Tag Archives: PIP fraud

Florida’s Third District Court of Appeal Retroactively Applies Allstate PIP Decision

According to Law360, on Wednesday, April 19th Florida’s Third District Court of Appeal retroactively applied a state Supreme Court decision involving Allstate Insurance Co.’s personal injury protection policy language regarding the use of the Medicare fee schedules, overriding a lower court’s ruling and handing Allstate the win. After denying the insurer’s request for review of a circuit court appellate division’s ruling in favor of medical provider Hallandale Open MRI LLC last September, the court reversed course, applying the Supreme Court’s January decision in Allstate v. Orthopedic Specialists.

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Filed under auto insurance, Case Law, FL Legislation, Florida, Insurance, PIP, PIP/No Fault

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

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

Man Charged With Staging Traffic Accidents for Insurance Money

The Florida Division of Insurance Fraud arrested a man in Orlando who was charged with orchestrating automobile accidents for the purpose of defrauding insurance companies.

Alma Germain was accused of buying used junk cars to intentionally cause wrecks. Channel 9 in Orlando said one car was in such bad shape, Germain had to stop several times to add water to the radiator on the way to a staged crash.

Germain was charged with using cash to recruit people to get into crashes with him, then telling them to seek treatment at a local healthcare clinic. The clinic would then bill the insurance company.

In one particular case, Germain had three people in the car with him during a crash. He ran from the wreck site but told the three passengers to go to Family Practice and Rehab in Orlando for treatment. Family Practice billed the insurance company for nearly $25,000.

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Filed under Florida, Florida Division of Insurance Fraud, Insurance Fraud, Personal Injury Protection, PIP/No Fault

Legal Troubles Continue For Dr. Ralph Miniet

The ongoing saga of Dr. Ralph Miniet added yet another chapter last week.

Miami Police arrested Miniet and two others last week after an anonymous tip and subsequent investigation uncovered alleged Personal Injury Protection (PIP) fraud at The Fast Rehabilitation Center at 815 NW 57th Ave. in Miami, according to multiple South Florida media reports on April 6th.

Police said the arrests were an attempt to arrest individuals involved in staging accidents and conspiring with clinics, physicians, massage therapists and lawyers to steal money from insurance companies with superfluous treatment and false lawsuits.

With Miniet arrested as he was about to board a plane to Kentucky to appear at a federal court arraignment, his legal woes became even more serious. Not only did he miss his arraignment, but Miniet likely violated terms of his house arrest. Miniet was arrested in Lexington in November where he faces charges in the Eastern District of Kentucky of illegally distributing oxycodone. Miniet was given an ankle bracelet and placed under house arrest with the condition that he stay out of trouble. He may have violated those terms, depending whether the alleged instances of fraud in Miami took place after his Kentucky arrest.

Miniet has been on the radar of the South Florida legal community for years. In 2003-4, Miniet provided 569 injections of Rho D to 567 patients that were later deemed “medically unbelievable” by the Department of Health and Human Services. Records show Miniet netted $2.3 million in that case.

Miniet also was linked to a fraud at V&V Rehabilitation Center, where true owners Janio and Jharildan Vico used Dr. Jennifer Adams as a straw owner to avoid oversight by the Agency for Health Care Administration (AHCA). The Vico brothers were convicted last October of mail fraud, money laundering and two conspiracy charges. The Vicos made about $3 million for staging traffic accidents and then billing insurance companies for fake injuries treated at V&V in Lake Worth, according to court records.

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Filed under Florida, Insurance, Insurance Fraud, Miami-Dade Fraud, Personal Injury Protection, PIP/No Fault

Cell Phone Video Shows Potential Insurance Fraud

With the number of cyclists and cars sharing the roads, collisions are a common fear and an unfortunate reality for many South Florida drivers. However, collisions where both parties emerge without a scratch can be more than just “lucky.” It could be too good to be true as discovered by this one Fort Myers couple.

