Author Archives: Mark J. Rose, Esq.

New Statute To Help Deflect Frivolous ADA Lawsuits

As reported in the Miami Herald, Florida lawmakers have implemented a new law aimed at ADA public accommodation compliance lawsuits often pressuring small businesses and property owners into quick settlements in order to avoid lengthy and costly court battles. In an analysis published in March by The News-Press (Fort Myers), of all the lawsuits filed under the ADA’s public accommodations law in Florida during the past five years, more than half of the approximately 6,000 suits were filed by just 12 plaintiffs. In addition, many of the plaintiffs are represented by the same law firms. The bill, receiving unanimous approval in both the Florida House and Senate during the 2017 legislative session, was recently signed into law by Gov. Rick Scott and is now in effect.

The new statute enables businesses and property owners to take substantive, preventative measures to help insulate themselves from the most frivolous claims. Under the law, a business or property owner may retain a qualified expert to conduct an inspection of their property to ensure compliance with building codes satisfying the ADA’s requirements. If the property is found to be in compliance with the ADA, the expert may issue a certificate of conformity that includes the date of inspection, proof of the expert’s qualifications, and a statement confirming that the property is in conformity. For properties that are not found to be in compliance, the owner may develop and submit a remediation plan approved by a qualified expert indicating that the property will be brought into conformity within a specified time period.

The compliance certifications or remediation plans may be filed with the state’s Department of Business and Professional Regulation, which will now maintain a publicly accessible website to serve as a registry for all of the certifications and remediation plans that it receives. Importantly, a remediation plan in existence before an ADA lawsuit is filed could serve to moot such a lawsuit.

The new law does not prohibit disabled plaintiffs from filing ADA public accommodations lawsuits, nor does it prohibit plaintiffs’ attorneys from seeking fees. It does, however, provide Florida businesses and property owners with a means to potentially defeat or limit frivolous ADA barrier-to-access lawsuits and greatly minimize their exposure to related attorney fees and costs.

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Filed under ADA, FL Legislation, Florida, Lawsuits

Pilot Theodore R. Wright III Faces Decades in Prison for Insurance Fraud

As reported by Flying Magazine, rising social media star Theodore Robert Wright III who gained notoriety for chronicling his larger-than-life flying exploits in photos on Facebook and Instagram has been charged with intentionally crashing his plane into the Gulf of Mexico to collect insurance money. Wright is facing serious prison time after federal law enforcement officials charged the 32-year-old with multiple counts of insurance fraud.

Wright and three associates (Shane Gordon of Texas, Raymond Fosdick of South Carolina, and Edward Delima of Hawaii) are charged with being involved in the destruction of a 1971 Cessna Citation, a Lamborghini Gallardo and a luxury sailboat in Hawaii, all to collect insurance payouts.

That’s not where the alleged fraud ended, prosecutors say. In an indictment filed in U.S. District Court in Tyler, Texas, Wright and three associates are charged with multiple felonies. Besides the Baron, officials say Wright was involved in the destruction of a 1971 Cessna Citation, a Lamborghini Gallardo and a luxury sailboat in Hawaii, all to collect insurance payouts. Prosecutors allege the men would acquire vehicles, insure them, destroy the vehicles and then collect the insurance money, a conspiracy that lasted from March 2012 to March 2017, according to the indictment.

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Filed under Insurance, Insurance Claims, Insurance Fraud

ROIG Attorneys Publish Ridesharing Article in Daily Business Review

ROIG Lawyers Attorneys Cecile S. Mendizabal and Lissette M. Alvarez published the article, “Ridesharing Legislation May Trigger New Wave of Litigation” in the Daily Business Review.

ROIG Lawyers Summer Law Clerk Yasbel Perez also contributed to the article.

