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The PIP Source

VIEWS: 99 PAGES: 6

									                          The PIP Source                                                         February 2011
                                                                                              Volume 1 Issue 8
Division of Insurance Fraud

                               DIF Arrests Five in Tampa Clinic Case
www.MyFloridaCFO.com/fraud


                               In a case worked jointly with the Tampa Police Department and Hillsborough
 INSIDE THIS ISSUE
                               County Sheriff’s Office, the Division of Insurance Fraud (DIF) arrested five
                               individuals accused of submitting $118,000 in fraudulent insurance claims through
                               a Tampa clinic in less than four months. Two of the suspects, husband and wife
 1   Tampa Arrest Sweep
                               Isidoro and Yusimy Martinez, were arrested by DIF for a similar scheme in 2007
                               involving another Tampa clinic. Also arrested were massage therapist Afranio
 2   LAAIA Fights PIP Fraud
                               Rosario, billing clerk Nadine Diaz, and receptionist Lidiana Cabrera. Hillsborough
                               County State Attorney Mark Ober’s office will prosecute the case.
 3   PIP Fraud In The News
                               Three years ago, Isidoro and Yusimy Martinez were arrested for similar activities at
 4   PIP Fraud Spotlight on    the former Bella Mar Medical Center in Tampa in a case that involved a staged
     Unlicensed Clinics        accident; which is why they could not own the clinic under their names.

 5   Statewide Arrests
                               Florida currently leads the nation in suspected fraudulent auto insurance claims,
                               particularly fraudulent Personal Injury Protection (PIP) claims. CFO Jeff Atwater is
 6   Office Contacts
                               committed to attacking this costly crime. “This kind of fraud robs hardworking
                               Floridians of the dollars they need to rebuild their businesses and meet the needs
                               of their families,” said CFO Atwater. “I will continue to work aggressively to expose
                               these crimes, and I applaud the fraud detectives who took swift action to notify the
   Unable to obtain the        insurance companies so that most of the claims were never processed.”
   nec es s ary lic ens e to   Due to DIF’s quick action, only $4,000 was paid by insurers. DIF used undercover
    open or operate the        operatives to verify all five participants were illegally submitting false medical billing
                               forms. DIF received assistance on this case from Nationwide, Allstate and Hallmark
   c linic under her own
                               Insurance Companies, along with the National Insurance Crime Bureau (NICB).
   name, the defendant
 Martinez allegedly paid       Unable to obtain the necessary license to open or operate the clinic under her own
                               name, the defendant Martinez allegedly paid a chiropractor $2,500 a month to
 a c hiroprac tor $2,500 a     falsify a license exemption with the Agency for Health Care Administration (AHCA)
      month to fals ify a      and open the Marbella Medical Center under his name. DIF has made several
     lic ens e exemption       unlicensed clinic arrests statewide, and this case is a clear example of a growing
 with…AHC A and open           problem Florida faces with clinic exemptions. Director John Askins proclaimed “We
                               are aggressively working to identify those individuals who try to circumvent the law
   the Marbella Medic al
                               and recruit others to conceal the true ownership of these accident clinics. When
 C enter under his name.       our detectives uncover the deception, we will arrest both the true owner and the
                               false owner.”
                               Please see our new feature PIP Fraud Spotlight On, in which we cover the issue
                               of unlicensed clinics, and the problem that some clinic exemptions create.
                               In a related item, the Hillsborough County Commission has taken up an ordinance
                               that would give them the ability to regulate clinics within their jurisdiction. They feel
                               the new ordinance is necessary to curtail the rampant increase in personal injury
                               protection insurance fraud occurring within Hillsborough County. Commissioners
                               plan to hold a public hearing on the issue on February 16. We eagerly await the
                               results.
                               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 or have comments
                               you wish to share, contact us at our new e-mail address at ThePIPSource@MyFloridaCFO.com.
  Page 2 – February 2011                                                                   The PIP Source

