On October 5, 2015, GEICO filed a lawsuit in federal court against Boston-based Big City Chiropractic & Sports Injury Clinic, according to a Law360 article. GEICO claims that Big City created a scheme to defraud the company out of, up to $1.1 million by overbilling for insurance payments and paying kickbacks to patients for cooperating with the scheme.
In the lawsuit, GEICO alleges that Dr. Brian Elias, Florida-based founder of Big City Chiropractic, and Karen Davis and Dr. Megan Bratton of Massachusetts were involved in the scheme to defraud GEICO. GEICO alleges that the trio earned substantial profits by using unskilled services and staff at their clinic while billing them as services performed by licensed staff. The lawsuit claims that that the trio overused chiropractic practices and submitted inflated demands for insurance payments based on false and deceptive bills and records.
GEICO states in the complaint, that it has already paid at least $110,000 of about $517,000 in submitted bills to Big City. The clinic has billed GEICO so far this year at an estimated annual rate of $600,000.
Big City Chiropractic & Sports Injury is the Massachusetts-based arm of an interstate network of chiropractic clinics operated by Elias.
GEICO is seeking damages including the money unfairly paid to Big City, the costs of handling the investigation, and treble damages under the Racketeer Influenced and Corrupt Organizations Act and Massachusetts consumer protection law.
Click here to read Law360 article (subscription required).
On Tuesday September 22, 2015, the Eleventh Circuit declined to allow a seventh trial in a GEICO General Insurance Co. coverage dispute, rejecting an argument by the estate of a car crash victim that the insurer wasn’t prejudiced by the exclusion of decisions reached after it denied coverage, according to a Law360 article.
The court refused to rehear the decision vacating a Florida federal court judgment in favor of Esperanza Garcia, who represents the estate of a women killed in a car accident with a GEICO-insured driver in a car rented by someone else. The court found that GEICO should have been able to tell the jury that the coverage decision preceding Garcia’s bad faith suit was overturned because of changes in Florida case law impacting whether the driver has the rental agency’s consent to drive the car.
The court stated that “the exclusion substantially prejudiced GEICO,” and “a jury would no doubt find it exceedingly relevant that Florida law on implied consent was in a state of flux, or that a panel of Florida’s First District Court of Appeal and a United States District Judge for the Southern District of Florida supported GEICO’s conclusion regarding implied consent.”
Garcia petitioned the court for a panel rehearing in early September, asking the Eleventh Circuit that GEICO could not have been hindered by the judge’s order excluding legal rulings reached after the company denied coverage, arguing that those rulings were based on previous, cumulative decisions, making their exclusion harmless.
The Eleventh Circuit rejected all of Garcia’s requests in an order on September 22, 2015.
Click here for article. (Subscription required)
On September 4, 2015, two Miami residents Alina Del Prado, 60, and Karla Patricia Figueroa, 40, were arrested for deceptively using unsuspecting licensed insurance representatives’ licenses to defraud Florida consumers and illegally conducting more than $200,000 in insurance transactions while operating Quality Insurance Agency (Quality) in Hialeah, Florida.
The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) and the Department’s Division of Insurance Agent and Agency Services (A & A) began an investigation in the beginning of January 2014, which uncovered that Alina Del Prado allegedly submitted an insurance agency license application for Quality using a licensed agent’s name and license number unbeknownst to the agent. A & A conducted an inspection of the agency, which discovered that Del Prado was allegedly using the agent’s name and license number to fraudulently transact insurance business in numerous instances.
The investigation revealed that Del Prado hired Karla Figueroa, who allegedly illegally sold automobile insurance policies as an unlicensed customer representative. Figueroa also utilized an unsuspecting insurance representative’s name and license number to illegally obtain automobile insurance policies.
DIF investigators located the unsuspecting insurance agent and representative whose information was used and confirmed the unauthorized use of their information by Del Prado and Figueroa.
Alina Del Prado and Karla Patricia Figueroa were arrested with a combined bond in excess of $1 million. Del Prado faces over 300 felony charges including money laundering, identify theft, grand theft, transacting insurance without an insurance license, and scheme to defraud. Figueroa faces charges including identity fraud, transacting without an insurance license, and scheme to defraud charges.
Click here to read press release.
Broward Health offered to pay $69.5 million to settle a four-year old federal investigation regarding allegations of massive Medicare and Medicaid fraud. According to an August 21, 2015 post by the FloridaBulldog.org, the settlement was offered on August 20, 2015 after a unanimous vote by Broward Commissioners. The Commissioners offered no public explanation for their decision or how the settlement offer will affect Broward Health’s operations.
The federal investigation into Broward Health began in May 2011, when the U.S. Department of Health and Human Services (HHS) agents subpoenaed Broward Health records regarding a number of doctors, including medical directors associated with the company’s orthopedic, sports medicine and cardiology practices. However, details of the government’s case against Broward Health remain secret. The only known information regarding the case is that the investigation started based on a complaint brought by an unidentified whistleblower.
Broward Health’s settlement offer, if accepted by the government, would be the second largest settlement offered by a large Florida hospital system for a federal probe.
Click here for full article.
Uber has chosen to open its Miami headquarters at Brickell City Tower. According to the South Florida Business Journal, Uber has signed a 9,333-square-foot lease in the 33-story tower at 80 S.W. 8th Street, which is located near Mary Brickell Village.
