Author Archives: John Leinicke, Esq. HCRM

FL Man Poses As NJ Doctor to Submit $1M in Fraud Claims

A Florida man, Yoandi Marrero, has been charged with insurance fraud, theft by deception, attempted theft by deception and identity theft after assuming a New Jersey doctor’s identity to submit more than $1 million in fraudulent medical claims. The services were never rendered and the medical center did not exist.

Marrero was found out when a woman claimed a doctor had billed her insurance for services that were never rendered.

Click here to read the full story.

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Filed under Florida, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

Roig Lawyers Orlando Managing Partner to Present at DRI Marijuana Law Seminar

If you’ve never attended a DRI seminar, you don’t know what you’re missing in terms of networking and education!

Roig Lawyers’ Orlando Managing Partner, Scharome Wolfe, will present “How High? Insurance and MedicalMarijuana” at the 3rd Annual DRI Marijuana Law Seminar in Chicago from June 26-27. It’s a fascinating area of rapidly-changing law. We encourage you to attend!

Click here for more information.

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Filed under Insurance, Marijuana, Uncategorized

Former Dade City Police Officer and Two Others Charged in Insurance Fraud Scheme

According to the Florida Department of Law Enforcement, former Dade City police officer Jonathan Lance Hobby and two others, Bruce Dewayne Wilson Jr. and Carl “Chuck” Roach Jr. were arrested for insurance fraud among other charges.

Hobby, Wilson and Roach were charged with combinations of conspiracy to commit insurance fraud, filing a false police report, conspiracy to deal in stolen property and operating a chop shop. According to detectives, Hobby filed a police report and auto theft claim in May 2017 claiming his 2015 Dodge Ram 1500 truck was stolen from Rancho Bonito in Lakeland. The insurance company paid a claim to Hobby in the amount of $24,712.72.

Hobby’s truck was located at Wilson’s business, After Hours Diesel Service. Investigators say Wilson and Hobby orchestrated a scheme to falsely report the truck as stolen and sell most of its parts, which Roach knew about and actually participated in dismantling the truck.

All three suspects were arrested and booked into the Pasco County Jail.

Click here to read the full article.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Fraud, Uncategorized

Florida Supreme Court Issues Order Extending Legal Time Limits for Miami-Dade Courts

We hope you withstood the wrath of Hurricane Irma with the least amount of damage to your home and surroundings. We want to keep you advised of the status of the litigation you have entrusted to us here at ROIG Lawyers. On September 19th, the Florida Supreme Court issued an administrative order extending all time limits through close of business on Monday, September 18th, 2017. This includes any deadline allowed by rule of procedure, court order, statutes applicable to court proceedings, or otherwise pertaining to court proceedings.

The Court further recognized in its order that there may be instances where, because of this emergency, these and other time limits applicable to matters in or outside Miami-Dade County could not be met even upon application of the periods stated above. If such a claim is made, the Court in which jurisdiction vested is directed to resolve the issue on a case-by-case basis when a party demonstrates that the lack of compliance with requisite time periods was directly attributable to this emergency.

If you have any questions or would like to discuss this issue in greater detail, please feel free to contact us by emailing marketing@roiglawyers.com or call us at 1-855-ROIGLAW.

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Filed under Florida Supreme Court, Hurricane Irma, Miami-Dade County

UPDATE: Naples Man in Florida Crash Ring Sentenced to 3 Years in Jail

On May 2, 2017, the Coalition Against Insurance Fraud reported that Wisler Cyrius of Naples was sentenced to three years in federal prison after pleading guilty of conspiracy to commit mail fraud and money laundering.

Cyrius and five other individuals conspired to solicit people to participate in staged motor vehicle accidents in exchange for compensation. According to the Justice Department, Cyrius was also ordered by the court to pay restitution to automobile insurance companies and to forfeit property in the amount of the proceeds traceable to the offense.

Click here to view the full article. (Previous post)

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Fraud

Brother Duo Accused of Massive Insurance Fraud Scheme

According to Law360, on January 3rd in a 427-page state court complaint the New Jersey Department of Banking and Insurance (DOBI) and Allstate Insurance Co. have accused brothers Anhuar and Karim Bandy of masterminding a massive personal injury insurance fraud scheme in which they recruited automobile accident victims for file claims for treatment. There were several law firms and health care providers involved in the schemes as well.

The Bandy brothers had previously pled guilty in July 2015 to organizing an insurance fraud scheme in which they recruited auto accident victims as patients for their clinics and received kickbacks from attorneys and medical professionals for patient referrals.

This recent complaint against the Bandy brothers detailed a series of alleged overlapping schemes that date back to their previous conviction. DOBI Commissioner Richard J. Badolato explained, “These and similar alleged fraudulent activities increase the cost of insurance to consumers.” While DOBI is seeking a fine against the Bandy brothers, Allstate is seeking reimbursement for paid benefits paid on behalf of its customers.

Click here to view the full story (subscription required).

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Filed under Auto Insurance Fraud, Insurance Fraud, Personal Injury Protection

Miami Police Arrest Twelve for Medical Fraud Schemes

On August 8, 2016, police arrested a dozen people in Miami-Dade County for their involvement in medical fraud schemes. Three of those arrested were employees of Brothers Medical Clinic on West Flagler St; which included a doctor, therapist and a woman who worked at the front desk.

According to detectives, the investigation began in September when an undercover officer walked into the clinic claiming he was involved in a car accident and needed therapy. The officer only visited that clinic once, but his insurance was billed thousands of dollars for services that were never provided.

“There wasn’t any type of treatment whatsoever,” an undercover detective with the National Insurance Crime Bureau said. “They were just billing the insurance companies for services not rendered, and this is something that goes on time and time again.”

The other nine arrests took place at a clinic in West Kendall.