                             LAAIA TAKES STAND AGAINST PIP FRAUD
                             On January 19, LAAIA held an Insurance Fraud Town Meeting before a passionate
                             crowd estimated at 300, under the banner of “Floridians United to Stamp Out PIP
                             Fraud”. The purpose was to gather support to take an urgent and united message to
                             legislators in Tallahassee about the increase in fraud, and their concerns about the
                             availability and affordability of auto insurance if something is not done. The meeting,
                             held in the auditorium at United Automobile Insurance Company, was the first of
                             many to come. LAAIA members met last year with the Fraud Alert Team of Tampa
                             Bay (spotlighted in the Oct 2010 PIP Source) and learned firsthand how bad the
                             problem had become in that part of the state, and worry about it getting worse.
                             LAAIA Board Member Dulce Suarez-Resnick stated “LAAIA organized this Town
                             Meeting to get everyone involved, insurance carriers, agents, trade association, law
                             enforcement and legislators; bringing together many voices with one message for
       L AAIA held an
                             Tallahassee.” Representatives from every agent association attended, including
 Ins uranc e F raud T own    LAAIA, PIA (Professional Insurance Agents), independent agents from the tri-county
     Meeting before a        area and the Specialty Agents, along with representatives from 15 insurance carriers.
     pas s ionate c rowd     Following the remarkable turnout and enthusiastic response at the Town Meeting,
    es timated at 300…       LAAIA is headed to Tallahassee on March 15 and 16 for a legislative fly-in and they
  R epres entatives from     hope to meet with their legislators about the fight against fraud.
every agent as s oc iation   Among others speaking at the Town Meeting were State Representative Eduardo
    attended, inc luding     “Eddy” Gonzalez, LAAIA President Luis de Gongora, LAAIA Fraud Task Force
         L AAIA, P IA,       Chairman Joe Mier, United Auto attorney Michael Neimand, NICB Supervisor Special
   independent agents        Agent Tony Fernandez, Hialeah PD Sgt Ricky Garcia and DIF Captain Steven Smith.
and S pec ialty Agents ...   The Latin American Association of Insurance Agencies was founded in Miami in 1969
                             to unite and serve as a voice for independent insurance agents. Today, it is a strong
                             network comprised of members of various background and different roles in the
                             industry, included agents, insurance firms and other firms.
                             From their website at www.laaia.com:
                             The LAAIA strives for an insurance environment that is healthy for agents and fair for
                             consumers by working on several areas such as education, networking,
                             communication, legislation as well as community involvement.
                             The LAAIA strives for an insurance environment that is healthy for agents and fair for
                             consumers by working on the following areas:
                             Tracking pertinent legislative issues and taking action for members through lobbying.
                             Providing members with insurance training and required continuous education
                             seminars, all approved by the Department of Insurance.
 T own Meeting B anner       Bringing top experts and industry leaders to speak on insurance issues at every
                             monthly member meeting; providing an informative quarterly newsletter and monthly
                             website newsletter on the latest insurance trends for the membership.




                                            Rep Eddy Gonzalez, Dulce Suarez-Resnick, Joe Mier and NICB’s
   A Passionate Assembly                  Tony Fernandez were among the speakers who energized the crowd

                                                                                  Photos provided by Alexander Dopazo
   The PIP Source                                                                   Page 3 – February 2011

PIP FRAUD – In The News
DIF Makes $50,500 in Reward Payments to Tipsters Who Reported Fraud
Last month, Florida CFO Jeff Atwater announced $50,500 in reward payments to eight Floridians who provided
information that led to the arrests and convictions in five major cases, four of which involved PIP fraud.
- $10,000 to a witness for conviction involving one subject and Tampa clinic and $500,000 in fraudulent bills.
- $10,000 to a witness for convictions of seven defendants involving two Tampa clinics and $175,000 in fraudulent bills.
- $1,500 each to two witnesses for convictions of four clinic employees and $110,000 in fraudulent bills.
- $2,500 to a witness for convictions of three participants in a staged accident and $48,000 in fraudulent bills.
The Reward program does work. You may remain confidential. A reward is paid upon conviction of the defendant(s) in
the case. Report insurance fraud and you too may be eligible for a reward. Call 1-800-378-0445 now!

Congratulations To Tampa’s New PIP Lieutenant Darrell Wilson
We would like to congratulate Darrell Wilson, who was promoted to Lieutenant in February and will supervise the new
PIP squad in Tampa for the Division of Insurance Fraud. Lt. Wilson started with DIF in 2010 and has over 17 years in
law enforcement. He previously served as a Captain with the Plant City Police Department and a Corrections Deputy
with the Polk County Sheriff’s Office. Lt. Wilson joins Lt. Carlos Rosario and Captain Michael Byrne as the go-to
supervisors in the fight against PIP fraud in the Tampa Bay area.
“I am committed to ensuring resources get to the areas in need, establishing stronger coordination between our
investigators and other law enforcement agencies and keeping targeted communities informed about how they can help
combat this crime.” said CFO Jeff Atwater. “We must act quickly to stop these losses and help Floridians keep their
hard-earned dollars in their pockets.”
According to the National Insurance Crime Bureau, Tampa now ranks number one in Florida following a 290% increase
in questionable claims related to staged or caused accidents in 2009. PIP fraud accounts for about 40 percent of
Florida’s yearly fraud referrals statewide.