According to Fox 4 news, on March 1, 2016, a couple collided with a bicyclist in Southwest Florida leaving him completely unscathed. However, once he stood up and began complaining about the value of the sunglasses that were ruined in the accident, a passing woman told him to get back on the ground, advising him that it would be worth a lot more than his sunglasses. Luckily, her husband, the passenger in the car involved in the collision, just happened to be recording on his cell phone.

“Stay right there! Stay right there! Then you got 72 to 76 hours to go to the hospital,” she tells him. The cyclist does not reply to the woman but you can see him sitting on the ground as he’s being coached on what to do. To this, the cyclist does not reply but rather continues to complain about his damaged “pair of $180 sunglasses,” which you can hear on the recording. “You can sue their insurance fund” yells the passing woman to the cyclist, trying to convince him that the sunglasses are not worth much in comparison to what he can make from a lawsuit.

The recording was taken to Mr. Auto insurance, a Fort Myers area insurance agency, where the video was shown to agents who have dealt with cases like this before. “Like these people here, they took a minute, record it, report it, that’s the most important thing,” says insurance agent Dave Lindback.

Video recordings can prevent individuals from paying more money in the long run. Most people think the insurance company is the one that has to cover the extra expenses, but that is not as true as some people believe it to be. Eventually, rates increase on renewals and in the end, customers pay for it.

Recording and reporting incidents like this do not only help your insurance rates but may also affect your case in court. “If I was on the jury and I saw that video, it would blow my socks off. I would absolutely find zero damages. I think maybe the state attorney needs to take a look at that,” says Fort Myers attorney Mike Chionopolous.

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Filed under Florida, Insurance, Insurance Fraud, PIP/No Fault

Florida Insurance Commissioner Kevin McCarty resigns

On January 5, 2016, Kevin McCarty resigned as Florida’s top insurance regulator and stated that his departure would be effective May 2, 2016, according to Bradenton Herald. McCarty, 56, is the state’s Insurance Commissioner who decides how much homeowners pay for their property insurance.  He was appointed to the position in 2003 by Governor Jeb Bush and has served under the leadership of three Governors since then. Under Bush tenure, McCarty helped navigate the state through a series of devastating hurricanes while seeking to protect elderly consumers from fraudulent merchants of insurance products.

After many years of navigating the capital’s perilous political landscape McCarty was viewed as vulnerable after Governor Rick Scott took the oath as governor for the second time. Scott’s office already had a replacement in mind: Ron Henderson, a Louisiana insurance official who was being promoted by Fred Karlinsky, a Tallahassee Lobbyist for insurance interests and Scott supporter. Consumer groups rallied to McCarty’s side as a result of the controversy following Scott’s removal of Gerald Bailey as the state’s top law enforcement official.

McCarty is the state’s first appointed insurance commissioner and director of the state Office of Insurance Regulation. His successor must win the support of both Scott and Jeff Atwater, Chief Financial Officer, in a vote by the Governor and Cabinet.

McCarty’s departure leaves an empty position, one of the most challenging jobs in state government due to the sensitivity surrounding the cost and availability of insurance in a state vulnerable to hurricanes and insurance fraud.

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Filed under Florida, Insurance, 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

Jacksonville PIP Fraud Scheme Involved Staged Auto Accidents

Roxana Suarez La Rosa was arrested for PIP fraud, according to an April 28 release by the Florida Department of Financial Services’ Division of Insurance Fraud.

Suarez La Rosa owned and operated the Saint Jose Injury Center in Jacksonville that was behind a string of staged auto accidents, according to witnesses. Crash participants were asked to sign for medical services they never received, which were then billed to insurance companies. More than 50 insurance claims were generated in the alleged scam. Billing amounts were not disclosed.

If convicted, Suarez La Rosa faces up to 50 years in prison on racketeering and fraud charges. Additional cases against the medical clinic are pending.

The Office of the State Attorney in the 4th Judicial Circuit of Florida, which covers Duval, Clay and Nassau Counties, is handling the case.

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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.

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Filed under Insurance Fraud