled a new educational outreach program
last month with a fresh series of materials. Included are new PIP Fraud brochures, posters and “Rack Cards”; two-sided
cards printed in English / Spanish, English / Creole and Spanish / Creole with clear information about staged accidents
and our reward program. All will eventually be made available in English, Spanish and Creole.
DIF hopes to partner with local law enforcement agencies to distribute these cards when responding to accident scenes.
DIF also plans to distribute these materials to insurance agencies, government offices and other public outlets. We hope
this continues what was started last year with the billboard / poster campaign in partnership with the Florida Outdoor
Advertising Association (FOAA).
This is part of the DIF statewide initiative to increase our visibility to the public, to better educate the community about
PIP fraud, and to work closer with other law enforcement agencies. “Just as we believe we have with our newsletter The
PIP Source, we are continuously thinking about new ways to improve our ability to distribute information to the industry
and the public,” stated Captain Steven Smith, who last year was named the Division’s Statewide PIP Coordinator. “I
have received a lot of positive feedback about The PIP Source and am proud that it has been received so well and
widely distributed by our readers. I was recently contacted by a law enforcement officer in California who had seen it.
We are making some very big arrests, and we always believed in publicizing important cases.” Captain Smith added,
“One of the difficulties I think we have is effectively articulating the size and scope of this crime. It’s more rampant than
any statistical report can show. We need to do a better job of reporting on PIP fraud in Florida.”
Below are examples of the new Rack Cards. On page 5, we showcase our “FAKE CRASH = REAL TIME” Fraud
Poster and the new PIP Fraud Brochure. All of these items will soon be available as a pdf for download at our main
website, www.myfloridacfo.com/fraud. You may also submit a request for these items as well as your comments, ideas
and suggestions to us at ThePIPSource@myfloridacfo.com.
The PIP Source
Page 5
DIF’s NEW OUTREACH PROGRAM
The New DIF PIP Fraud Brochure
The New DIF “Fake Crash = Real Time” Posters
May 2011
Page 6
Statewide PIP Arrests – April 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.
Jose Luis Pahua-Guzman, 42 – staged acct 01/09/10 (passenger) $6,000 - Universal Rehab (Liberty Mutual) T
Jill Chow, 41 – jump-in $11,432 – Florida Wellness & Rehab Center (California Casualty) B
Carlos Martinez Hejses, 40 – staged acct 07/20/10 (recruiter) $57,773 – Psychologist Tech / V & R Medical (Allstate /
Progressive) M
Carlos Martinez Hejses, 40 – staged acct 07/28/10 (recruiter) $11,439 – Continental Rehabilitation (State Farm) M
Lien Gomez Yera, 41 – staged acct (passenger) $48,012 – Absolute Rehab / Sunland Therapy (Allstate / Geico / Star Casualty) M
Mayra Sanchez Rodriguez, 50 - pip patient - $14,470 – Universal Rehab Med Group (Allstate) W
Jose Rojas, 39 – pip patient - $975 – Universal Rehab Med Group (Allstate) W
Tina Marie Figueroa, 46 – staged acct 04/02/10 (recruiter) $0 T
Tina Marie Figueroa, 46 – staged acct 12/06/09 (driver) $10,863 - PVC Medical Center (1st Acceptance / Windhaven) T
Luida Rieche Suarez, 29 - pip patient - $12,854 – Universal Rehab Med Group (Allstate) W
Rosa Almenares, 46 - pip patient - $14,599 – Universal Rehab Med Group (Allstate) W
Imarlin Mathurin, 22 – staged acct 07/13/10 (driver) $1,627 (RepWest) F
Casimiro Ereu Clara, 42 - pip patient - $14,695 – Universal Rehab Med Group (Allstate) W
Juan Benitez Nunez, 40 - pip patient - $11,750 – Universal Rehab Med Group (Allstate) W
Yailen Gonzalez Garcia, 37 - pip patient - $14,040 – Universal Rehab Med Group (Allstate) W
Raul Menendez Aguilar, 54 - pip patient - $14,599 – Universal Rehab Med Group (Allstate) W
Albert Potel, 71 – patient brokering W
Gilberto Hernandez Cordero, 49 - staged acct 07/28/10 (driver) $11,439 – Continental Rehabilitation (State Farm) M
Michel Perez, 25 – staged acct 08/20/10 (recruiter) $28,625 – C&N Therapy Center / Emoge Medical Services (Geico) M
Alysha Forbes, 26 – sale of fake ins card (Ocean Harbor) B
Roberto Martinez, 27 – staged acct 03/24/08 (recruiter) $17,950 - First Care Solution / MCJ Medical Center (Geico) M
Keaira Falauna Tiller, 28 – sale of fake ins card (Ins Co of Maryland) T
Julio Hernandez Chile, 30 – staged acct 03/10/08 (driver) $13,605 - Angie Diagnostic & Medical (Affirmative / Travelers / United
Auto) M
Omar Cabrera Hernandez, 42 - clinic employee - $10,932 - Medico de la Familia (State Farm) M
Leonardo Jimenez, 39 - staged acct 07/20/10 (passenger) $56,168 - Psychologist Tech / V & R Medical (Allstate / Progressive) M
Gisela Cobiella, 54 – staged acct 03/24/08 (recruiter) $17.950 - First Care Solution / MCJ Medical Center (Geico) M
Dionna Jakes, 36 – jump in / lost wages -$3,600 (21st Century) TL
Oliver Steven Zidor, 28 – clinic employee $27,548 – Bethel Health & Rehab Center (Direct General) O
Jean Fritz Petiote, 41 – clinic employee $27,548 – Bethel Health & Rehab Center (Direct General) O
Jean Fritz Petiote, 41 – staged acct 02/14/10 (recruiter) $36,360 – Bethel Health & Rehab Center (Direct General) 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
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
Tampa Field Office - 813.972.8602
Captain Michael BYRNE
Lt. Carlos ROSARIO
Lt. Darrell WILSON
NICB Contact Info - 954-329-7427
South Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt
Fort Myers Field Office - 239.278.7527
Lt. J.D. SALOME
Central Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt
Copy goes her.
Editor’s
Corner
2011 has been a busy year for PIP fraud so far, and
it is shaping up to be a good year for arresting
many of those who are involved in committing that
fraud.
With the support of CFO Jeff Atwater, the Division
of Insurance Fraud is taking big strides against
some major players in the PIP fraud world. Last
month’s Operation Dark Horizon was just the start
of what we believe will be a very active year.
There are some very exciting cases that we will be
covering over the summer.
We want to recruit you to participate in the fight
against insurance fraud.
Report fraud to our
hotline at 1-800-378-0445 and you may be eligible
for a reward. Be a part of the solution. Call today!
A good place for a photo or graphic