Author Archives: Mark J. Rose, Esq.

Crooked Opioid Treatment Center Owner Arrested for Insurance Fraud

James Durkin, owner of a Boynton Beach opioid treatment facility The Hope Center of Recovery, has been arrested for insurance fraud. Durkin was charged for allegedly submitting fraudulent insurance billing for over $104,000.

CFO Jimmy Patronis said, “Insurance fraud at crooked addiction treatment centers fuels the ongoing opioid epidemic in Florida.” An investigation revealed Durkin’s was falsified billings to Cigna and United Health Care for addiction recovery treatments that were never performed.

Durkin faces up to 30 years in prison.

Click here to read the press release.

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Filed under Uncategorized

Palm Beach County Business Owner Charged with Workers’ Compensation Fraud

According to the Florida Department of Financial Services, Vanessa Arreguin, owner of V&G Concrete, Inc. was arrested in August for three felony counts of concealing payroll to avoid workers’ compensation premiums and two felony counts of application fraud. Arreguin claimed she made less than $50,000 will conducting more than $7.5 million in business to avoid paying $51,000 in workers’ compensation.

Florida Chief Financial Officer (CFO) Jimmy Patronis said, “Last year alone, our fraud detectives made more than 400 arrests for workers’ compensation fraud and I can assure you my office will continue to hold these individuals accountable.” Arreguin could face up to 20 years in prison if convicted.

Click here to read the press release.

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Filed under Insurance Fraud, Uncategorized

FL Insurance Commissioner David Altmaier Warns Homeowners to Protect Themselves

Florida Insurance Commissioner David Altmaier issued a warning to residents facing damage from Tropical Storm Gordon be careful and to make sure they fully read and understand any documents they sign in Gordon’s aftermath. Altmaier has been an outspoken critic of the ongoing assignment of benefits abuse happening in the state of Florida.

Many insurers throughout Florida have been seeing an uptick in litigation due to the inflated and fraudulent claims stemming from unlicensed contractors who have homeowners sign over their insurance policy rights in exchange for needed repairs to their homes.

Florida Chief Financial Officer Jimmy Patronis also issued a warning to consumers to protect themselves against fraud and has activated the Florida Department of Financial Services Disaster Fraud Action Strike Team (DFAST) for the 2018 hurricane season.

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Filed under Assignment of Benefits, Property Insurance

Pinellas County Sheriff Going After Unlicensed Contractors

Thirty people were arrested in a three-day sting to “flush-out” unlicensed contractors preying on property owners in Pinellas County. The sting produced at least 60 felony and misdemeanor charges against the violators. Operation Flush Out is Sheriff Bob Gualtieri’s third sting since October 2017.

A Tampa Bay Times’ investigation in 2017 revealed how the Pinellas County Construction Licensing Board preferred to punish unlicensed contractors with fines rather than pursue violations in criminal court. Contracting without a license carries a misdemeanor for first-time offenses and a felony the second time.

Pinellas County government took control of the agency on July 1st. Gualtieri launched the Construction Licensing Investigative Unit and trained deputies to investigate contracting crimes. The department’s previous stings in October and February netted more than 45 arrests and dozens of charges.

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Filed under Insurance, Property Insurance

Florida Public Adjuster Sentenced in $14M Insurance Fraud Plot

Corrupt public adjuster Jorge Fausto Espinosa recruited dozens of homeowners via his firm, Nationwide Adjusters, in an insurance fraud plot where he inflated insurance claims to the tune of $14 million.

Espinosa paid marketers to lure homeowners with free kitchens and remodeling jobs if they allowed him to manufacture damage to their homes. He earned around 30% of the insurance payouts he lined up for the homeowners. Espinosa earned payouts of more than $317,000 at times.

Insurers were pushed to pay overblown insurance payouts from claims resulting from rigged fires to water damaged. Espinosa hit at least 14 insurers with more than 50 inflated claims. He was sentenced to 20 years in state prison for racketeering and insurance fraud among many other charges.

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Filed under AOB, Florida, Florida Division of Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Property Insurance

Two GEICO Adjusters Charged in Miami Insurance Fraud Ring

On Monday, July 10th, 14 people were charged in “Investigation Vehicle Roulette” conducted by Florida’s Bureau of Insurance Fraud and the State Attorney’s Office. Two GEICO insurance adjusters, Juan Carlos Diaz and Cesar Santiago Tapanes, prosecutors say got cash kickbacks for helping defraud their own company were among those arrested.

In September 2016, a Lexus GS350 was involved in a fender bender with a Chrysler 320 in North Miami-Dade. The rogue insurance adjusters reported inspecting the Lexus and authorized a series of payments totaling over $16,000. However, investigators say the accident never actually happened.

In fact, the same Lexus had been the subjection of 10 previous claims involving crashes that never occurred, all signed off by Diaz and Tapanes. The scam ended up costing GEICO more than a million dollars.