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Filed under auto insurance, Claims Handling, FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense, Personal Injury Protection, PIP, PIP/No Fault, Ridesharing, Transportation Network Companies

Florida Doctors With Multiple Malpractice Settlements Face Little Discipline

According to Health News Florida, there are 29 Florida doctors operating with clear medical licenses although they have at least six malpractice complaints against them that have resulted in insurance payments since 2000. These doctors are continuing to practice without discipline from the state system that oversees them, which means either insurers paid to settle the cases that had no merit or the state hasn’t always followed up.

Critics say Florida’s system is broken and it’s putting people’s lives at risk. Dr. Sidney Wolfe, founder of the Public Citizen Health Research Group, based in Washington D.C has studied medical discipline nationwide for decades and says Florida’s Board of Medicine must intervene.

Patients and their families can also file a complaint with the state’s regulatory agencies, although the odds are stacked against them. 6,713 complaints and reports were filed with the Department of Health from 2015-2016. Only about 15 percent or 1,018 of them were found “legally sufficient.” Of those, 762 were taken to a probable cause panel, and three-fourths were rejected. The 188 administrative complaints filed that year represent less than 3 percent of the number of complaints and reports that came in.

In some cases involving doctors with multiple claims, records show the Department of Health received early warnings, but took little or no action. One of those cases was that of Dr. Michael Rosin, a Sarasota dermatologist who was convicted in March 2006 of defrauding Medicare of more than $3 million in a scheme that dated back more than a decade. He was sentenced to 22 years in prison and ordered to pay millions of dollars in restitution. After his criminal conviction, the Department of Health revoked his license, according to state records. Federal records show that Rosin, now 66, is at Otisville Federal Correctional Institution in Otisville, N.Y. He is scheduled for release in 2025.

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Filed under Department of Health, DOH, Florida, Florida Healthcare, Health care, Insurance, Malpractice

Geico Sues Florida Health Clinic for ‘Unnecessary’ Massage Claims

As reported by Law360, Geico sued Medical Wellness Services Inc. of Miami, FL for allegedly making $1.2 million in claims for providing medically unnecessary treatments for automobile accident victims who were eligible for coverage under their no-fault insurance policies. According to Geico, some of the claims were for services that were not actually provided and contained billing codes that misrepresented and exaggerated the services.

“The defendants do not now have — and never had — any right to be compensated for the fraudulent services that were billed to Geico through Medical Wellness,” Geico said. Geico claims Medical Wellness Services Inc. submitted claims for massage therapist services which are not reimbursable because Florida law prohibits no-fault insurance reimbursement for massages or other similar services.

According to the suit, the scheme began no later than 2013 and continues to this day. In addition to the request for $1.2 million in damages, Geico is also requesting a declaration from the court saying it will not have to pay any pending fraudulent claims by the health clinic which totals more than $75,000.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Miami-Dade County, Miami-Dade Fraud, Personal Injury Protection, PIP/No Fault

UPDATE: Sixth Person Found Guilty in Unlicensed Chiropractic Clinics Scam

A Naples man convicted of committing mail fraud back in September of 2016 has been sentenced to 14 years in prison. According to the Naples Daily News, Nesly Loute, was also ordered to pay restitution of almost $2.15 million to the insurance companies.

Loute and five others plead guilty and were convicted of operating five unlicensed chiropractic clinics and fraudulently billing auto insurers for Personal Injury Protection benefits.

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

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Filed under auto insurance, Auto Insurance Fraud, Florida, Insurance Fraud, Personal Injury Protection, PIP, PIP/No Fault, Unlicensed Clinics

Chiropractor’s Challenge To ‘PIP’ Law Kicked Back By Appeals Court

In a 14-page ruling on Wednesday, February 15th, the 3rd District Court of Appeal upheld part of a 2012 overhaul of the state’s personal-injury protection auto insurance system that limits No-Fault (Personal Injury Protection) benefits to $2,500 for individuals who were not diagnosed with an emergency medical condition. The appeals court overturned a judge’s decision in a Miami-Dade County court citing arguments that the 2012 law overhaul was intended to help prevent fraud in the PIP insurance system, but was unconstitutional.