City of Miami Police Department Announces Pilot Project to Fight PIP Fraud
The City of Miami Police Department has initiated a pilot unit that will investigate entities engaging in staged accidents,
fraudulent clinics, body shops, and related entities operating within the city of Miami. The unit will consist of three (3)
detectives and will be augmented by the Traffic Homicide Unit along with the Tactical Operations Section. The City of
Miami investigated numerous cases and made numerous arrests in 2010, and intends to continue to work with both
NICB and other law enforcement agencies to investigate insurance fraud.
Miami now joins other law enforcement agencies around the state that have formed dedicated units to fight insurance
fraud, including Hillsborough County Sheriff’s Office, Collier County Sheriff’s Office and Hialeah Police Department. We
are glad to hear it and welcome them to the fight.

Organized Crime Chief Prosecutor Is New Judge In Miami-Dade County Court
On December 7, 2010, then-Governor Charlie Crist appointed Charles K. “Charlie” Johnson of the Miami-Dade State
Attorney’s Office as a Judge for the Miami-Dade County Court. Judge Johnson is a graduate of the University of Florida
and received his law degree from Florida State University. Judge Johnson replaces Judge Bronwyn Miller, who was
appointed to the Eleventh Circuit Court. Judge Johnson not only brings respect and integrity to his new position, but a
strong understanding of insurance fraud.
Judge Johnson was a prosecutor with the Miami-Dade SAO since 1989, and headed up the Organized Crime Division
for the last 8 years. In that role, he also supervised the dedicated prosecutors of the Insurance Fraud Unit since it’s
inception in 2004.
We just received word that Judge Johnson was awarded the FATIU (Florida Auto Theft Intelligence Unit) Prosecutor Of
the Year Award for his prosecution of Operation Crash and Bash for Cash, a case involving body shop fraud that
resulted in 26 arrests in a joint investigation by Hialeah, Miami-Dade and Hialeah Gardens Police Departments.
We send Judge Johnson our best wishes, and know that he will serve the citizens of Miami-Dade County proudly.
    Page 4 – February 2011                                                                        The PIP Source


PIP FRAUD SPOTLIGHT ON – UNLICENSED CLINICS
This month we introduce a new feature called “PIP Fraud Spotlight On”, in which we highlight important PIP topics.
In Florida, if you own a clinic that treats patients from auto accidents, you are required to obtain a license from the Agency
for Health Care Administration (AHCA)…unless you hold a specific license with the Department of Health (DOH), then you
are exempt from licensing. This means, if you are a doctor, chiropractor, or osteopath, and wholly own your practice, you
do not need an AHCA license for your clinic because you are licensed with DOH. Additionally, if you are a massage
therapist, a physician assistant, or a certified chiropractic physician’s assistant, you can also own a clinic without an AHCA
license, treat accident victims and bill PIP insurers for your services. You may elect to file an application for said
exemption, and receive a certificate of exemption from AHCA that does not expire. Or you may choose not to file for an
exemption if you qualify for one. Despite the intention of the law to regulate clinics in Florida, those that are exempt
currently outnumber those that are licensed with AHCA by a ratio of 4 to 1 or greater.
According to AHCA, the total number of clinic exemptions in Florida has increased dramatically. For the period between
2008 and 2009, the exemptions issued in Miami-Dade County increased by 32%, while the exemptions in Hillsborough
County increased by 110%. These two counties accounted for almost half of all the exemptions issued throughout the
state. In 2010, the growth continued, with Miami-Dade increasing another 66%, while Hillsborough slowed to a mere 5%
increase. The following figures were obtained from AHCA:
Between 2008 and 2009, exemptions issued to Chiropractors in Hillsborough County increased from 13 to 19, an increase
of 46%. In 2010, exemptions to Chiropractors increased jumped 58% from 19 to 30.
Between 2008 and 2009, exemptions issued to Chiropractors in Miami-Dade County dropped from 44 to 41, a decrease of
7%, but went up 10% in 2010 from 41 to 45.
The number that most concerns law enforcement involves the number of clinic exemptions issued to Massage Therapists.
Between 2008 and 2009, the exemptions issued to Massage Therapists in Miami-Dade County increased. from 25 to 106,
an increase of 324%. The number of exemptions went to 251 in 2010, an additional jump of 137%.
Between 2008 and 2009 in Hillsborough County, the exemptions issued to Massage Therapists increased from 4 to 43, an
astounding increase of 975%. The number of exemptions dropped to 33 in 2010, showing a drop of 23%. However, the
numbers show that there are now 76 exempt clinics owned by Massage Therapist, up from only 4 two years ago.
Why is there concern by insurance companies and law enforcement about exemptions? Sometimes referred to as de
facto clinics, these fraudulent scammers evade licensure and regulation by taking advantage of a weakness in the law,
and a lack of resources to adequately oversee this activity. Neither AHCA nor law enforcement has enough manpower to
make sure that all clinics are properly licensed or lawfully exempt. However, as reported on page 1, the Division of
Insurance Fraud has made several arrests statewide and is investigating dozens of cases involving clinics where the
owner on paper is not the true owner.
In December 2009, The Florida Chiropractic Association warned its members about the issue of unscrupulous clinic
owners using Chiropractors to feign ownership so they could claim the exemption; that any such activity could be a felony
and could result in the loss of their license.
We agree, and issue our own warning to any and all licensees that enter into such a scheme – we are looking for you,
we will arrest you, we will seek to send you to prison and we will work to see that you lose your license.
Clinic Responsibilities - Florida Statutes 400.9935 states:
(3) All charges or reimbursement claims made by or on behalf of a clinic that is required to be licensed under this part, but
that is not so licensed, or that is otherwise operating in violation of this part, are unlawful charges, and therefore are
noncompensable and unenforceable.
(4) In addition to the requirements of s. 408.812, any person establishing, operating, or managing an unlicensed clinic
otherwise required to be licensed under this part or part II of chapter 408, or any person who knowingly files a false or
misleading license application or license renewal application, or false or misleading information related to such application
or department rule, commits a felony of the third degree…

