Tag Archives: DIF

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.

Click here to read the article.

Comments Off on Pinellas County Detectives Arrest 35 Unlicensed Contractors in Undercover Sting

Filed under Fraud

Palmetto Bay Man Arrested for Insurance Fraud and Grand Theft

Carlos Guillermo Aponte of Palmetto Bay was arrested in September for three counts of insurance fraud and grand theft for allegedly defrauding Citizens Property Insurance Corp. The Department of Financial Services’ Disaster Fraud Action Strike Team (DFAST) investigated Aponte after receiving a tip about fraudulent invoices and false rental agreements with letters claiming lost of rent for more than $30,000.

Aponte could face prison time of up to 45 years and fines up to $45,000.

Click here to read the article.

Comments Off on Palmetto Bay Man Arrested for Insurance Fraud and Grand Theft

Filed under Insurance Fraud

Florida Insurance Leaders Hope to Rein In AOB Crisis

The Florida insurance industry is hoping to put an end to its AOB crisis with education. Barry Gilway, president, CEO and executive director of Citizens Property Insurance Corp. says the key to slowing Assignment of Benefits (AOB) abuse in Florida is for the insurance industry to link AOB to its impact on the consumer and the premiums they are paying.

Insurance carriers from across the state have seen an increase in litigation due to AOB lawsuits from homeowners who work with unlicensed contractors who file inflated and fake claims on their behalf. According to the Florida Department of Financial Services, AOB lawsuits in Florida have increased from 405 to 28,200 between 2006 and 2016 with South Florida being the worst region for this issue.

Florida insurance industry leaders are hoping for a legislative fix with the new Senate leadership coming in next year.

Click here to read the full article.

Comments Off on Florida Insurance Leaders Hope to Rein In AOB Crisis

Filed under AOB, Property Insurance

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.

Click here to read the full article.

Comments Off on Florida Public Adjuster Sentenced in $14M Insurance Fraud Plot

Filed under AOB, Florida, Florida Division of Insurance Fraud, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud, Property Insurance

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.

Click here for full article.

Comments Off on Two GEICO Adjusters Charged in Miami Insurance Fraud Ring

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

Georgia Insurance Agent Arrested for Stealing Thousands From Seniors

On February 18, 2016, the Department of Insurance Fraud (DIF) announced the arrest of William David Rodeffer III of Folkston, Georgia. According to DIF, Rodeffer allegedly accepted insurance premium payments totaling nearly $40,000 for two clients for insurance policies that were never purchased. One of the consumers believed he had purchased a workers’ compensation policy which covered him if one of his workers were injured on the job. Unfortunately, he had an employee who was injured and, as his employer, he was left to cover an additional $30,000 in medical bills and lost wages.  In total, nearly $70,000 in financial losses were caused by Rodeffer.

Rodeffer was a licensed insurance agent in Georgia and was working as an agent in Georgia, but moved to Yulee, Florida when his company opened a second office in Florida. Rodeffer then applied for a license in Florida, which was denied due to his criminal history, resulting in a lack of qualification to transact insurance business in Florida.

According to DIF’s three year investigation, Rodeffer continued to illegally sell insurance policies in Florida despite his denied application for licensure. During this time he repeatedly accepted premium payments from two clients for policies he never purchased, meaning that his clients never had coverage.

One of Rodeffer’s clients, a 91 year old Floridian, thought he had purchased a workers’ compensation policy from him until one of the workers’ under his policy was injured and filed a claim against the policy sold by Rodeffer. Once the worker filed the claim against the policy it was revealed that the policy never existed. Rodeffer’s client made at least 10 premium payments for the policy, which Rodeffer fraudulently kept.

A second client, American Legion Post 283, was led to believe they held general liability property insurance coverage after providing numerous premium payments to Rodeffer. The investigation revealed that Rodeffer failed to obtain insurance coverage for them as well.

Rodeffer is currently awaiting trial in Georgia for similar charges where had previously been charged in 2014 by Nassau County Sheriff’s Office for a separate offense.

 

 

Comments Off on Georgia Insurance Agent Arrested for Stealing Thousands From Seniors

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

State Charges Couple with Insurance Fraud Over $15K Engagement Ring

Zian Scott Snyder, 29, and Alicia Maria Hill, 26, of Cantonment, Florida have been charged with scheme to defraud, insurance fraud, grand theft, and conspiracy to commit insurance fraud by the Florida Division of Insurance Fraud (DIF) for alleged false claims over a custom-made engagement ring.

According to an article on NorthEscambia.com, the couple filed a false claim on a $15,000 ring that Hill claimed she lost swimming in the Gulf. She was also recorded claiming she lost the ring on a boat in the Gulf. Four days after filing the claim with her insurance company, Hill took the ring to Marks and Morgan Jewelry store in Ft. Walton Beach to have the ring repaired.. The custom-made ring was identified by photographs taken at the Ft. Walton Beach jewelry store.

Around the same time the couple filed the insurance claim, the store manager of the Jewelry store told authorities she witnessed the ring for sale on Craigslist and that she was positive that it was the same ring in question because she was the one who custom made the ring. The couple told her that the ring had not been stolen, but was eaten by a dog and was later recovered.

A month after the couple filed the insurance claim, Hill called the insurance company to report that the ring had been recovered. The insurance company then advised that the ring or the check must be returned. Three days after Hill informed the insurance company of the recovery, she changed her story once again, stating that it was actually a different ring that was recovered.

The insurance company told state investigators that neither the ring nor the insurance proceeds were ever returned by the couple.

www.roiglawyers.com

Comments Off on State Charges Couple with Insurance Fraud Over $15K Engagement Ring

Filed under Insurance Fraud

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.

Comments Off on South Florida Men Arrested For Insurance-Billing Fraud

Filed under Auto Insurance Fraud, Insurance Fraud

Insurance Agent Arrested for Fraudulent Polices

Insurance Agent Arrested for Fraudulent Polices

On July 27, 2015, the Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced the arrest of insurance agent Julia Shurdom, 67, for conducting insurance related business with a suspended insurance license, scheming to defraud, and uttering a forged document.

Shurdom was allegedly working for Absolute Insurance Services in Orlando, Florida with a suspended license when the fraud was committed. According to the press release, DIF received a complaint in regards to Ms. Shurdom, after a client who purchased homeowners’ insurance in 2013 and 2014 discovered that her home had remained uninsured. After the complaint, DIF began an investigation which found, per Ms. Shurdom bank records, that she collected two homeowners’ insurance premium payments and used the money for personal profit.

According to the investigation, DIF conducted a license search for the accused agent and found that the Department’s Division of Agent & Agency Services (A&A) had already begun investigating Ms. Shurdom for a number of unrelated events. The investigation also revealed that A&A had suspended Julia Shurdom’s license to conduct insurance related business.

A follow up audit by A&A and the ongoing investigation by DIF revealed that Ms. Shurdom continued to sell insurance polices without the proper licensing from the Department of Financial Services, and that the transactions were fraudulent, according to DIF.

Shurdom was booked into Orange County Correctional Facility with a bond of $6,500 on charges which include scheme to defraud, uttering a forged instrument, and violation of a suspension order. Shurdom’s faces up to 15 years in prison.

Click here for the press release.

www.roiglawyers.com

Comments Off on Insurance Agent Arrested for Fraudulent Polices

Filed under 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.

Comments Off on Miami PIP Fraud Leads to Three Arrests

Filed under Insurance Fraud