Author Archives: Mark J. Rose, Esq.

Favorable Third District Court of Appeals Decision

Favorable decision from the Third District Court of Appeal upholding Defendant’s Proposal for Settlement and entitlement to attorney’s fees in a case where the Plaintiff claimed that the declaratory relief count filed along with a breach of contract count invalidated the Insurer’s Proposal for Settlement.

To read the appellate decision, click here.

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Filed under Fourth District Court of Appeals, Insurance

Fort Myers Woman Arrested for Insurance Fraud

Crystal Danielle Clarkson of Fort Myers was arrested for submitting false claims to her insurance company for treatments she did not receive. She sent 34 extra claims totaling $70,546.12 although she had only been seen by hospital medical providers two times. Clarkson is facing up to 30 years for charges of organized scheme to defraud, grand theft, insurance fraud.

Click here to read the article.

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Filed under Insurance Fraud

Stuart OB/GYN Found Guilty in Health Insurance Fraud Scheme

A federal court jury found Dr. Sheetal Kanar Kumar, former Stuart obstetrician and gynecologist, guilty of 23 counts of health insurance fraud. Kumar faces up to 10 years in prison and fines of $250,000 for each charge as a result of her fraudulent claims to Medicare, Medicaid and Blue Cross Blue Shield. Kumar’s claims involved charges for patient office visits involving complex cystometrogram, anorectal manometry, uroflowmetry and voiding pressure studies.

Click here to read the article.

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Filed under Healthcare Fraud

Two Arrested in Patient-Brokering and Insurance Fraud Scheme

Licensed pharmacist Richard Vallette and a “middleman” Todd Mulvaney were arrested in patient-brokering and insurance fraud scheme. Vallette and Mulvaney conspired to split thousands of dollars in insurance reimbursements from fraudulent prescriptions with who they thought was a drug-treatment center owner, but turned out to be an undercover cop.

Both men are facing six counts of patient brokering and six counts of insurance fraud. According to the Palm Beach County State Attorney’s Office, this is an active investigation and there will likely be additional arrests.

Click here to read the article.

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Filed under Fraud

Crooked Opioid Treatment Center Owner Arrested for Insurance Fraud

James Durkin, owner of a Boynton Beach opioid treatment facility The Hope Center of Recovery, has been arrested for insurance fraud. Durkin was charged for allegedly submitting fraudulent insurance billing for over $104,000.

CFO Jimmy Patronis said, “Insurance fraud at crooked addiction treatment centers fuels the ongoing opioid epidemic in Florida.” An investigation revealed Durkin’s was falsified billings to Cigna and United Health Care for addiction recovery treatments that were never performed.

Durkin faces up to 30 years in prison.

Click here to read the press release.

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Filed under Uncategorized

Palm Beach County Business Owner Charged with Workers’ Compensation Fraud

According to the Florida Department of Financial Services, Vanessa Arreguin, owner of V&G Concrete, Inc. was arrested in August for three felony counts of concealing payroll to avoid workers’ compensation premiums and two felony counts of application fraud. Arreguin claimed she made less than $50,000 will conducting more than $7.5 million in business to avoid paying $51,000 in workers’ compensation.

Florida Chief Financial Officer (CFO) Jimmy Patronis said, “Last year alone, our fraud detectives made more than 400 arrests for workers’ compensation fraud and I can assure you my office will continue to hold these individuals accountable.” Arreguin could face up to 20 years in prison if convicted.

Click here to read the press release.

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Filed under Insurance Fraud, Uncategorized

FL Insurance Commissioner David Altmaier Warns Homeowners to Protect Themselves

Florida Insurance Commissioner David Altmaier issued a warning to residents facing damage from Tropical Storm Gordon be careful and to make sure they fully read and understand any documents they sign in Gordon’s aftermath. Altmaier has been an outspoken critic of the ongoing assignment of benefits abuse happening in the state of Florida.

Many insurers throughout Florida have been seeing an uptick in litigation due to the inflated and fraudulent claims stemming from unlicensed contractors who have homeowners sign over their insurance policy rights in exchange for needed repairs to their homes.

Florida Chief Financial Officer Jimmy Patronis also issued a warning to consumers to protect themselves against fraud and has activated the Florida Department of Financial Services Disaster Fraud Action Strike Team (DFAST) for the 2018 hurricane season.

Click here to read the article.

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Filed under Assignment of Benefits, Property Insurance

Pinellas County Sheriff Going After Unlicensed Contractors

Thirty people were arrested in a three-day sting to “flush-out” unlicensed contractors preying on property owners in Pinellas County. The sting produced at least 60 felony and misdemeanor charges against the violators. Operation Flush Out is Sheriff Bob Gualtieri’s third sting since October 2017.

A Tampa Bay Times’ investigation in 2017 revealed how the Pinellas County Construction Licensing Board preferred to punish unlicensed contractors with fines rather than pursue violations in criminal court. Contracting without a license carries a misdemeanor for first-time offenses and a felony the second time.

Pinellas County government took control of the agency on July 1st. Gualtieri launched the Construction Licensing Investigative Unit and trained deputies to investigate contracting crimes. The department’s previous stings in October and February netted more than 45 arrests and dozens of charges.

Click here to read the article.

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Filed under Insurance, 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.

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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.

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