Tag Archives: Palm Beach County

Labor Day Highway Safety Programs Underway in Florida

Florida drivers will see more speed traps and DUI checkpoints this holiday weekend as law enforcement personnel hit the roads with several safety initiatives aimed at stopping risky drivers.

Drive Sober or Get Pulled Over, supported by The Florida Highway Patrol, is a national campaign that began on August 15 and will run through Labor Day on September 1. FHP officers will be on the lookout for impaired drivers across the state.

“Take a shot at drinking and driving, and we’ll provide the chaser,” said FHP Director Col. David Brierton. “The choice to drink and drive is a bad decision that could have grave consequences. Be responsible, don’t drink and drive.”

The annual “Hands across the Border” is a separate Southeastern U.S. regional campaign coordinated by highway safety agencies from Florida, Georgia, Alabama, and Tennessee, among others, to look for drivers under the influence (DUI) of alcohol as they cross state lines.

The blood alcohol content (BAC) is .08 in all 50 states, note the program sponsors, meaning that impaired drivers cannot claim ignorance of the law. Drivers who fail a sobriety test are likely to be arrested.

The “Hands across the Border” program, which is now in its 23rd year, also encourages safe driving habits such as the use of seat belts and observance of speed limits.

AAA Travel predicts that almost 35 million Americans will travel 50 miles or more from home during the Labor Day holiday weekend, defined as Thursday, August 28 to Monday, September 1. Automobile travel makes up the largest portion of this number, with 29.7 million travelers planning a road trip. The overall traffic projections represent a 1.3 percent increase from 2013 and the highest Labor Day traffic volume since 2008. Recent reductions in gas prices are contributing to increased travel plans, notes AAA.

Drive safely!

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Filed under Uncategorized

Three Arrested for Staged Car Crash and False Insurance Claims

West Palm Beach Police arrested and charged three people in connection with a scheme to get insurance money after staging a fake traffic accident.

According to a story on WPTV News Channel 5, the three accused of the alleged crime were Jose Begas, Donicio Ruiz, and Marilu Rodriguez.  On the evening of May 5, 2010, police reported a two-car crash around Roseland Drive and Lake Avenue, in which Rodriguez and Ruiz were driving, and Begas was a passenger in Ruiz’s car.

After the accident, police say that Begas made a false claim with his insurance, Progressive Insurance Company, to receive personal injury protection benefits. His claim was denied because his policy had lapsed when the accident occurred.  Rodriguez and Ruiz later admitted to police that the accident was staged.

The State Division of Insurance Fraud arrested Ruiz and Rodriguez on Dec. 5 and Begas on Dec. 9, all on fraud charges. The three have been released on bond.

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Filed under Insurance Fraud

Defective Pre-Suit Demand Letter Leads to Defense Ruling

The double billing of $450 for one date of service with multiple CPT codes ultimately led to the granting of defendant’s Motion for Final Summary Judgment.

Earlier this year the Palm Beach County Court addressed the case of Foundation Chiropractic Clinic, Inc. v. State Farm Mutual, involving PIP benefits.

The undisputed facts involved a motor vehicle accident on November 1, 2010. Foundation Chiropractic Clinic, the plaintiff, sent a May 23, 2011 pre-suit demand letter to defendant State Farm, which was received on May 25, 2011. Plaintiff requested $7,310, with various discounts, for allegedly overdue PIP benefits in accordance with Florida Statute §627.736(10). Medical treatment was rendered between January 3, 2011 and March 9, 2011.

The real trouble began during a deposition of Dr. Charles Mitzelfeld on September 10, 2012. During his testimony, Dr. Mitzelfeld acknowledged that a $450 service rendered on January 6, 2011, was incorrectly double-billed as $900.

Initial Court hearings took place on February 19, 2013, at which time the court ordered an abatement until March 21, 2013 to grant plaintiff time to comply with the Statute.

Key facts emphasized by the Court included but were not limited to the following:

1)    The pre-suit demand letter was defective, since:
a)    Demand letters must strictly adhere to Florida Statute §627.736(10)
b)    PIP claims require medical billing precision
c)    The $450 double-billing means the amount was never due and payable
2)    Dismissal, not abatement, was the appropriate remedy for the facts of the case

Accordingly, the Court granted defendant’s Motion for Final Summary Judgment.

Case Details

The case is Foundation Chiropractic Clinic, Inc. v. State Farm Mutual, Case No. 502011SC006973XXXXMB(RJ), Claim No. 59-A670-488, heard in Palm Beach County Court. John M. Gioannetti was the lead attorney for Roig Lawyers. The case initially began as a small claim. Click on the link to read the Amended Final Judgment for the Defendant.

