The PIP Source
September 2010
Volume 1 Issue 3
Division of Insurance Fraud
www.MyFloridaCFO.com/fraud
Florida Cities Ranked at the Top in Staged Accidents
INSIDE THIS ISSUE
1 Staged Accidents
2 What Makes A Good
Fraud Referral
3 Statewide Arrests
4 Office Contacts
The DIF database
shows that we
have received
more than 2,100
staged accident
referrals statewide
since January
2009.
A May 2010 report by the National Insurance Crime Bureau (NICB) listed
four Florida cities in the top ten nationally for staged accidents: Tampa,
Miami, Orlando and Hialeah. In the report, Florida had the highest number
of reported staged accidents; more than 3,000 from 2007-2009, nearly
double the numbers reported in either New York or California.
The DIF database shows that we have received more than 2,100 staged
accident referrals statewide since January 2009. The counties with the
highest rate of these referrals are Hillsborough, Miami-Dade, Orange, Palm
Beach, Lee, Broward and Collier. Together, these seven counties account
for 93% of the staged accident referrals in Florida. A June 2010 NICB
report showed a 290% increase in staged accidents in the Tampa area
from 2008 to 2009.
Florida Statutes 817.234 (9) states - A person may not organize, plan, or
knowingly participate in an intentional motor vehicle crash for the purpose
of making motor vehicle tort claims or claims for personal injury protection
benefits as required by s. 627.736. Any person who violates this
subsection commits a felony of the second degree, punishable as provided
in s. 775.082, s. 775.083, or s. 775.084. A person who is convicted of a
violation of this subsection shall be sentenced to a minimum term of
imprisonment of 2 years.
Staged accident fraud is not the only PIP crime reported, and is actually
third in number of referrals behind fraud by claimant and fraud by provider.
Of course, many of these other referrals may involve staged accidents, but
the person making the referral may not have enough information to make
that determination. Miami-Dade is still the leader in total referrals, but
Hillsborough is closing fast, and is expected to move into first place.
The Department of Financial Services offers a reward of up to $25,000 is
offered for information leading to the arrest and conviction of persons
committing complex and organized insurance crimes. Tips may remain
anonymous. Call toll free 1-800-378-0445. Thanks to NICB and DFS CIA
Lori Rodabaugh for much of the information in this article.
The PIP Source Newsletter is now available online each month at
www.MyFloridaCFO.com/fraud. You can find each new issue posted at our
website by the third week of each month. Previous issues are also available.
If you prefer to receive The PIP Source by e-mail, submit your request to
Steve.Smith@MyFloridaCFO.com.
Page 2 – September 2010
The PIP Source
What Makes A Good Fraud Referral?
Under Florida law, insurance companies are required to report fraudulent claims
directly to the Division of Insurance Fraud (DIF), and the method for such
referrals is through the Division’s online E-File system. Member companies of
the National Insurance Crime Bureau can also use the NICB link with ISO to
make their referrals. Citizens can use the same online system at the DIF
website, www.MyFloridaCFO.com/fraud
The Division receives more than 12,000 fraud referrals each year. What follows
is a general guide for how best to make referrals to DIF
•Do not assume the DIF supervisor reviewing your referral has prior knowledge
of the documented activity. It is important for you to include as much detail in
the narrative section as possible
The Division
receives more
than 12,000 fraud
referrals each
year...It is
important for you
to include as
much detail as
possible.
The narrative of the alleged fraudulent activity should include the following:
•Who was involved in the alleged fraud
•What the alleged fraudulent activity was
•When the alleged fraud occurred
•Where the alleged fraud occurred
•How the person was involved with the alleged fraudulent activity
It is important to also include in the narrative section a summary of the evidence or
documents that you have to support the allegation of fraud
•Examples of evidence – recorded statements or an EUO; witness statement,
confessions, surveillance or any other information that supports the allegation
•Whether claim paid or not, and amount
•Files in conflict with prior claims
•Multiple fraudulent claims by same provider
•Need both timely and multiple referrals to show a pattern of fraudulent activity
•If you have discussed the case with a DIF Detective, or your referral is related
to another investigation, please include that in your narrative
•Include a direct contact number where the DIF Detective can reach you
If you are using the NICB / ISO gateway to make referrals:
•Use the narrative section to include details that other fields may not allow
•If subject of your referral is not the insured or claimant, please include that
information into the narrative (examples – clinic provider / runner / recruiter for
staged accident / etc)
•If the claim is still under investigation, wait until you have sufficient supporting
documentation to articulate fraud before submitting referral to DIF
•Do not submit a referral before you have sufficient facts to establish fraud
If an insurance company denies a claim for fraud, there must be a matching referral
to DIF, and it must be clearly defined and substantiated by adequate evidence
Follow-up on E-File
•If you enter your e-mail address when you make the referral, you will receive a
automated e-mail response with the tip number, along with the phone number of
the office that will review the information you provided
•All E-file referrals are reviewed, not all will be assigned
•The better the content of the referral, and the greater detail it contains, the more
likely it will be assigned
If an insurance
company denies a
claim for fraud,
there must be a
matching referral
to DIF, and it must
be clearly defined
and substantiated
by adequate
evidence.
Page 3
The PIP Source
Statewide PIP Arrests – August 2010
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.
