Tag Archives: Chiropractor

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.

Click here to view the full story.

Comments Off on Chiropractor’s Challenge To ‘PIP’ Law Kicked Back By Appeals Court

Filed under FL Legislation, Florida, Insurance, Insurance Claims, Insurance Defense, Miami-Dade County, Personal Injury Protection, PIP/No Fault

Mobile Ultrasound Owner Pleads Guilty in $29 Million Fraud

The owner of a mobile diagnostic ultrasound company pleaded guilty on June 21 to a nearly $29 million insurance fraud scheme.

Michelle Kobran, 68, admitted to falsifying medical bills and giving kickbacks to doctors at her chiropractic and physical therapy center in Wheeling, IL. Kobran said she altered the information on documents to get reimbursements from Blue Cross Blue Shield of Illinois, Aetna Health Insurance and other major insurance companies.

Law360 reported that for at least three years, Kobran had a deal with Vladimir Gordin Jr.

Kobran would do ultrasounds one day a week at Gordin Medical Center, and Kobran would pay Gordin one third of the bills she charged patients referred by the chiropractor. After Kobran realized insurance companies wouldn’t reimburse for multiple ultrasounds done on the same patient in the same day, she would change the dates of service on bills. Sometimes Kobran would tell her technician not to do all the ultrasounds ordered by doctors but charge for them anyway.

Kobran’s business submitted $28.8 million in fraudulent insurance bills over a six-year period ending in 2012 with insurance companies reimbursing those services for $10.8 million.

Kobran and Gordin were indicted in August 2015 along with three managers. Kobran’s plea includes her promise to testify against the others at trial in January. She faces 10 years in prison, but by testifying against the others she could end up with only two years in prison and $658,000 in restitution.

Click here for full story (registration required).

Comments Off on Mobile Ultrasound Owner Pleads Guilty in $29 Million Fraud

Filed under Insurance Fraud, Medicare

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.

Comments Off on Orlando PIP Clinic Owner Arrested for Defrauding Insurance Companies

Filed under Insurance Fraud

Operator of Unlicensed Orlando PIP Clinics Arrested

Josue Pierrissaint, 30, was arrested by the Florida Division of Insurance Fraud (DIF) for charges related to operating unlicensed Orlando PIP clinics earlier this year.

A string of three PIP clinics were opened by Pierrissaint from 2010 to 2012, as listed below.

  • Edgewater Chiropractic was first opened in 2010. It was based in Lockhart, Fla., located in Orange County northwest of Orlando. Chiropractor Sham Mohammed was named as the straw owner.
  • Dr. Wilson’s Straight Up Chiropractic was opened several months later by Pierrissaint in association with chiropractor Koteuaisa Wilson, who also served as the straw owner. The same Lockhart, Fla. address was used in the AHCA application. Wilson later left the clinic, which reportedly did not stop Pierrissaint from using her name.
  • Dr. Koteuaisa Chiropractic was next launched by Pierrissaint in 2012. The clinic was opened in Orlando without the knowledge or consent of Dr. Wilson, although her name was listed on the AHCA paperwork.

Collectively, the clinics were paid in excess of $425,000 by 16 insurance companies.

Pierrissaint, who is not a doctor, was also arrested early in 2014 on similar charges.

Comments Off on Operator of Unlicensed Orlando PIP Clinics Arrested

Filed under Insurance Fraud

Staged Accident Organizer Arrested in Orlando

A 41-year old from Orlando, who was at the center of an alleged staged vehicle accident which occurred in 2013, was recently apprehended by the Florida Division of Insurance Fraud (DIF).

Jean Severe was arrested in November for organizing the fake crash.  According to DIF, participants were sent to Florida Chiro & Rehab Center for unnecessary medical treatment of their bogus injuries.  The scheme resulted in more than $6,000 in false claims filed with insurers Allstate and GEICO.

Comments Off on Staged Accident Organizer Arrested in Orlando

Filed under Insurance Fraud

Boca Raton Medical Billing Company Members Indicted in Ohio Fraud

Seven people and a Florida medical billing company were indicted on December 17, 2014 for their roles in a multi-million dollar health care fraud conspiracy involving a controversial form of chiropractic manipulation, according to a news release by the U.S. Attorney’s Office for the Northern District of Ohio.

