Category Archives: Miami-Dade County

Two Miami Medical Clinics Raided for Staged Accidents & Insurance Fraud

Florida’s Department of Investigative and Forensic Services Bureau of Insurance Fraud and the Miami Police Department raided two South Florida medical clinics accused of paying for patients and fraudulent billing. Both clinics have been under investigation since early 2017 for recruiting people for staged accidents and billing insurance companies for thousands of dollars in treatments that they were not providing.

According to Captain Emissael Díaz of Florida’s Bureau of Insurance Fraud “Just in South Florida alone, most of your rates are going to go up 20 to 25 percent just because of the insurance fraud.” The captain stated that schemes of this kind are the reason insurance rates are going in South Florida.

The suspects taken into custody are facing several charges, including patient brokering, insurance fraud and grand theft.

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Filed under Florida, Florida Division of Insurance Fraud, Insurance, Insurance Claims, Insurance Fraud, Miami-Dade County, Miami-Dade Fraud

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

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

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

Trooper Fired and Arrested for Helping Friend Cover Up Crash

Florida Highway Patrol Trooper David Casillas was arrested on Tuesday, February 28th and charged with organized fraud, filing a false insurance claim and official misconduct after trying to help a friend cover up a traffic crash that occurred in June of 2015. FHP fired Casillas in January as a result of the investigation which lasted over a year.

During the investigation, it was discovered that Casillas had written a false report for a bogus insurance claim submitted by his friend, dentist Jesus Del Valle. The insurance claim was submitted as a result of damage the dentist had done to his vehicle when he sideswiped a landscaping crew and kept driving.

Del Valle’s crash left Yoel Montero, a gardener with Lewis Tree Service, with a traumatic head injury and severe injuries to his right leg. The false insurance claim alleges that the accident happened a week later than it actually happened and that he had crashed the SUV into a palm tree instead of a landscaping crew.

The key to breaking the case was the fact that Del Valle’s 2015 Land Rover needed a new passenger-side mirror which could only be ordered from Range Rover manufacturers. Only one such had been sold in that time period and it was to Del Valle’s mechanic (and friend) Ariel Perera who performed the repair on his vehicle. Perera also allegedly submitted inflated invoices to Del Valle’s insurance company as well as charged the company for replacement parts that were never actually replaced. He is also facing charges with Del Valle and Casilla.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Fraud, Miami-Dade County

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

Miami Woman Arrested and Charged in Insurance Fraud Scheme

According to the Palm Beach Post, Carmen Montalvo-Rivera of Miami was arrested and charged in Lake Worth, FL on Thursday, October 27th after investigators say she defrauded SUNZ Insurance Company. The arrest report states that Montalvo-Rivera’s shell company, Enterprises Remodeling Group Inc., used uninsured employers to do construction work. Once the job was finished, she would then cash the checks made out to the shell company in order to pay the workers in cash and severely underreport her company’s wages to the insurance company.

Montalvo-Rivera reported Enterprise Remodeling Group’s wages at $26,665 when they were actually $4,307,092.48. Her insurance premium should have been between $327,000 and $525,000 instead of the $1,796 premium she had been paying due to her fraudulent reporting.

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Filed under Florida, Insurance, Insurance Fraud, Miami-Dade County, Uninsured

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.

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Filed under Insurance Fraud, Miami-Dade County

Three from Miami Sentenced in $40M Medicare Fraud

Jorge Lorenzo, Yahima Pardo and Roberto De Jesus Alonso, all of Miami, were sentenced to prison and ordered to pay more than $40 million as a result of their involvement in what is considered the Medicare fraud scheme that caused the greatest loss to the government in 2015.

In addition to the nearly $40.4 million in restitution, the government seized over $2 million in cash and personal assets including Rolex and Cartier watches and artwork by prominent Cuban artists.

The case, before U.S. District Judge William Dimitrouleas, centered around Lorenzo’s ownership or control of 8 home health agencies in Miami-Dade County that received in excess of $40 million from Medicare as a result of fraudulent claims by way shell owners at each agency funneling claim payments to other fictitious companies staffed by co-conspirators. Once indication of a Medicare fraud investigation arose, Lorenzo would close the home health agency, keeping them open for only 8 months on average.

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Filed under Florida, Insurance Fraud, Medicare, Miami-Dade County, Uncategorized

Miami PIP Attorney Charged With Insurance Fraud

Miami attorney Anett Lopez was arrested on charges of taking part in a $1.5 million personal injury protection (PIP) fraud scheme.

Lopez is accused of filing lawsuits seeking reimbursements for the treatment of patients at Care Resources Group, a Miami healthcare clinic fraudulently operated under a straw owner.

A February investigation by the Florida Division of Investigative and Forensic Services (DIFS) uncovered that Care Resources Group was a PIP clinic illegally operating under a straw owner to avoid state licensing requirements. Lopez, straw owner Dr. Mario Torres and four others were arrested for alleged money laundering and soliciting of car accident victims in connection with the straw ownership of the clinic.

Lopez, who state authorities say was aware of the clinic’s straw ownership, filed lawsuits against at least a dozen insurance companies that resulted in payouts of nearly $1.5 million. Lopez faces seven counts each of insurance fraud and grand theft, and one count of organized scheme to fraud. She faces up to 85 years in prison if convicted of all 15 felonies.

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Filed under Fla. Stat. 627.736 (2012), Florida Agency for Health Care Administration (AHCA), Health care, Insurance Fraud, Miami-Dade County, Personal Injury Protection, PIP/No Fault