Keary McNish, 28 – staged acct 07/12/08 (driver) $38,500 – Solution Care Center (Geico / Direct) B
Luis Eduardo Carlos, 51 – caused acct 08/08/08 (driver) $10,518 – MDC Chiropractic (Progressive) B
Ricardo Latchman, 41 – jump in 12/20/09 - $17,040 – Advanced Chiro & Medical (Allstate) M
Timothy James Bates, 51 – unlicensed atty, insurance fraud, theft - $40,000 (Avis / Hanover / State Farm / Workman’s Auto) TL
Hilda Aristondo, 47 – PIP patient, false statement (United Auto) M
Uriel Dubreuze, 30 – staged acct 2/08 (recruiter) $38,500 – Solution Care Center (Geico / Direct) B
Emmanuel Eloi, 56 – doctor - $8,818 – All Family Medical Center (Direct) O
Yuriem Garcia Hernandez, 35 – false statement jump-in 11/27/08 - $13,226 (Victoria) M
Yunay Carbonell, 29 – jump in 02/21/01 - $5,000 (Security National) B
Pauline Joseph, 24 – false statement jump-in - $3,511 - (Geico / Progressive) W
Fritz Leguerre, 38 – jump-in 05/31/09 - $3,511 – Armas Physicians Associates (Geico / Progressive) W
William Gutierrez, 35 – fake insurance card (US Security) B
Jeffrey Bernard Hicks, Jr, 24 – sale fake insurance card (Florida Farm Bureau) T
Terry Washington Davis, 24 – sale fake insurance card (Florida Farm Bureau) T
Juan Miranda, 48 – staged acct 09/29/09 (driver) $7,132 – Back 2 Health Chiropractic Clinic (Explorer) F
Osselito Pierre, 35 – staged acct 09/29/09 (passenger) $20,348 – Russell Turner, DC (Met Life) F
William Jean, 32 – staged acct 09/29/09 (passenger) $0 – Back 2 Health Chiropractic Clinic (Explorer) F
Carline Julmisse, 38 – staged acct 09/29/09 (passenger) $13,385 – Russell Turner, DC (Geico) F
Charles Philome, 45 – staged acct 06/24/09 (recruiter) $81,950 – Acu Rehab & Medical Center / Complete Rehab Medical Center /
Pompano Family Chiropractic (Affirmative / Northern / Progressive / Republic Western) B
Franck Sibert, 38 – staged acct 06/24/09 (passenger) $28.857 – Complete Rehab Medical Center (Northland / Republic Western) B
Delisthene Joseph, 53 - staged acct 06/24/09 (driver) $18,786 - Complete Rehab Medical Center (Affirmative / Republic Western) B
Lodace Mede, 49 – staged acct 06/24/09 (passenger) $10,000 – Acu Rehab & Medical Center (Northland / Republic Western) B
Office Code –B (Broward) F (Ft Myers) M (Miami) O (Orlando) T (Tampa) TL (Tallahassee) W (West Palm Beach)
FRAUD ALERT
FLORIDA DIVISION OF INSURANCE FRAUD
"Fake Crash = Real Time"
If you participate in a staged accident,
you face a minimum of two (2) years to fifteen (15) years in prison.
File a false claim with your insurance company and you will go to jail.
Insurance Fraud - it's not worth it!
The PIP Source
Page 4 – September 2010
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
Captain Buddy HAND
Lt. Joseph HOLOKAN
850.453.7802
610 Burgess Road
Pensacola, FL 32504
TALLAHASSEE FIELD OFFICE
850.413.3115
200 East Gaines Street
Tallahassee, FL 32399-0324
EAST CENTRAL REGION
Counties: Brevard, Indian River, Lake, Martin,
Okeechobee, Orange, Osceola, Palm Beach,
Seminole, St. Lucie, Volusia
WEST PALM BEACH FIELD OFFICE
Major Simon BLANK
Captain Glen HUGHES
Lt. Evangelina BROOKS
561.837.5601
3111 S. Dixie Hwy., Suite 310
West Palm Beach, FL 33405-1557
ORLANDO - FIELD OFFICE
Lt. Jewel CAMERON
407.835.4402
400 West Robinson Street, Suite S-823
Hurston Building, Orlando, FL 3280l
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
Captain Brian McCOY
Lt. Kevin JONES
904.798.5802
921 North Davis Street, Bldg. B, Ste.149
Jacksonville, FL 32209
WEST CENTRAL REGION
Counties: Charlotte, Collier, DeSoto, Glades, Hardee,
Hendry, Hernando, Highlands, Hillsborough, Lee,
Manatee, Pasco, Pinellas, Polk, Sarasota
TAMPA FIELD OFFICE
Captain Michael BYRNE
Lt. Carlos ROSARIO
813.972.8602
8600 Hidden River Parkway, Suite 100
Tampa, FL 33637-1016
FORT MYERS FIELD OFFICE
Lt. J.D. SALOME
239.278.7527
4700 Terminal Drive, Suite 5
Fort Myers, FL 33907
SOUTH REGION
Counties: Broward, Dade, Monroe
MIAMI FIELD OFFICE
Captain Steven SMITH
Lt. Violeta SERRANO
Lt. John DYGON
Lt. Stanley JEAN-FELIX
305.536.0302
40l N. W. 2 Avenue, Suite N-32l
Miami, FL 33l28
PLANTATION FIELD OFFICE
Lt. Bill LEE
954.321.2902
499 N.W. 70 Avenue, Suite 309
Plantation, FL 33317
NICB Contact Info
South Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt
954.349.7427
Central Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt
954.349.7427