April 2011
Volume 1 - Issue 10
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DIF Arrests Orlando
Clinic Owner in
Unlicensed Activity Fraud
The Division of Insurance Fraud (DIF) arrested the owner of US Chiromatrix
Centers, Corp last month for unlicensed activity.
“This case is one of many
that DIF is currently
investigating that involves
unlicensed providers and
clinics throughout
Florida.”
Gardy Jeune, 53, who incorporated the clinic in 2005, located at 6444 West
Colonial Drive in Orlando, previously held a license with the Department of
Health (DOH) as a registered chiropractic assistant (RCA). However, his license
is currently identified as “null and void” on the DOH website, having expired in
March 2010.
The four month investigation by DIF revealed that US Chiromatrix Centers was
billing insurance companies for treatment allegedly rendered by Jeune. The
clinic was licensed by the Agency for Health Care Administration (AHCA).
A chiropractor who previously worked at US Chiromatrix Centers told DIF that
when he was hired, Jeune told him that all patients had to be treated at least 36
times, which the chiropractor disagreed with. The chiropractor, who worked at
the clinic for about nine months, reviewed patient files and discovered that there
were treatments allegedly provided that he did not render, and were signed off
on by Jeune as the treating physician. When the chiropractor confronted Jeune
about the discrepancies, Jeune laughed and said that was the way it was done.
INSIDE THIS ISSUE
1
DIF Arrests Orlando
Clinic Owner
2
PIP Fraud in the
News
3
PIP Fraud Spotlight
on FIFEC
4
5
Statewide Arrests
Office Contacts
DIF also questioned the medical director, who came to the clinic once a month to
review the patient files and billing.
In the case filed against Jeune, three patients provided statements that they
were treated by Jeune. The investigation revealed that Jeune also allegedly
billed for services that were not provided by his clinic to these patients.
Jeune admitted to DIF detectives that he worked unlicensed without the
supervision of a chiropractor or certified chiropractic physician assistant.
This case is one of many that DIF is currently investigating that involves
unlicensed providers and clinics throughout Florida.
Jeune was charged with unlicensed activity and insurance fraud, and faces up to
10 years in state prison.
DIF anticipates additional charges in this case.
April 2011
Page 2
PIP FRAUD – In The News
DIF Arrests Three Clinic Owners For Workers Compensation Fraud in Tampa
The Division of Insurance Fraud arrested three clinic owners for failing to obtain workers compensation coverage at their
clinics in Tampa. Leticia Leon, owner of Town Medical and Rehab Center; Dean Palestra, owner and office manager of
Long Chiropractic & Rehab Center; and chiropractor Hector Vasquez, owner of West Coast Chiropractic & Medical
Center; all in Tampa, surrendered once informed that warrants had been issued. Stop work orders were also issued
against the clinics by the Workers Compensation Bureau of Compliance (check the agency name), and their offices were
closed. Each obtained the necessary insurance coverage and reopened.
This action was part of a coordinated effort by DIF to focus on all aspects of potential criminal activity in the Tampa area
involving PIP clinics.
North Miami Beach PD Arrests Chiropractor for PIP Fraud
As a result of a yearlong undercover investigation by the North Miami Beach Police Department, NICB and the
assistance of Unitrin Direct Insurance, a local chiropractor was arrested on 03/03/11 for insurance fraud.
The 61-year old chiropractor, Eileen G. Dvorkin, who also allegedly owned the Accident Injury and Family Health Care
Clinic, was charged with 1 count each of Patient Brokering, Insurance Fraud and an Organized Scheme to Defraud.
According to the NMBPD press release, Dvorkin paid “runners” to go out an find patients and clients to bring back to her
clinic and make false claims of injury from staged traffic crashes. Dvorkin then covertly treated these alleged patients for
injuries they did not have and then fraudulently billed the insurance company for the treatment.
The North Miami Beach Police Department recognizes the severe negative impact these types of crimes have on our
community and communities around the country especially during these times of a floundering economy. The North
Miami Beach Police Department pledges to continue to aggressively investigate these crimes in partnership with the
National Insurance Crime Bureau.
NICB - PIP Fraud Increases in Florida
In a review of questionable claims submitted in Florida
for the years 2008-2010, the National Insurance Crime
Bureau (NICB) found an increase of 34 percent during
the 3 year period.
For the year 2010, Tampa was the top city in Florida,
followed by Miami, Orlando, Hialeah, West Palm
Beach, Jacksonville, Ft Myers, Ft Lauderdale, Naples
and Lehigh Acres.