Coming Next Month in the Spotlight:
Give us your feedback about our Spotlight feature. Next month, we take a detailed look at solicitation.
   The PIP Source                                                                          Page 5 – February 2011

Statewide PIP Arrests – January 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.


Yunier Ramirez, 28 - staged acct 12/16/09 (recruiter) $14,135 – ABC Therapeutic Center / Elliott Krakow, DC (State Farm) M
Adolfo Rivera Navarro, 42 - staged acct 06/06/07 (recruiter) $42,756 - Orlando Med Therapy Group / (Avis Budget / State Farm) O
Gregory Sommer, 39 - clinic employee - $28,749 – West Coast Chiropractic (Direct / State Farm) F
Yeneili Rodriguez Batista, 29 - staged acct 05/13/09 (passenger) $68,688 – JKR Rehab Wellness / Angelica Medical
Center (Allstate / Geico) M
Serenity Toler, 24 - clinic employee - $6,105 – Health Park Chiropractic Center (Progressive) F
Ricardo Uranga Guemes, 32 - staged acct 07/15/10 (recruiter) $77,897 – CAC Medical Service / L & A Majestic Medical
(Allstate / State Farm) M
Yamilka Turino Mauricio, 30 - staged acct 07/15/10 (passenger) $7,650 – CAC Medical Service / (Allstate) M
Marlene Lina Mendez, 48 - staged acct 05/13/09 (driver) $19,800 – JKR Chiropractic (Geico) M
Santos Colero, 40 - staged acct 08/20/10 (recruiter) $28,625 – C&N Therapy Center / Emoge Medical Services (Geico) M
Odalys Sardinas, 42 - clinic employee - $24,405 - C&N Therapy Center (Geico) M
Jorge Luis Dominguez, 40 - staged acct 01/09/10 (passenger) $17,489 – Libertad Medical (Mercury) M
Enrique Anglada, 38 - staged acct 10/25/08 (passenger) $7,960 – Medical Service Center of Florida (State Farm) M
Heide Esther Pacheco, 37 - staged acct 01/09/10 (driver) $15,753 – Libertad Medical Center (Mercury) M
Louis Martinez, 42 - staged acct 01/09/10 (recruiter) $48,770 - MA-R Medical / Libertad Medical (Mercury / Republic Western) M
Ivan Zamora, 37 - staged acct 07/15/10 (recruiter) $75,887 - CAC Medical / L & A Majestic Medical (Allstate / State Farm) M
Eloy Avila Amaya, 22 - staged acct 10/05/09 (passenger) $1,177 - Kennedy Medical Rehabilitation Center (Star Casualty) T
Tamara Kay Williams, 60 – staged acct 08/26/09 () $32,513 – HBC Professional Group (Progressive) T
Caitlin Russo, 19 - staged acct 08/26/09 (driver) $0 - American Healing Center (Infinity) T
Yusimy Martinez, 36 - clinic owner - $118,000 (Allstate / Hallmark / Nationwide) T
Isidoro Martinez, 43 – clinic owner - $118,000 (Allstate / Hallmark / Nationwide) T
Afranio Rosario, 54 – clinic employee - $118,000 (Allstate / Hallmark / Nationwide) T
Nadine Diaz Viana, 34 – clinic employee - $118,000 (Allstate / Hallmark / Nationwide) T
Lidiana Cabrera, 33 – clinic employee - $118,000 (Allstate / Hallmark / Nationwide) T
Jean Odne, 34 – application fraud (Hallmark) F
Sanford Marcus, 72 – solicitation (United Auto) M