According to an arrest warrant by detectives, at least 45 bogus claims were made. The group faces charges including grand theft, insurance fraud, and racketeering.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Florida Division of Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud

UPDATE: Ringleader Pleads Guilty To His Role In $23 Million Auto Insurance Fraud Crime Ring

Andrew Rubinstein of Miami and the self-confessed ringleader, Felix Filenger of Sunny Isles pleaded guilty to a racketeering conspiracy charge last year. Rubinstein and Filenger were paying kickbacks to tow truck drivers and body shop workers who illegally steered accident victims to chiropractic clinics they owned at a rate of $1,500 to $2,000 per “patient.” Clinic workers would then have patients attend multiple visits, document exaggerated pain levels, and bill insurance providers for treatment in the amount of $10,000, the maximum allowed under Florida law.

According to Prosecutors, the clinics were located throughout south and central Florida, including Sunrise, Hollywood, Hallandale Beach, Pompano Beach, Delray Beach, West Palm Beach, Miami, Orlando and Kissimmee.

Under the terms of his plea agreement, both sides had agreed to recommend the six-year sentence for Rubinstein. Filenger’s sentencing has been postponed. Several other people who also admitted their roles in the fraud are scheduled for sentencing later this year.

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

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Filed under Auto Insurance Fraud, Florida, Fraud, Insurance, Insurance Fraud, Personal Injury Protection, PIP, PIP/No Fault

Minor ADA Violations Cost Florida Businesses Thousands in Attorneys Fees

Central Florida businesses being sued by a Daytona Beach attorney for potential violations of the Americans with Disabilities Act are awaiting a federal ruling to determine whether they’ll have to pay settlements in the form of attorney fees. The law forbids plaintiffs from receiving money for “relief” regardless of a court’s decision.

The alleged violations are often quick fixes, but they can cost businesses thousands in legal fees and settlement costs that could be passed on to customers.

More than three dozen Central Florida businesses have recently been hit with almost identical lawsuits filed by attorney Joe Quick. Quick represents the same four clients, often referred to as “testers” by some critics, in each lawsuit filed in the U.S. District Court for the Middle District of Florida.

Last legislative session, State Rep. Tom Leek introduced and passed legislation that allows business owners to hire ADA experts to inspect their businesses. Businesses are able to apply for a grace period to fix violations, but so far, only two businesses in the state have done so. Click here for more information on the Florida Department of Business and Professional Regulation’s ADA Title III Registry.

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Filed under ADA, FL Legislation, Florida, Lawsuits

Ringleader Pleads Guilty To His Role In $23 Million Auto Insurance Fraud Crime Ring

According to the Sun Sentinel, Felix Filenger of Sunny Isles, pleaded guilty this week to his role in an elaborate crime ring that operated at several South Florida chiropractor clinics. The fraud totaled at least $23 million from 10 auto insurance companies over the last seven years, per court records.

Federal prosecutors say Filenger and Andrew Rubinstein took over troubled clinics and hid their ownership by having chiropractors and other people register the practices in their names. The men told chiropractors what treatments they wanted to be performed, based on the potential revenue from the services, prosecutors said. Medical staff who refused to “play ball” were fired, they said.

Filenger admitted he, and other group leaders, paid kickbacks of $1,500 to $2,000 – per patient – to tow truck drivers and body shop workers who agreed to illegally steer accident victims to chiropractic clinics that were secretly owned by Filenger and his allies.

Filenger plead guilty to one count of racketeering conspiracy on Monday in federal court in Miami and is scheduled to go to trial on January 8.  Two co-defendants, who are still scheduled for trial that day, may plead guilty to related charges on Wednesday, court records show.

Andrew Rubinstein, 48, of Miami, is jailed on charges of racketeering and mail fraud conspiracies, wire fraud, health care fraud, and making false statements.

Olga Spivak, 59, a chiropractor from Hollywood, is free on bond. She faces the same charges.

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Filed under auto insurance, Auto Insurance Fraud, Broward County, Florida, Florida Division of Insurance Fraud, Insurance Fraud, Miami-Dade County, Palm Beach County, Personal Injury Protection, PIP, PIP/No Fault

UPDATE – Pilot Theodore R. Wright III Pleads Guilty to Insurance Fraud

UPDATE – Pilot Theodore R. Wright III Pleads Guilty to Insurance Fraud

According to KLTV 7 of Texas, Theodore R. Wright III, the well-known pilot who survived a 2012 Gulf of Mexico crash and used an iPad to record his time in the water, has pleaded guilty to conspiring to commit wire fraud and conspiring to commit arson. Wright and three others also pleaded guilty to buying, over-insuring and ultimately destroying planes, boats, and cars to collect cash.

In May 2017, the Wright and his co-conspirators, Shane Gordon, Raymond Fosdick, and Edward Delima were charged with using fire to commit a felony and aiding and abetting, arson of property used in interstate or foreign commerce or used in an activity affecting interstate or foreign commerce, conspiracy to commit wire fraud, and wire fraud.

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