Dr. Lherisson Domond, a Coconut Creek physician, fronted ownership of the Unity Pain and Injury Center clinic for most of 2012 in exchange for monthly payments of $1,500, according to the Florida Department of Financial Services.
Domond admitted that he agreed to be paid for the use of him name as owner of the unlicensed medical clinic. Further investigation revealed that Nesly Loute of Naples and Pierre Alex Herisse of Orlando actually managed the clinic’s operations.
In investigating Unity Pain and Injury Center, the Division of Insurance Fraud discovered that the clinic illegally provided medical treatment and physical therapy to individuals involved in automobile accidents. The clinic then billed the treatments to various insurance companies under the PIP coverage of patient insurance policies.
The three individuals face felony charges for fraud, operating an unlicensed clinic, and grand theft, all of which carry sentences of up to 30 years.
The Division of Insurance Fraud reports that it has made 249 PIP arrests since July 1, 2014.
Click on the link to read the news announcement about the Unity Pain and Injury Center.
Miami is one of the latest cities to be targeted by the controversial ride-sharing services of Lyft and UberX. Using smartphone apps, the companies connect drivers with riders via the Internet.
The taxi industry is mounting strong objections to the new services. In Miami, licensed taxi drivers have called on Miami-Dade County Commissioners to jail drivers who have been hired by the rideshare services. The City has already levied fines, conducted undercover sting operations, and impounded vehicles of Lyft drivers, according to a recent Miami Herald article.
Uber has a big war chest to withstand legal challenges. The company recently raised $1.2 billion in new funding, giving it a valuation of $18 billion. Started as a luxury car service in 2009, the company later rolled out the UberX low-cost service featuring non-professional drivers who use their personal cars.
Many questions about insurance coverage cloud the controversy, including the items outlined below.
- The transporting of people or goods for hire is normally excluded under a personal auto policy.
- Rideshare drivers who operate a personal auto covered by a consumer auto policy run the risk of being denied coverage in the event of an accident. In a tragic New Year’s Eve accident, for example, an Uber driver struck and killed a 6-year old pedestrian.
- Passengers and third parties that sustain personal injury or property damage may not have access to full insurance benefits when an accident involves a rideshare driver operating a private auto under a personal auto policy.
- If the rideshare driver fails to inform the insurance carrier of livery-related usage of their private auto, the carrier may attempt to void the policy for misrepresentation.
- Private vehicle insurance coverage for a blended use of personal and commercial applications is not a standard industry practice, meaning that states and courts have not had a chance to consider and test all the legal implications.
Uber now operates in 128 cities across 37 countries, according to Reuters. Competitors include Lyft, Sidecar, Flywheel, and Hailo. Some services use mobile apps to hail a licensed taxi, while others rely on private individuals as drivers.
Click on the links to read more about Uber and Lyft.
On April 16, 2014, Roig Lawyers Partner, and Board Certified Trial Attorney, Jeff Tutan presented at the Medical Claims Defense Network Conference in Orlando, Florida. Jeff Tutan, head of the firm’s trial practice group, discussed his recent success at jury trial in a case involving a medical provider’s claim for reimbursement for “mobile x-ray” services. During the round table presentation, Attorney Tutan discussed how he, partner Jessica Martin, and senior associate attorney Jenna Hackman, successfully defended such a case involving these increasingly prevalent medical services.
For more information, contact attorney Jeff Tutan at firstname.lastname@example.org.
Conducting insurance transactions without a Florida license landed agency owner Amada Ruz, 69, in jail this week. She was released the same day after posting a $4,500 bond.
Ruz was first arrested in August 2012 for selling a fake driver license. The insurance agency was also suspected of producing fake insurance cards and immigration documents. The Florida Division of Insurance Fraud filed a probable cause affidavit at the time. Ruz was released on $3,000 bond following the 2012 arrest.
The State revoked the insurance license of Ms. Ruz in April of this year, several months following her guilty plea on charges of unlawfully manufacturing identification cards.
An agent of the Florida Division of Insurance Fraud was conducting a routine follow up investigation in July 2013 when he found Ruz working at her insurance agency, Vizon Insurance, in Lake Worth. The agent warned Ruz that she was required to stop conducting insurance business.
One month later, in August, Ruz was again discovered to be conducting insurance business when the Florida Division of Insurance Fraud carried out another on-site visit.
Florida Division of Corporation records show Vizon Insurance as being active, although Ruz is not currently listed as an officer or director. The agency has been in business since 2007.
Florida Wellness & Rehabilitation Center owner, Mark Cereceda, surrendered Friday to charges of illegal campaign donations throughout Florida. The owner of the Hialeah injury clinic, a chiropractor himself, donated over $25,000.00 from 2010 to 2012 to the campaigns of: Florida Senate President Don Gaetz, state Sen. Joe Negron and Miami-Dade County Commissioner Rebeca Sosa in addition to candidates for state representative Carlos Trujillo, Katie Edwards and Eddy Gonzalez. Cereceda and his brother, Kemel Cereceda, were in jail Friday night on felony charges. Cereceda is charged with illegally forcing his employees to donate to these campaigns and reimbursing them for these donations in violation of Florida law.