However, when the numbers were broken down by
county, Miami-Dade was first, followed by Hillsborough,
Orange, Palm Beach, Broward, Lee, Duval, Collier,
Pinellas and Polk.
The questionable claims for personal auto insurance
increased 23 percent from 2009 to 2010, on top of the
15 percent increase in 2009 from 2008. Personal Auto
Claims account for 87 percent of the questionable
claims reported in Florida to NICB during 2010.
At right is a chart from NICB showing the questionable
claims in Florida by County. Clearly, Miami-Dade and
Hillsborough County (in red) are the hot spots.
The full report is available at: http://www.nicb.org/File%
20Library/Public%20Affairs/Florida -QuestionableClaims-08-10.pdf
The PIP Source
Page 3
PIP FRAUD SPOTLIGHT ON – FIFEC
This month we take a look at FIFEC, the Florida Insurance Fraud Education Committee, as they prepare for their Annual
Conference which will take place June 8-10, 2011 in Orlando. It is a fun time, but informative as well, where fraud folks
gather to network, attend training sessions, and share war stories about insurance fraud. The conference is well attended
by law enforcement, insurance investigators and professionals, members of IASIU (International Association of Special
Investigative Units) and NSPII (National Society of Professional Insurance Investigators).
According to their website, the Florida Insurance Fraud Education Committee began its existence as the DIF/SIU Annual
Training Seminar representing the Florida Department of Insurance’s Division of Insurance Fraud and the Special
Investigations Unit (SIU) community in 1992. DIF hosted this first seminar, which was actually a one-day open forum-type
workshop held in Altamonte Springs, with no agenda other than to foster a favorable working environment between the
public and private sectors involved in the fight against insurance fraud. A bold idea, but the beginnings were small, with
only about 50-60 attendees at the initial meeting. But it was a good start for a great relationship that would grow through
the years. At that first meeting, the audience asked about making fraud referrals, what DIF would do with them, and
record keeping, among other topics.
The idea was deemed a positive beginning to a relationship the Division of Insurance Fraud believes is essential in the
fight against fraud. So the conference became an annual event, growing each year, with attendance last year at the 2010
event numbering more than 600. This year, Florida Chief Financial Officer Jeff Atwater will make his first appearance at
the conference as the Keynote Speaker on opening day.
In addition to the informative courses and networking opportunity, the Conference presents awards in three categories.
The 2010 winners included Jim Halliday from Sentry Insurance as the Insurance Investigator of the Year; Dennis
Mensch was given the Jerry Zappolo Distinguished Service Award; and six officers from the Hillsborough County
Sheriff’s Office, Jose Morales, Ronnie Cooper, Anthony Mannarino, Kevin Patrick O’Brien, Robert Gogolin and
Matthew Carter were named the Law Enforcement Detectives of the Year.
This year's conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center, located at
8101 World Center Drive in Orlando, where it has been since 2004. Scheduled among this year’s offerings are the
following PIP related courses:
- Its No Wonder That Truth is Stranger Than Fiction. Fiction Has to Make Sense. Uncovering The True Clinic Owner
- Recent Case Law & PIP Claims
- Advanced Techniques in the Detection and Investigation of Suspected Staged Accidents
- Current Trends and Case Law Update in PIP Litigation
- Accident Reconstruction Top Ten
- Profile of Runners & How the Fraudulent Providers Prepare Against the Insurance Industry
- PIP Fraud as a Business Practice - Finding and Proving It
- Minor Accident Reconstruction & Biomechanics
- Staged Accidents - Deputy, Detective & SIU Perspectives
- Interviewing Doctors & Health Care Providers
- Fraud Referrals to the Division of Insurance Fraud
Fighting Insurance Fraud through Education and Commitment. Join the crowd in a gathering that is both fun and
educational. For more information, go to their website at www.fifec.org.
Thanks to Partners State Farm and NICB
We would like to thank our partners at State Farm Insurance Company for their
donation to our agency of two undercover vehicles which will be used by the
Division of Insurance Fraud to fight fraud in the East Central Region, which covers
eleven counties stretching from West Palm Beach to Orlando and the Space Coast.
State Farm is also donating electronic surveillance equipment which will bolster our
ability to conduct undercover investigations of the accident clinics that commit fraud
in our State. We also want to thank our partners at the National Insurance Crime
Bureau (NICB) for their assistance in facilitating the donation process.
 Pictured from left to right are:
Fred Burkhardt, NICB; unidentified DIF officer; and Alan Edwards, State Farm.
