Category Archives: Fraud

Pinellas County Detectives Arrest 35 Unlicensed Contractors in Undercover Sting

Pinellas County Detectives arrested 35 unlicensed contractors in an undercover sting operation coined “Operation Cast Out.” The suspects’ charges include unlicensed specialty contracting violations, workers compensation fraud, and various other criminal charges unrelated to unlicensed contracting.

The sting operation was conducted from November 3-5 at a vacant storefront in Madeira Beach. The unlicensed contractors were found advertising on social media platforms and came to the business agreeing to engage in illegal contracting work without a license or permit.

Citizens in Pinellas County can search for licensed contractors or report unlicensed construction activity by visiting the PCCLB website.

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Filed under Fraud

Three Unlicensed Contractors Banned for Post-Storm Fraud

According to the Florida CFO Jimmy Patronis, three unlicensed contractors in Leon, Gadsden and Gulf counties have been banned from soliciting and conducting any work in Florida pending a full investigation. The Disaster Fraud Action Strike Team is investigating additional reports of potential fraud in Bay, Gulf, Washington and Leon counties. CFO Patronis is stressing the importance of verifying professional license information and whether the company has workers’ comp insurance before you hire a contractor.

Here’s a list of Tips to Stop Post-Storm Fraud:

  • Beware of Crooked Contractors.
  • Don’t Sign Anything.
  • Too Good to Be True? It Probably Is.
  • Beware of Door-to-Door.
  • Check a License.

Click here to read the press release.

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Filed under Fraud

Owner of Medical Billing Company Pleads Guilty to Healthcare Fraud Scheme

According to the report, Billings USA received or created fabricated bills for its clinic customers. The clinics would then bill insurance companies for allowable amounts and create records to back up the charges.  Billings USA collected a 6% fee on the reimbursement from insurers. Palma’s company filed $5.7 million in fraudulent claims to Blue Cross Blue Shield with one clinic and then an additional $5.9 million in fraudulent claims to Blue Cross and Cigna with another clinic.

Mauricio Palma, the owner of medical billing office Billing USA in Miami, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to eight years in prison. Palma faces $2.1 million in restitution lost $1.8 million in forfeiture.

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Filed under Fraud, Healthcare Fraud, Healthcare Fraud

Florida Medical Professionals Charged in Largest Healthcare Fraud Crackdown In US History

Over 600 medical professionals in 35 states across the U.S. are on the hook for submitting more than $2B in fraudulent claims in what the U.S. attorney’s office is calling the largest healthcare fraud crackdown in the history of the Department of Justice. Of the 601 charged in this crackdown, almost 150 of the accused are from Florida.

Many of the crimes committed in this crackdown are linked to the opioid crisis, but also includes money laundering, check cashing and billings to Medicare.

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Filed under Fraud, Insurance Fraud

Deltona Man Charged With Arson in Insurance Fraud Scheme

Brian Lee Caswell of Deltona was arrested and charged with second-degree arson, arson resulting in injury, burning to defraud an insurer, giving false information to a law enforcement officer and making a false police report.

According to Caswell’s arrest warrant, he had hatched a plan with Alex Spivey of Orlando and Melinda Philbrook of Lady Lake to destroy their truck and collect an insurance payout. Caswell initially claimed the vehicle had been stolen, but later admitted planning the scheme after co-conspirator Spivey caught fire during the arson.

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

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.

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

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

Florida Man Charged with Theft and Fraud in Property Insurance Scheme

According to investigators, Roderick Clark of Indian Harbour Beach is facing charges after filing a false claim for more than $30,000 in hurricane damages last year.

Clark claimed his home had sustained electrical damage during Hurricane Irma including having to replace 11 outlets and electronic devices that did not belong to him. According to court records, Clark also submitted a forged letter from an electrical company to USAA Insurance Co. stating that they made repairs in the about of $31,350.67.

Clark was arrested and charged with grand theft and insurance fraud.

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Filed under Florida, Florida Division of Insurance Fraud, Fraud, Hurricane Irma, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Property Insurance

Pending PIP Litigation on the East and West Coasts Could Impact States In Between

PropertyCasualty360 published a report about pending automobile personal-injury litigation in California and New York that could have a lasting impact if the decisions spread to other jurisdictions. Courts will determine allowable evidence for suits involving these insurance claims.

East Coast

In New York, insurers investigated radiologist Andrew Carothers, a suspected illegal straw owner after he filed 20,000 lawsuits against auto-insurance carriers. After insurers refused to pay Carothers, he flooded the state’s courts with more than 20,000 lawsuits seeking collection for unpaid “services.” The civil cases were consolidated, and the jury agreed Carothers was fraudulently engaged in the corporate practice of medicine. The Appellate Division affirmed, so Carothers went to the New York Court of Appeals, where the case awaits a decision.

A favorable decision can deter scams like Carothers’ in other states that forbid the corporate practice of medicine. Fraudsters who often quickly expand operations to line their pockets in other states could be deterred. A decision is expected in 2019.

West Coast

Dave Pebley was involved in a serious vehicle accident, sought medical care and filed suit. He had health coverage but decided not to submit his bills for payment. That is because, under California law, the jury would only hear about the amount paid by his health insurer as the measure of his medical expense while Pebley was billed at the top rate for medical services by refusing to use his health insurance.

The insurer cried foul, asserting that such actions mislead the jury, and are fraudulent because medical providers never expect to receive such high payments. They argued the plaintiff may present the higher medical bills but must provide expert testimony to prove the charges are fair and reasonable. Similarly, the defendant or their insurer may present counter-evidence as to what the health providers normally accept for payment of those services.

The California Second District Court of Appeal reasoned that juries should be allowed to ultimately decide the appropriate charge for the medical services. Parties are lining up to support an appeal of the case to the state Supreme Court. If Pebley succeeds in California, potentially winning the $3.6 million he seeks, the strategy of refusing to use health insurance can be expected to spread rapidly to other states.

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Filed under auto insurance, Auto Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, PIP, PIP/No Fault, Uncategorized

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