Mark Cereceda was recently in the news due to his involvement with former county court judge Ana-Maria Pando. According to the Miami Herald:
Detectives began investigating after news broke last year that Ana Maria Pando, a Hialeah-branch county court judge, had penned a letter to state authorities — on official letterhead — asking that Cereceda’s company be reinstated.
The clinic had let its business license lapse. The Florida Division of Corporations treated the judge’s letter as a court order and reinstated the company for free.
Pando was investigated for ethics violations, a probe eventually dropped when she lost a reelection big last year and she agreed not to run again. At the time, companies affiliated with Cereceda had cases pending before Pando. And Cereceda also contributed to her reelection campaign. The Florida Judicial Qualifications Commission accused Pando of not reporting a “financial gift” from Cereceda.
The full article from the Miami Herald is available here.
“Operation Never Ends,” the multi-organizational investigation organized by Miami police, the Secret Service, local and state agencies and insurance companies, has led to the closure of two clinics involved in staging accidents and making fraudulent insurance claims.
The more than one year long operation led to the arrest of, among others, Jorge Felix Felipe Pupo, 49, accused of being the ringleader, and Yanaris Ramirez Paneque, 36, a receptionist at one health clinic, according to authorities. According to the report from NBC 6:
Police say they went undercover inside a medical building in the 700 block of Northwest 23rd Avenue and at another location near Flagler and the Palmetto Expressway.
Detectives said recruiters would find those willing to participate in the staged accidents, then bring them to medical clinics where paperwork was done to get money back from insurance companies.
Police Sgt. Luis Taborda explained the scheme.
“The clinics are the main,” he said. “They provide the money to a runner and the runner puts together the crash — orchestrates the crash.”
Police said the ring was making big money on the claims.
“I could tell you that in one investigation that we did at the beginning, they were up to $80,000 before we shut them down — in just one crash,” Taborda said.
The article from NBC 6 South Florida is available here.
Wednesday, Volusia County chiropractor, Joseph Wagner, was sentenced to 15 years in federal prison and $2 million in restitution as a result of years of healthcare fraud. Wagner, in addition to billing insurance companies and Medicare for services never rendered, illegally prescribed controlled substances under another doctor’s name. Patients who were without insurance paid Wagner $100 cash each month for these prescriptions.
According to the Orlando Sentinel article on Wagner’s sentencing:
Senior U.S. District Judge G. Kendall Sharp said Wagner relegated the trust he had as a chiropractor, and now taxpayers will have to pay the price for his fraud.
The full article is available here.
See also: Volusia County Chiropractor Pleads Guilty to Federal Charges of Illegally Prescribed Drugs, Healthcare Fraud
On Tuesday, Broward county chiropractor Jennifer Adams, 39, of Boca Raton, admitted to one count of conspiring to commit mail fraud and agreed to pay more than $1.92 million in restitution to 10 insurance companies.
Adams permitted her name to be used to create two chiropractic clinics: Ovy Rehabilitation Medical Center, Inc. in West Palm Beach, and Chiropractic Office of South Florida, LLC in Palm Springs. Both clinics submitted fraudulent PIP claims on behalf of individuals involved in staged accidents.
Adams, a chiropractor in Florida since 1999, agreed to relinquish her medical licenses. According to the Sun-Sentinel report:
The maximum punishment is 20 years in prison and a fine of $250,000 though she will likely face a much lesser penalty when she is sentenced by U.S. District Judge Daniel T. K. Hurley in federal court in West Palm Beach in the next several weeks.
The full story is available here.
Two more arrests were made as a result of a personal injury protection (PIP) fraud scheme in Manatee County involving patient brokering. The arrests of Nerber A. Iglesias, 40, and Michael Borkowski, 42, were the result of an undercover sting, according to an announcement made by Florida Chief Financial Officer Jeff Atwater.
According to the Claims Journal report:
An investigation by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Iglesias approached a Sarasota chiropractor about becoming the straw owner of Garden Relief Center, LLC. The chiropractor contacted law enforcement and, under the direction of the department, applied for a clinic exemption certificate to begin operating the facility. The chiropractor, working undercover, was also contacted by a local body shop owner named Michael Borkowski, who made arrangements to provide accident patients to the clinic for a fee. During the course of the investigation, Garden Relief Center submitted almost $40,000 in fraudulent insurance claims to six different insurance companies.
The full article is available here.
Tampa Bay Fox 13 recently featured a segment regarding the effect of House Bill 119, the 2012 PIP law change, on PIP premium rates. Lynne McChristian of the Insurance Information Institute, shed some light what appears to be a lack of a premium decrease. McChristian indicates that the recent insurer reports are not indicative of what could likely be the case after January 1, 2013, when all of HB119’s changes take effect.