Tag Archives: Auto Insurance Fraud

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.

Click here to read the full story.

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

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

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

Five Naples Residents Charged with Insurance Fraud

Five residents from Naples have been charged with auto insurance fraud, according to an article published by News-Press.com. The five individuals were involved in the operation of chiropractic clinics that defrauded several automobile insurance companies from June 2013 to February 2015.

According to the U.S. Attorney’s Office in the Middle District of Florida the following individuals were charged with insurance fraud and each charge carries a maximum penalty of 20 years:

Garry Joseph, 36, was charged with conspiracy to commit mail fraud.

Nesly Loute, 51, was charged with conspiracy to commit mail fraud.

Wisler Cyrius, 34, was charged with conspiracy to commit mail fraud and conspiracy to commit money laundering.

Anouce Toussaint, 32, was charged with conspiracy to commit mail fraud.

Sijames Melus, 32, was charged with conspiracy to commit mail fraud.

According to the article, Joseph and Melus paid licensed healthcare practitioners to allow their names to be used in official documents and submitted claims of services to accident victims treated at the clinics. The clinics involved with Joseph and Melus are Parkway Medical and Rehab LLC and Collier Chiropractic Center. In addition, Cyrius, Loute, and Toussaint are charged with filling fraudulent claims at Tamiami Pain and Rehab LLC and First Choice Pain and Rehab Inc. According to the article, Cyrius, Loute, and Toussaint attempted to recruit other participants in staged car accidents in exchange for money.

Click here to read the article.

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Filed under Florida

South Florida Men Arrested For Insurance-Billing Fraud

On August 5, 2015, four South Florida men were arrested for their alleged involvement in insurance- billing fraud cases. According to The Florida Department of Financial Service’s Division of Insurance Fraud (DIF), they have been accused of orchestrating crashes and processing phony claims roughly totaling $145,000.

The first individual arrested was Nayef Casas Diaz, the owner of M&N Rehabilitation Center in Miami. According to DIF, Casas was charged for conspiring with bystanders to crash cars, call the police, and collect insurance money. There are suspicions that he paid the participants $1,000 each to receive treatment at M&N Rehab and another rehab facility.  The insurance company paid a total of $63,000.

The second and third individuals arrested Alexis A. Gonzalez and Erik A. Perez, directed an undercover state insurance-fraud agent to pose as a patient and sign documents for treatment that was never carried out. The undercover agent was given $1,000 compensation while the total arrangement produced over $11,000 in claims.

According to the State of Florida, the last offender, Vicente Ortiz Alpizar, was arrested for staging an accident resulting in over $70,000 in false claims. He is accused of receiving $1,500 from A&J Rehabilitation Center and D&J Rehabilitation Center in Miami, FL and received unnecessary treatments following these staged accidents.

Click here to read press release from the Florida Department of Financial Services.

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Filed under Auto Insurance Fraud, Insurance Fraud

Miami PIP Fraud Leads to Three Arrests

Three individuals from the Miami-Dade area, who have allegedly been involved in personal injury protection (PIP) fraud schemes, were arrested on June 30, 2015 by the Division of Insurance Fraud (DIF) in separate cases.

The first individual arrested was Mariela Quintana, a licensed massage therapist at D&J Rehabilitation Center in Miami. According to DIF, the 46-year old fraudulently billed for treatments never performed and signed off on treatment forms. Her role in the scheme resulted in more than $10,000 in fraudulent claims and is the second time in less than six months that she has been arrested for similar activities at the same clinic, DIF said. Quintana has been charged with Insurance Fraud, Grand Theft, and Organized Scheme to Defraud.

The second individual arrested, Noel Vazquez Lazo, organized a staged accident and paid for the policy of the at-fault automobile used in the accident. The 44-year old, paid participants in the staged accident to seek treatment for fake injuries. The PIP scheme resulted in filing claims totaling in excess of $89,000, according to DIF. He is charged with Organizing a Staged Accident, Insurance Fraud, and Grand Theft.

Last but not least, Rodney Fabian, 27, was charged with Solicitation, Patient Brokering, Insurance Fraud, and Grand Theft for his role for soliciting an individual of a hit and run accident and offering to pay for their treatment at a specific clinic, DIF reported. Fabian paid the individual $1,000 for seeking treatment at the specific clinic. However, the insurance company suspected the fraud scheme and refused to process the claims, which caused Fabian to demand the money back from the individual.

According to DIF, the three individuals face jail sentences ranging from 5 to 30 years and each case will be prosecuted by the Miami-Dade Office of the State Attorney Katherine Fernandez Rundle.

Click here to read press release from the Florida Department of Financial Services.

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Filed under Insurance Fraud

Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies

Dr. Troy Godsey and Renata Berriel Deazevedo were arrested in connection with an illegal insurance scheme involving multiple insurance companies and totaling more than $100,000. Godsey, a licensed chiropractor, served as an owner of the clinic, and Deazevedo managed the day-to-day activities of the business.

According to the Florida Department of Financial Services, Godsey and Deazevedo ran Spine Health Solutions PA in Orlando, and provided medical treatments to people who were injured in car accidents. The pair billed insurance companies for reimbursements for “patients” under their Personal Injury Protection coverage. Three insurance companies were billed nearly $300,000 for the alleged treatment of 20 injured individuals.

They both face more than 50 years in prison if convicted under the felony charges, including operating an unlicensed health care clinic, and filing false and fraudulent insurance claims.

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Filed under Insurance Fraud

Century Woman charged with Auto Insurance Fraud

The Florida Department of Financial Services Insurance Fraud Division charged Trisha Michelle Milstead a resident of Century, FL with one felony count of insurance fraud. Assistant State Attorney Greg Marcille stated that on September 8, 2014 Milstead was involved in a vehicle accident, but at the time her vehicle policy had lapsed for non-payment. She then reinstated her insurance policy on September 9, signing a statement that there had been no previous damage during the lapsed time period.  Two days after the policy was reinstated she filed a claim for the accident and damage associated.

Trisha Milstead remains in the Escambia County Jail with bond set at $10,000 and is scheduled for an arraignment hearing next month.

Click here for news article.

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Filed under Insurance Fraud

Two operators of Lake Worth clinic arrested

Janio Vico and Jharildan Vico, were arrested April 30th for PIP fraud, according to the Palm Beach Post.  Janio Vico and Jharildan Vico owned and operated V & C Rehabilitation Center in Lake Worth which offered chiropractic and message therapy to those involved in auto accidents and solicited patients who were involved in auto accidents.

The two individuals operated the unlicensed clinic since 2009 and have filed at least $1 million in fraudulent insurance claims.  The two men, solicited patients who were involved in auto accidents even though the individuals did not require any treatment.

Janico Vico and Jharildan Vico along with other co-conspirators have been charge with 12 counts of mail fraud and one count of conspiracy to commit mail fraud.  The two individuals face 20 years of imprisonment per count if convicted of the charges.

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Filed under Fla. Stat. 627.736 (2008)