Author Archives: Michael A. Rosenberg, Esq.

Miami Woman Facing 47 Charges in Insurance Fraud Scheme

Shanequa Veal, alleged “ringleader” of an insurance fraud scheme, is facing 47 charges for these crimes. Veal is being accused of submitting about $357,000 in doctored insurance claims for herself and other people, including her two children.

Click here to for the video.

Filed under Fraud

Update: Florida Governor Signs AOB Reform Bill

In recent years, lawmakers deliberated changes to the AOB process but could not reach an agreement, amidst heavy lobbying by groups on both sides of the issue. This year, however, the House and Senate came to an agreement and sent the bill to Florida Governor Ron DeSantis. DeSantis signed House Bill 7065 on Thursday, marking the end to a seven-year battle by the industry and reform advocates. This law takes effect on July 1, 2019.

Click here to view our earlier post on what the bill entails or contact us to discuss the implications of this significant change in Florida law.

Filed under Property (Homeowners)

Palm Beach Gardens Man Charged In Insurance Fraud Scam

 Jonathan Ryan of Palm Beach Gardens was arrested and charged with insurance fraud and perjury after claiming someone stole his Ford Mustang. Ryan’s 2015 Ford Mustang GT was later found submerged in a Riviera Beach canal not too far from where it was reportedly taken.

Ryan was later identified on surveillance video pulling off in his car just before it was reported to his car insurance company.

Click here to read the article.

Filed under Fraud

Florida Legislature Passes Assignment of Benefits Reform Bill

On April 24, 2019, by a vote of 25-14 the Florida Senate passed SB 122 that addresses AOB’s for residential or commercial property insurance claims and limits attorney’s fees related to AOB agreements. The Senate bill was a committee substitute for House Bill 7065, which passed the House on April 11, 2019. Governor Ron DeSantis is expected to sign the bill which would become law effective July 1, 2019. Click here to view the entire Bill: Florida SB 122/HB 7065

Contact us for more information or to discuss the implications of this significant change in Florida law.

Filed under Legislation, Property (Homeowners)

Survey Finds More Insurers Fighting Fraud with Data Analytics

According to a survey by Coalition Against Insurance Fraud, insurers are turning to analytics to fight insurance fraud which they believe is on the rise. Of the 84 carriers surveyed, 65% reported an increase in fraud over the past three years, 10% said fraud decreased and 25% said it remained the same.

Survey results also say that 21% of the carriers plan to invest in artificial intelligence. There has also been an increase in the use of unstructured data.

Click here to read the article.

Filed under Fraud

Global Blockchain Expected to Grow in the Insurance Market

Insurance companies globally lose more than US$80 billion to fraud every year. A growing number of fraudulent insurance claims, increasing need to have transparent and trustworthy systems, and a focus on reducing the total cost of ownership will most likely drive the growth of the market.  A new study from ReportLinker projects global blockchain will have a compound annual growth rate of 84.9% between 2018 and 2023 ($64.5M to $1.393.8M) in the insurance market. The identity management and fraud detection segment are expected to hold the largest market size during that period.

The insurance sector of the Asia-Pacific (APAC) area is increasing its adoption of blockchain technology now and is expected to grow the fastest.

Click here to read the article.

Filed under Fraud, Technology

The Evolution of Investigative Tools in Insurance Investigations

Since Hurricane Season is underway, here’s a Daily Business Review article published by Roig Lawyers Partner Patricia Preciado that still holds true today.

Click here to view the article.

Aerial image of Florida Keys after Hurricane Irma

Aerial image of Florida Keys after Hurricane Irma

Filed under Property (Homeowners)

Three from Miami Sentenced in $40M Medicare Fraud

Jorge Lorenzo, Yahima Pardo and Roberto De Jesus Alonso, all of Miami, were sentenced to prison and ordered to pay more than $40 million as a result of their involvement in what is considered the Medicare fraud scheme that caused the greatest loss to the government in 2015.

In addition to the nearly $40.4 million in restitution, the government seized over $2 million in cash and personal assets including Rolex and Cartier watches and artwork by prominent Cuban artists.

The case, before U.S. District Judge William Dimitrouleas, centered around Lorenzo’s ownership or control of 8 home health agencies in Miami-Dade County that received in excess of $40 million from Medicare as a result of fraudulent claims by way shell owners at each agency funneling claim payments to other fictitious companies staffed by co-conspirators. Once indication of a Medicare fraud investigation arose, Lorenzo would close the home health agency, keeping them open for only 8 months on average.

Click here for full story.

Filed under Uncategorized

Woman Sent to Jail for Stealing Identities of Insurance Customers

A routine traffic stop uncovered the scheme of a former employee of a health insurance company who stole the identities of customers.

Quinzella J. Romer, 39, was sentenced to 32 months in prison and ordered to pay $16,264 in restitution. Romer pleaded guilty to one count of possession of 15 or more unauthorized access devices (Social Security numbers) issued to other people and one count of aggravated identity theft.

The federal prosecutor said Romer’s scam started unraveling after a traffic stop in Coral Springs in 2014. Police noticed Romer had an outstanding warrant for petit theft, and during a pat down, officers found a Florida driver’s license in another person’s name and a cellphone.

After getting a search warrant, officers found 20 screenshots on the phone containing 50 names with Social Security numbers and dates of birth. Romer had taken the shots between 2007 and 2013 during her work as a short-term disability benefit manager at a health insurance company.

An investigation revealed that 12 of the numbers in Romer’s phone were victims of tax-related identity theft in 2013. Tax returns filed on behalf of those names sought refunds of $38,196, with the Internal Revenue Service actually paying out $16,264.

Click here for full story.

Filed under Uncategorized

Mississippi, Florida Residents Part of Pharmaceutical Scheme

The U.S. government confiscated $11 million worth of properties involved in a healthcare fraud scheme centered in Mississippi that also involved residents of Florida, Alabama and Utah, according to a report in the Clarion-Ledger of Jackson, MS.

The Internal Revenue Service described the criminal activity as a compounding pharmacy scheme. The pharmacies engaged in “price rolling,” in which a pharmacy submits a bill to an insurance company to test the amount the provider will reimburse for a specific prescription. The claim is canceled, then another claim is sent for a compounded formula to see if that is reimbursed at a higher rate. Compounding is the process of creating a prescription unique for the patient’s particular needs, such as providing the same medicine in a pill and a liquid.

The IRS also said the scheme involved split billing, where a prescription is split into smaller portions. The split prescription can include separate dispensing fees as well as automatic refills that might not have been intended by the doctor.

Search warrants were served in January during the compounding pharmacy investigation. No arrests were made, but the properties were recently confiscated by the feds because evidence showed they were purchased with dirty money. Such civil forfeiture is based on the idea that the property, not the owner, has violated the law.

Following the 12 warrants, the government interviewed hundreds of people and confiscated 24 vehicles, five planes, two boats and money from 80 bank accounts totaling $15 million, according to a Mississippi Bureau of Narcotics spokeswoman.

Click here for full story.

Filed under Healthcare