Members of the fraud scheme indicted are:

  • Physicians Surgical Group (PSG) of Boca Raton, Fla.
  • Christopher Liva, 36, of Boca Raton
  • Edward Liva, 64, father of Christopher Liva, based in Boca Raton
  • Carolyn Via, 51, of Boca Raton
  • Mark Fritz, age not provided, of Coral Springs
  • Three other medical professionals from Northeast Ohio

The Livas and Via owned PSG and were also part owners of Shaker Heights Surgical Center (SHSC), located in Ohio.  Fritz was chief financial officer at PSG.

The U.S. Attorney for the Northern District of Ohio alleged that, from 2007-2010, the defendants deceived various private insurance companies, bilking them out of millions of dollars on behalf of patients who underwent manipulations under anesthesia, a risky treatment that is normally reserved for those who have not responded to more conservative chiropractic treatment.  The procedure is classified as surgery by the American Medical Association, according to the indictment.

In order to defraud the insurance companies, the defendants disregarded actual diagnoses, created fake diagnoses, submitted false billing claims, and represented that the procedures were performed by medical doctors, when in fact they were performed by chiropractors.

Additionally, the indicted parties marketed SHSC and the experimental manipulation procedure to chiropractors in Ohio. Chiropractors were paid a flat fee of $4,000 for each patient they referred to SHSC, and the clinic waived patients’ co-pays and deductibles.  The clinic then typically submitted three types of claims to the insurance companies—for professional fees, facility fees, and fees for anesthesia services.

The Livas, Fritz, PSG, and the three Ohio medical professionals are charged with one count each of conspiracy, wire fraud, health care fraud, and money laundering.  The Livas and Via each face an additional count of money laundering.

Prosecutors are also seeking to seize property derived from the criminal conspiracy, including two properties in Boca Raton, money, a watch, and 4.18-karat diamond stud earrings.

Comments Off on Boca Raton Medical Billing Company Members Indicted in Ohio Fraud

Filed under Insurance Fraud

Staged Accident Recruiter from Palm Beach County Sentenced to Nine Years

A West Palm Beach man, who participated in an $8 million insurance fraud scam, was recently sentenced to nine years in prison for his role in the matter.

Joel Antonio Simon Ramirez, about whom we reported on our FL PIP Guide in April, helped recruit individuals to participate in staged automobile crashes. According to a story in the Palm Beach Post, the 30-year old worked together with three other chiropractors who filed fake insurance claims for the participants in these crashes. They operated the scheme out of clinics throughout Palm Beach County.

Following a six-week trial in April, all four defendants were found guilty of money laundering and mail fraud. Ramirez was also found guilty of helping stage the auto accidents.

By violating PIP insurance provisions, these schemes not only cost insurers but also hurt Florida drivers, federal prosecutors said. The conspiracy was part of a larger staged accident ring dubbed “Operation Sledgehammer” by investigators who discovered that many participants damaged vehicles using sledgehammers to give the appearance of a crash.

Nearly 60 people have been charged in federal court and almost 40 have been charged in state court as part of this sweeping investigation. Most have pleaded guilty to participating in staged accidents and then seeking treatment for bogus injuries. According to prosecutors, the five ringleaders fled to Cuba.

Comments Off on Staged Accident Recruiter from Palm Beach County Sentenced to Nine Years

Filed under Fla. Stat. 627.736 (2008), Insurance Fraud

Five Arrested, Two Wanted in Organized South Florida PIP Fraud Scheme

Attorneys, chiropractors and clinic employees in Martin, Miami-Dade and Palm Beach Counties were swept up this morning in the culmination of a year-long undercover investigation led by the Florida Department of Financial Services’ Division of Insurance Fraud.

Two Boca Raton attorneys are among the five individuals arrested today:

• Brian Greenspoon (attorney), Boca Raton
• Cory Meltzer (attorney), Boca Raton
• Roger Hughes Bell (chiropractor), Hobe Sound
• Alejandro Marin, Homestead
• Douglas Santiago, Boynton Beach

Lake Worth chiropractor Ray Grand and Stuart resident Christina Savoye have warrants out for their arrest.

A brokering agreement among participants governed the payment of fees to a patient broker who recruited patients illegally for treatment at unnamed South Florida medical clinics. Unbeknownst to the crime ring organizers, the broker was in reality an undercover agent. Other law enforcement personnel, also working under cover, infiltrated the clinics involved to document the allegedly criminal activities.