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Filed under Case Law, Demand Letter, Fla. Stat. 627.736 (2008), Fla. Stat. 627.736 (2012)

Operation Sledgehammer Results in Sentencing of Ninth Person in Car Insurance Scam

A Miami woman, who helped manage a widespread car insurance fraud ring from her chiropractic clinic in West Palm Beach, has received a six-year sentence in connection with “Operation Sledgehammer.”

Maria Testa Baceiro, 29, who co-owned the clinic with her boyfriend Luis Ivan Hernandez, pleaded guilty to 48 charges, mostly related to money-laundering and fraud.  Hernandez also pleaded guilty to similar charges and will be sentenced on November 4.

According to prosecutors, Testa collected $4.2 million from Febre’s Medical Center on Forest Hill Boulevard, as well as Universal Rehab Med Group in Miami.  She is the ninth person sentenced as part of Operation Sledgehammer—a federal investigation named for a favored tool the fraudsters used to make millions in South Florida by staging car accidents and filing fake claims with insurance companies.

Of those linked to the scam, 40 have been arrested; however, some of the 92 indicted in June have fled primarily to Cuba to escape prosecution, according to a September 30 Palm Beach Post news article.

Testa and Hernandez also participated in fraudulent activity that operated out of other clinics in Palm Beach and Miami-Dade counties, but prosecutors have been unable to secure financial records in order to put a dollar amount on those losses, the news article said.

U.S. District Judge Kenneth Marra ordered Testa to pay $4.2 million in restitution.

Testa, who moved from Cuba to the U.S. as a teenager, apologized for her actions and agreed to testify against others in the case, hoping for a reduced sentence.  According to Testa’s attorney, her mother had to move from New York to raise Testa’s and Hernandez’s 3-year old son.  The judge allowed her to start her sentence December 2.

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Filed under Insurance Fraud

Two Favorable PIP Rulings for Mercury Insurance

Medicare Part B and other statutory fee schedules were permitted as a basis for reimbursement in the recent case Timothy M. Kehrig, DC, P.A. v. Mercury Insurance Company of Florida, heard by a Palm Beach County court.

The plaintiff filed suit charging that Mercury did not pay 80% of the amount billed for medical services. Rather, the defendant determined payment by calculating 80% of 200% of the charges allowed in the Medicare Part B fee schedule.

The question in dispute was whether Mercury could pay benefits in accordance with the fee contained in Fla. Stat. §627.736(5)(a)(2) (2008) and the policy.

The court ruled that Mercury could limit payment in accordance with statutory fee schedules.

Separately, a Pinellas County court recently permitted Mercury to limit payment by using statutory fee schedules in the PIP dispute Orthopedic Specialists v. Mercury Insurance Company of Florida.

The case related to a 2011 injury in which Mercury reimbursed the medical services provider at a rate of 80% of 200% of the benefits available under Medicare Part B.

“Medical benefits” were defined in the policy as meaning “eighty (80%) percent of all reasonable expenses allowed by the No-Fault Law, subject to the applicable fee schedules and payment limitations, for medically necessary …”

The court cited Geico General Ins. Co. v. Virtual Imaging Services, Inc., stating that the description of medical benefits payment “is not inconsistent with application of the fee schedules and limitations.”

Case Documents

Click on the link to read the Final Judgment for Defendant in the matter Timothy M. Kehrig, DC, P.A. v. Mercury Insurance Company of Florida, (Case No. 50-2011-SC-008363).

Click on the link to read the Final Summary Judgment in the matter Orthopedic Specialists v. Mercury Insurance Company of Florida, (Case No. 13-000073-SC).

Both cases involved a “U85 (05/2010)” endorsement to the policy.

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Filed under Case Law, Fla. Stat. 627.736 (2008), The Statutory "Fee Schedules"

Palm Beach County Court: PIP Demand Letter Requirements Must Be Strictly Adhered

On May 8, 2012, Palm Beach County Court Judge Sandra Bosso Pardo granted Final Judgment for State Farm in a claim for PIP benefits filed by Lake Worth Emergency Chiropractic Center, P.A.

Judge Bosso Pardo granted Defendant’s Motion for Final Summary Judgment, entering final judgment for the defendant, State Farm, upon finding that the pre-suit demand letter, required by Florida Statute 627.736(10) (2010), was insufficient in that it demanded payment for services that were never billed to State Farm.  Judge Bosso-Pardo found that the Plaintiff’s “withdrawing” the unbilled service after suit had commenced was insufficient to cure the defect and that the demand letter requirements under Florida Statute 627.736(10) must be strictly construed and adhered to by those seeking to initiate litigation against a Florida PIP insurer.

The full text of the Court’s ruling is available here.

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Filed under Case Law, Demand Letter, Fla. Stat. 627.736 (2008)