The ruling was in response to chiropractor Eduardo Garrido’s legal victory against Progressive American Insurance Company. Garrido was seeking a determination that the insurer should pay up to the policy limit of $10,000 in the absence of diagnosis that the patient suffered an emergency medical condition as the result of an automobile accident. He also challenged that it was unconstitutional to bar chiropractors from being able to diagnose patients with having suffered an emergency medical condition. The chiropractor treated a patient after an accident in 2013 and submitted invoices to Progressive who only paid $2,500 of the $6,075 billed. According to Progressive, there had been no determination, other than Dr. Garrido’s, a chiropractor, that the patient suffered an emergency medical condition.

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Filed under FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense, Miami-Dade County, Personal Injury Protection, PIP/No Fault

Two Pharmacies in Florida to Pay $750k for False Billing

U.S. Attorney’s Office, Middle District of Florida announced that Lemon Bay Drugs North, Inc. in North Port, FL and Brooksville Drugs, Inc. operating in Brooksville, FL have agreed to pay a total of $750,000 to the government to resolve allegations that the pharmacies violated the False Claims Act.

Both pharmacies are managed by Benzer Pharmacy Holding LLC and are owned by Alpesh Patel.

The allegations were that Lemon Bay and Brooksville Drugs provided Medicare and Medicaid patients generic versions of certain medications, but charged Medicare and Medicaid for the brand name versions of those medications. These allegations were initiated in a lawsuit filed by a whistleblower who was a former pharmacy technician who worked at Lemon Bay Drugs. The whistleblower will receive $142,500 as her share of the recovery.
This investigation was handled by Assistant U.S. Attorney Kyle S. Cohen with assistance from the Department of Health and Human Services – Office of Inspector General, the Defense Criminal Investigative Service, the FBI, the Florida Medicaid Fraud Control Unit, the North Port Police Department, and the Sarasota County Sheriff’s Office.

According to the Department of Justice, the claims resolved by the settlement are allegations only, and there has been no determination of liability.

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Filed under Florida, Health care, Insurance, Insurance Fraud

Sixth Person Found Guilty in Unlicensed Chiropractic Clinics Scam

According to Southwest Florida Online News, a federal jury found Nesly Loute guilty of fraud after a six day trial where he and five others testified that they had conspired to operate five unlicensed chiropractic clinics and fraudulently billing auto insurers for Personal Injury Protection benefits. This ruling was the culmination of a two-year law enforcement investigation dubbed Operation Fraudulent Pain.

Loute and five other individuals who have also pleaded guilty are facing a maximum penalty of 20 years each in federal prison and must make restitution to the insurance companies they have defrauded. The unlicensed chiropractic clinics had received more that $2 million in fraudulent PIP payments.

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Filed under Auto Insurance Fraud, Florida, Insurance Fraud, PIP/No Fault, Uncategorized

Third DCA at Odds With Another Court After OKing Red-Light Cameras

The Third District Court of Appeal ruled in favor of red-light camera programs, setting up a disagreement between appellate courts and likely meaning the issue will go to the Florida Supreme Court.

Red-light cameras run by municipalities have long come under fire from critics. Opponents decry the fact that traffic tickets can be given out by someone other than a police officer, especially a private company. That’s exactly what the Fourth DCA said in 2014, ruling that red-light cameras are an unlawful delegation of police power to the third parties issuing the tickets.

The Third DCA said the most recent case was a bit different though. Judges Thomas Logue, Kevin Emas and Linda Ann Wells ruled that it was legal for municipalities to hire private companies to review traffic images and decide which ones to forward to police officers. However, the Third DCA judges said a sworn police officer is required to review the evidence for a final decision and not just rubber-stamp the third-party recommendations.

The Third DCA case arose from a suit challenging red-light cameras in Aventura, while the Fourth DCA case concerned a similar program in Hollywood. Logue and Emas designated the case as one of great importance for the Florida Supreme Court to consider, while Wells asked to certify a conflict with the Fourth DCA.

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Filed under Uncategorized