The ride-sharing service is currently operating in Miami-Dade County. Miami-Dade County Mayor Carlos Gimenez has expressed support for Uber and has stated that it should be specifically addressed by county regulations that do not hinder the business. However, Uber has announced that it will halt service in Broward County on July 31st because it said new regulations there imposed great difficulties on its business.
Uber’s new Miami headquarters reveals the companies’ plans to remain a key player in the Miami market.
Click here to read news article.
Douglas Price was arrested for insurance fraud and three counts of patient brokering, according to a June 15, 2015 news story by ABC Action News. Investigators stated that Price had been under investigation for 8 months under suspicion of insurance fraud and patient brokering. Investigators focused on Price’s South Tampa and Auburndale clinics.
Price is accused of paying patients to seek unnecessary treatments at his clinics. According to investigators, Price would pay patients up to $1,000 each to seek unnecessary medical treatment at both clinics.
Investigators also arrested, Sonya Rivera, an employee of Price who is accused of recruiting patients, and assisting in the fraud.
On June 1, 2015, the Florida Department of Transportation (FDOT) announced a partnership with GEICO Insurance to help curb the issue of distracted driving on Florida’s roadways. According to the announcement, sixty-four different “Safe Zones” are being created at different rest areas, welcome centers, and turnpike service plazas. “Safe Zones” are to be used by drivers for calling, texting, and accessing mobile apps.
“Motorist safety is our top priority and we are committed to reducing distracted driving on our roads,” stated Brian Blanchard, FDOT Assistant Secretary for Engineering and Operations. According to the Florida Highway Patrol, distracted driving accidents in Florida have increased 25 percent since 2012.
GEICO is sponsoring the addition of new signage along highways directing drivers to rest areas, welcome centers, and turnpike service plazas in order to remind drivers to use the “Safe Zones.”
“Distracted driving is a major concern for motorists in Florida and across the country. Each year, there are a growing number of injuries and fatal accidents directly related to this issue,” said George Rogers, GEICO Regional Vice President.
Click here to read news release.
Two individuals from Miami who have allegedly been involved in personal injury protection (PIP) fraud schemes have recently been arrested by the Division of Insurance Fraud (DIF) in separate cases.
Ariel Santana was arrested after he was revealed to be the owner of A & J Rehabilitation Center, a PIP clinic located in Miami, that illegally submitted more than $350,000 in fraudulent claims to various insurance companies, according to a press release issued by the Florida Department of Financial Services’ Division of Insurance Fraud.
DIF’s investigation found that Santana hired chiropractor Peter Maffetone to operate as the clinic’s straw owner and fraudulently obtained a licensure exemption from the Agency for Health Care Administration which resulted in the clinic operating without a license for more than three years. Santana and Maffetone submitted fraudulent claims totaling nearly $367,000 to four insurance carriers: Esurance, Geico, Progressive and United Auto.
Raul Antonio Perez Payes was apprehended, in an unrelated case, after DIF detectives discovered that he organized a staged car accident in August 2012. According to investigators, Payes recruited and paid accomplices to participate in the scam, which resulted in fraudulent insurance claims totaling more than $86,000.
Both cases will be prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle.
It has come to light through an investigation conducted by the Associated Press that four of the 48 self-driving cars on California’s roads have been involved in four accidents since September 2014. In a recent article published on Quartz.com, two of the accidents occurred while the self-driving vehicle was driving, and the other two accidents occurred while the human safety driver was in control. The two companies responsible for the self-driving vehicles were Google and Delphi. Google’s Director of self-driving program, Chris Urmson, revealed that the tech giant’s fleet has experienced 11 minor accidents in 1.7 million miles in six years since the driverless car program began.
The AP reported that the national rate for reported “property damage only crashes” is about 0.3 per 100,000 miles driven, according to data from the National Highway Traffic Administration. If one uses this statistic and compares Google’s crashes in about 140,000 miles the crash rate seems high.
The self-driving car program is required to submit data to the California Department of Motor Vehicles; however this information has not been readily released to the public based on the state’s Vehicle Code which requires accident reports concerning traffic injuries or fatalities to remain confidential.
Many believe that as a matter of public policy the government does not want to reveal to much information since they do not want these tech companies to be put under a microscope while this program is still in its testing phase.
The self-driving car program has yet too prove to be as flexible and responsive as humans on the road in dealing with unpredictable situations on the road.
On May 12, State Attorney Bill Eddins announced the arrest of Randall Peterson. Peterson was a Cantonment insurance agent who conducted a fraudulent insurance scheme while operating under multiple business names which involved the theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.
Peterson’s scheme began with him advertising job opportunities on the Internet for his fictitious company, College Consultants of the Gulf Coast. He then had hundreds of applicants provide information for life insurance which he and his associates expressed to the job applicants as a free job benefit. The prosecutor’s office showed that Peterson used the information from the job applicants to complete life insurance applications that he submitted to the insurance companies in order to receive advanced commissions, which were as much as 130 percent of the first year premiums and bonuses.
Randall Peterson was found guilty of racketeering and money laundering by Circuit Court Judge Ross Goodman. The state will request at a future hearing that restitution be set at an amount over $500,000.