“South Florida has become the capital of the country for medical fraud, and these types of clinics are an epidemic in the country,” said Miami Police Officer Rene Pimentel.

These fraudulent schemes are affecting insurance rates across the United States and are costing insureds hundreds of millions of dollars, where the sole beneficiaries are the clinics and doctors who facilitate these schemes.

Click here for full story.

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Filed under Insurance Fraud, Miami-Dade County

Three Miami-Dade Residents Charged in Billion-Dollar Scheme

Three Miami-Dade County residents were charged with conspiracy, obstruction, money laundering and healthcare fraud for their alleged involvement in a $1 billion scheme.

Philip Esformes, 47; Odette Barcha, 49; and Arnaldo Carmouze, 56, were charged in an indictment July 22.

“This is the largest, single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” said Assistant Attorney General Leslie R. Caldwell of the Department of Justice.

Law360 reported that Medicare paid out at least $464 million in improper reimbursements.

The U.S. Attorney’s office in the Southern District of Florida spelled out the scheme as follows:

Esformes operated the Esformes Network, a group of more than 30 skilled nursing homes and assisted-living facilities. Barcha and Carmouze worked as a hospital administrator and physician’s assistant. The network allowed Esformes to find thousands of Medicare and Medicaid beneficiaries, many who didn’t qualify for an assisted-living facility or skilled nursing home care. The government claims Esformes and his two accomplices admitted the nonqualifying beneficiaries to Esformes’ facilities, where Medicare and Medicaid were billed for unnecessary services. In addition, the three are accused of receiving kickbacks to steer the beneficiaries to medical providers, including community mental health centers and home healthcare providers. The kickbacks were hidden by being paid in cash, disguised as donations to charity or falsely labeled as lease payments.

Enformes already paid $15.4 million in 2006 to resolve fraud claims of unnecessarily admitting patients to assisted-living facilities in a Miami-area hospital. Afterward, Enformes changed his fraud scheme in an effort to prevent detection, the federal government says.

Click here to read press release.

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Filed under Health care, Insurance Fraud, Medicare, Miami-Dade Fraud, Southern District of Florida

Medicare Fraud Roundup Is Largest in U.S. History

A nationwide sweep on June 21 resulted in the largest coordinated takedown of alleged Medicare fraudsters in U.S. history.

The Medicare Fraud Strike Force led a sweep in 36 federal court districts that resulted in charges against 301 individuals, including 61 medical professionals. The schemes involved about $900 million in fraudulent billing. South Florida was home to 100 of those defendants participating in fraud schemes involving $220 million in false billings for home health care, mental health services and pharmacy fraud.

The defendants face charges of conspiracy to commit healthcare fraud, violations of anti-kickback statutes, money laundering and aggravated identity theft. More than 60 of the individuals arrested are charged with fraud related to Medicare Part D, the prescription drug plan that is the fast-growing part of Medicare.

The defendants were part of schemes to bill Medicare and Medicaid for treatments that were medically unnecessary or never performed. Medicare beneficiaries and patient recruiters were paid kickbacks for supplying beneficiary information to providers, who used that information for fraudulent billing.

In one case in the Southern District of Florida, nine defendants were charged with operating six home health companies in the Miami area that gave bribes and kickbacks to bill for services that were not medically necessary. Those six companies defrauded Medicare of more than $24 million.

In the Middle District of Florida, which includes Orlando and Tampa, 15 individuals were charged with crimes including compounding pharmacy fraud and intravenous prescription drug fraud involving $17 million in fake bills. The owner of several infusion clinics is accused of being reimbursed by Medicare for $17 million for intravenous prescription drugs that were never purchased or administered to beneficiaries.

Click here for the press release.

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Filed under Health care, Insurance Fraud, Medicare, Miami-Dade Fraud, Southern District of Florida, Uncategorized

25 Charged in $26 Million Medicare Fraud in Miami

Twenty-five people were charged in Miami federal court for alleged schemes to defraud Medicare. The three cases totaled about $26 million in false claims through the Medicare Part D program.

U.S. Attorney Wifredo A. Ferrer said the April 28 charges include conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to defraud the United States, and paying and receiving healthcare kickbacks.

In the first indictment, 18 people were charged with filing false claims through eight separate pharmacies. Pedro Torres, 43, of North Bay Village and Antonio Hevia, 53, of Miami are accused of recruiting people to be owners of the pharmacies. Torres and Hevia then allegedly instructed the pharmacy staffs to submit fraudulent claims for $16.7 million for prescription drugs that were not medically necessary and not provided to the Medicare Part D beneficiaries.

In the second indictment, Ronald Dias, 28, of Miami used eight pharmacies that he owned and worked with two other Miami residents to defraud the Medicare Part D program of $10.4 million in fraudulently obtained claims. The indictment said the drugs were neither medically necessary nor provided to Medicare beneficiaries.

In the third indictment, four Miami residents are accused of receiving kickbacks and bribes to recruit Medicare beneficiaries to obtain prescriptions for drugs to be used through the OMG Pharmacy Discount with false claims filed to the Medicare Part D Program.

“Those who commit Medicare fraud through the filing of false claims, payment or receipt of kickbacks, or fraudulent medical practices jeopardize the integrity of the government benefit programs that countless citizens rely on for their well-being,” Ferrer said in a statement.

The various charges carry potential sentences each ranging from five years to 20 years in prison.

Since March 2007 in the Southern District of Florida, nearly 900 individuals have been charged in alleged frauds netting $2.5 billion through Medicare billings.

Part D prescription medicine coverage is the fastest-growing area of the Medicare program.  The federal government estimates as much as $10 billion of last year’s $120 billion in Medicare Part D spending may be fraudulent.

Click here for full story.

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Filed under Insurance Fraud, Medicare, Southern District of Florida