Division of Insurance Fraud
Referrals
Presented to the
Automobile Insurance Fraud Strike Force
January 24, 2013
Captain Steven Smith
Division of Insurance Fraud
DIF PIP Resources
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In response to the expanding PIP fraud problem, DIF
created dedicated squads around the state
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Currently, we have 9 squads and 48 detectives that are
dedicated to PIP fraud investigations
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Miami, Broward, WPB, Orlando, Tampa have dedicated
squads and Ft Myers and Jacksonville have dedicated
detectives
In each of those jurisdictions except Ft Myers, we also have
dedicated prosecutors
Working with Other Agencies
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DIF works with various other law enforcement and regulatory
agencies throughout the state, including local police
departments, federal agencies like the FBI and IRS, and
state agencies like DOH and AHCA
We work closely with the National Insurance Crime Bureau
(NICB), which operates two major task forces in Florida
(Plantation and Tampa). NICB is instrumental in providing
support and resources to law enforcement, including vehicles,
equipment, u/c pretext policies, and is a liaison between law
enforcement and the insurance companies
Referrals to DIF
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All licensees must report suspected acts of insurance fraud
directly to the fraud division
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If they deny a claim for fraud, there must be a matching
referral to DIF
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Referrals are automatically entered into DIF’s case tracking
system and forwarded to the appropriate Captain or
Lieutenant for review and assignment
More than 90% of our PIP fraud referrals come from
insurance companies
Volume of Referrals
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We want to work the cases that have most impact on PIP
fraud and we need to have a probability of successful
prosecution
In 2011-12, DIF received more than 7,700 PIP referrals,
which accounts for 51% of the total referrals, an increase
of nearly 16% from the previous year
Statewide, we made 496 PIP-related arrests, an increase of
40% from the previous year
The PIP problem is greater than any numbers can show
Staged Accident Rings and Clinic Investigations
Fraud Cases
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Staged Accidents and Accident Clinics
Unlicensed Clinics / Straw Ownership
Crash Reports / Solicitation / Patient Brokering
Fraud by Patient and Jump-Ins
Work these investigations up the food chain to get to the
persons who are controlling the schemes and profiting from
the fraud
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Some cases can be done relatively quickly, others can take
months or even years, depending on the scope of the scheme
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Operation Dark Horizon
Recent Impact Changes
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Hillsborough County PIP Ordinance – impacted and educated
community, and people got involved
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Prosecutors working with Department of Health to take the
licenses of medical personnel convicted of fraud
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DIF’s expansion of dedicated PIP squads throughout state
Huge successes in West Palm Beach through recent actions
including Operation Sledgehammer and other cases
Major cases underway in Jacksonville against organized rings
Major arrests in Tampa and Ft Myers
Training with law enforcement agencies (increased awareness
and active reporting)
Potential Changes from HB 119
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Shift from straw ownership of clinics by massage therapists
to chiropractors and doctors
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Bypass billing PIP and shift to BI (bodily injury) and med pay
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Shift of licensing by massage therapists to chiropractic
assistants
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State missed an opportunity – should have required that
clinics obtain an AHCA license to bill for PIP, without any
exemptions
Education and Public Awareness
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In an effort to better inform the public about PIP fraud,
DIF and the Florida Outdoor Advertising Association (FOAA)
joined together in a statewide campaign using billboards and
bus posters
DIF has provided training to various law enforcement
agencies including the Florida Highway Patrol, who also
recently launched a website on staged crash awareness
DFS has a reward hotline (800-378-0445) for the public to
report fraud and has distributed more than $300,000 to
citizens
We publish a monthly newsletter called The PIP Source which
reports on successful investigations, publishes the names of
persons arrested, and provides other useful information on
PIP related issues