April 2011
Page 4
Statewide PIP Arrests – March 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.
Anthony Darius, 25 – paper accident 08/23/10 (passenger) $18,671 - Lorena de Jesus Rehabilitation (State Farm) M
Leticia Leon, 38 – clinic owner / no workers comp coverage – Town Medical and Rehab Center T
Dean Palestra, 43 - clinic owner / no workers comp coverage – Long Chiropractic & Rehab Center T
Hector Vasquez, 42 - chiropractor / no workers comp coverage – West Coast Chiropractic & Medical Center T
Erich Robles, 26 – staged acct 11/05/09 (passenger) $0 – (Assurance America) T
Rebecca Jennings, 59 – staged acct 06/24/09 (driver) $7,681 – Brandon Chiropractic (Geico) T
Odalys Roque, 41 – jump-in 04/11/10 - $20,014 – Margate Pain and Rehabilitation (Geico) B
Aaron Sanchez, 21 - staged acct 11/11/09 (passenger) $98 - Medical Therapy Practitioners (Allied Property & Casualty) T
Jesus Iluminado Guerrero, 28 – staged 11/03/09 (recruiter) $91,856 - ORD Medical Center (Allstate / Budget / Progressive) M
Michelle Capers, 20 – staged acct 03/18/10 (driver) $5,669 - Massage Health Clinic – (Assurance America) T
Quinyanna Capers, 23 - staged acct 03/18/10 (passenger) $5,566 - Massage Health Clinic – (Assurance America) T
Boquasha Wimbush, 19 - staged acct 03/18/10 (passenger) $5,734 - Massage Health Clinic – (Assurance America) T
Luis Hernaiz, 33 - staged acct 03/18/10 (jump-in driver) $607 – Crystal Rehabilitation Clinic – (Hallmark) T
Nesly LeFrance, 43 – staged acct 12/17/09 (driver) $40,000 – Kim Habibi, DC (State Farm) B
Adel Ostreal, 42 - staged acct 12/17/09 (passenger) $40,000 – Kim Habibi, DC (State Farm) B
Armando Junco, 54 - paper acct 08/20/10 (driver) $4,359 - Healing Mental Care / Oasis Diagnostic Center (State Farm) M
Magaly Junco, 53 - paper acct 08/20/10 (passenger) $4,359 - Healing Mental Care / Oasis Diagnostic Center (State Farm) M
Anthony Fedd, 55 – false statement in support jump-in 07/12/10 - $6,000 - (Direct General / Geico) J
Isiah Darrell Arce, 21 – staged acct 12/01/09 (driver) $0 - (Geico) T
Alberto Correa, 40 – staged acct 07/01/10 (recruiter) $26,636 - Care Resources Group, LLC (Republic Western / Progressive) M
Yasmany Consuegra, 31 – staged acct 07/20/10 (recruiter) $57,773 – Psychologist Technology / V & R Medical
(Allstate / Progressive) M
Yasmany Consuegra, 31 – staged acct 07/28/10 (recruiter) $11,439 - Continental Rehabilitation Center (State Farm) M
Carlos Begueria Gonzalez, 36 – staged acct 07/01/10 (driver) $26,636 – Care Resources Group, LLC (Progressive /
Republic Western) M
Yilimilaidy Placeres, 29 - staged acct 07/01/10 (passenger) $26,636 – Care Resources Group, LLC (Progressive / Republic Western) M
Sharronda Sweet, 25 – staged acct 08/17/10 (driver) $14,801 – Choice Medical Center (Assurance America) B
Allen Blanco, 23 – staged acct 09/14/10 (passenger) $14,936 – Doral Center Rehab (Unitrin Direct) M
Gardy Jeune, 53 – unlicensed clinic owner - $5,444 – US Chiromatrix Centers Corp (Progressive) 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 5
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
We want to thank our readers for sharing the PIP
Source with your friends and co-workers. We feel
we have an important message for everyone that is
affected by PIP fraud in Florida.
We apologize, but we had to delay presenting our
new PIP Outreach program until next month.
We encourage our fellow fraud fighters to join us at
FIFEC in Orlando this June. It is always a good
time to share tales of encouragement and success
in the battle against insurance fraud. We hope to
see our old friends as well as meet new ones.
Spring is here and the Florida Legislature is geared
up and working on many bills, and we hope you are
playing your part in helping with the fight against
fraud. Get involved - call or write your legislator
and share your voice about the issues that affect
you. Join in the fight against insurance fraud.
A good place for a photo or graphic