  Office Code –B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)


T he P IP S ourc e is a free news letter publis hed by the F lorida Divis ion of Ins uranc e F raud. It is available online at
   www.myfloridac fo.c om/fraud or you may s ubmit a reques t to T heP IP S ourc e@ MyF loridaC F O.c om to rec eive
     c opies by e-mail. F eel free to s hare it with your family, friends , c o-workers , employees and c us tomers .
  Page 6 – February 2011                                                            The PIP Source

                                     Statewide PIP Contacts

PANHANDLE REGION                                        EAST CENTRAL REGION
Counties: Bay, Calhoun, Escambia, Franklin,             Counties: Brevard, Indian River, Lake, Martin,
Gadsden, Gulf, Holmes, Jackson, Jefferson,              Okeechobee, Orange, Osceola, Palm Beach,
Lafayette, Leon, Liberty, Madison, Okaloosa, Santa      Seminole, St. Lucie, Volusia
Rosa, Taylor, Wakulla, Walton, Washington
                                                        WEST PALM BEACH FIELD OFFICE
PENSACOLA FIELD OFFICE                                  Major Simon BLANK
Captain Buddy HAND                                      Captain Glen HUGHES
Lt. Joseph HOLOKAN                                      Lt. Evangelina BROOKS
850.453.7802                                            561.837.5601
610 Burgess Road                                        3111 S. Dixie Hwy., Suite 310
Pensacola, FL 32504                                     West Palm Beach, FL 33405-1557

TALLAHASSEE FIELD OFFICE                                ORLANDO - FIELD OFFICE
850.413.3115                                            Lt. Jewel CAMERON
200 East Gaines Street                                  407.835.4402
Tallahassee, FL 32399-0324                              400 West Robinson Street, Suite S-823
                                                        Hurston Building, Orlando, FL 3280l


NORTH REGION
Counties: Alachua, Baker, Bradford, Citrus, Clay,       SOUTH REGION
Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton,   Counties: Broward, Dade, Monroe
Levy, Marion, Nassau, Putnam, St. Johns, Sumter,
Suwannee, Union.                                        MIAMI FIELD OFFICE
                                                        Captain Steven SMITH
JACKSONVILLE FIELD OFFICE                               Lt. Violeta SERRANO
Captain Brian McCOY                                     Lt. John DYGON
Lt. Kevin JONES                                         Lt. Stanley JEAN-FELIX
904.798.5802                                            305.536.0302
921 North Davis Street, Bldg. B, Ste.149                40l N. W. 2 Avenue, Suite N-32l
Jacksonville, FL 32209                                  Miami, FL 33l28

                                                        PLANTATION FIELD OFFICE
                                                        Lt. Bill LEE
WEST CENTRAL REGION                                     954.321.2902
Counties: Charlotte, Collier, DeSoto, Glades, Hardee,   499 N.W. 70 Avenue, Suite 309
Hendry, Hernando, Highlands, Hillsborough, Lee,         Plantation, FL 33317
Manatee, Pasco, Pinellas, Polk, Sarasota.

TAMPA FIELD OFFICE
Captain Michael BYRNE
Lt. Carlos ROSARIO                                      NICB Contact Info
Lt. Darrell WILSON
813.972.8602                                            South Florida Major Medical Fraud Task Force
8600 Hidden River Parkway, Suite 100                    Supervisory Special Agent Fred Burkhardt
Tampa, FL 33637-1016                                    954.349.7427

FORT MYERS FIELD OFFICE
Lt. J.D. SALOME                                         Central Florida Major Medical Fraud Task Force
239.278.7527                                            Supervisory Special Agent Fred Burkhardt
4700 Terminal Drive, Suite 5                            954.349.7427
Fort Myers, FL 33907

								
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