Principals in the fraud scheme acknowledged on several occasions that it was illegal to pay for patients, so all referrals were paid under the guise of marketing services, according to a press release issued by Florida Chief Financial Officer Jeff Atwater.

Apparently, insurance carriers and others were billed by participating clinics for medical and chiropractic services that were not rendered. Patients were also being taught how to fake injuries, according to the release.

While exact dollar amounts are not available, the crime ring is believed to be responsible for hundreds of thousands of dollars in fraudulent billings.

The defendants will be prosecuted by the 15th and 19th Judicial Circuit State Attorney’s offices, according to the release.

Click on the link to read the full news release.

Comments Off on Five Arrested, Two Wanted in Organized South Florida PIP Fraud Scheme

Filed under Insurance Fraud

South Florida Chiropractor Tied to 2013 PIP Fraud Investigation Surrenders License

On our FL-PIP Guide in September 2013, we reported that chiropractor David Hirschenson was arrested and charged with 19 counts of obtaining illegal crash reports and one count of solicitation.

An update in the case is now being reported. According to the Florida Department of Insurance Fraud (DIF), the 56-year old chiropractor was sentenced in a Miami-Dade County Court this September as a result of the charges made against him a year ago. He received five years probation and also surrendered his chiropractor’s license to the Department of Health.

Details in the case revealed that Hirschenson actually worked with two others in the scheme. The first was a runner who solicited accident victims. In an interesting development in that case, the victims were not referred to Hirschenson’s clinic, but instead to another clinic in North Miami Beach—Advanced Chiropractic and Medical Center.

The second co-conspirator was a local radio station staffer who used the media exception status at the station to request accident reports from a variety of police departments. Hirschenson then used this information illegally to solicit accident victims. DIF arrested both co-conspirators, who cooperated in the investigation against Hirschenson.

Hirschenson, who originally received his chiropractor license in Florida in 1982, also had a prior arrest in the late 1980s as part of an investigation involving solicitation and insurance fraud in Broward County. He was placed on probation for two years by the Board of Chiropractic, but retained his state license for cooperating with the State Attorney’s Office. Hirschenson worked at and operated several clinics, including Pines Total Health Center in Pembroke Pines and Body and Mind Wellness Center in Coral Gables.

Comments Off on South Florida Chiropractor Tied to 2013 PIP Fraud Investigation Surrenders License

Filed under Insurance Fraud

Operation Sledgehammer Finds Three Chiropractors Guilty of PIP Fraud

A federal jury has convicted one West Palm Beach chiropractor and two Miami chiropractors for their roles in a massive staged automobile accident scheme, following a seven-week trial in U.S. District Court for the Southern District of Florida.

Using the U.S. mail in a scheme involving Personal Injury Protection (PIP) payments, defendants were found guilty of defrauding insurance companies through mail fraud and money laundering.

Kenneth Karow, 54, of West Palm Beach, Hermann J. Diehl, 44, of Miami, and Hal Mark Kreitman, 50, of Miami Beach were all convicted on multiple counts. Karow was sentenced to 11 years in prison, Diehl to nine years, and Kreitman to eight years for the fraud scheme that ran from October 2006 through December 2012.

The fraud was perpetuated in several ways across 21 chiropractic clinics, according to a release issued by the U.S. Attorneys’ Office for the Southern District of Florida. Key elements of the scheme are outlined below.

  1. Licensed chiropractors were recruited to serve as the “named owners” of chiropractic clinics, in circumvention of Florida licensing requirements, with others actually in financial control of the business.
  2. Recruiters were used to attract real or fake auto accident victims who were fraudulently treated at the chiropractic clinics for injuries.
  3. False chiropractic treatment claims where then billed to insurance carriers.
  4. No co-pays or deductibles were collected from the “patients,” and this fact was not disclosed to the insurance companies.
  5. The money received from this scheme was then used to pay recruiters and participants and to enrich members of the conspiracy.

The prosecution is the latest in a series of charges that have been part of a four year investigation into the massive conspiracy. The joint federal and state investigation, known as Operation Sledgehammer, has resulted in charges against 93 defendants for their roles in the organization. Of these 93 defendants, 57 have been charged by the U.S. Attorney’s Office, resulting in court-ordered restitution of more than $11 million to defrauded insurance companies.

Click on the link to read the full release.

Comments Off on Operation Sledgehammer Finds Three Chiropractors Guilty of PIP Fraud

Filed under Fla. Stat. 627.736 (2012), Insurance Fraud