Tag Archives: PIP

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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Jacksonville Clinic Owner Arrested for Racketeering and Insurance Fraud

Sandy Morales, who owned and operated Gate Parkway Diagnostic Center, has been arrested for racketeering and insurance fraud charges, as reported in a June 18, 2015 article by the Jacksonville Business Journal.

According to the Florida Department of Financial Services, Sandy Morales organized a complex Personal Injury Protection (PIP) fraud scam that resulted in over $100,000 in fraudulent filing claims for injuries in accidents which did not occur.

Investigators stated that Morales’ arrest is one of 180 arrests since September 2012 that are tied to the fraud network. According to the Division of Insurance Fraud, Morales elaborately staged multiple car accidents, paid people to pose as passengers, and then paid those individuals to seek treatment in his clinic for bogus injuries. Morales is also accused of recruiting other clinic owners to participate in the fraud, and sending patients to those clinics in order to increase the fraud network.

The clinics involved in the PIP scam, now closed, include:

  • Arlington Rehabilitation Services Inc.
  • Baymeadows Injury Center LLC
  • Health Point Injury Center LLC
  • One Touch Therapy Center Inc.
  • Saint Jose Injury Center LLC
  • Therapy Diagnostics Tech Medical Inc.
  • Wellness Rehab Services Inc.
  • Atlas Massage Therapy Corp.

Morales could face a maximum of 45 years in prison, and is currently being held in Duval County Jail with a bond of over $600,000.

Click here to read article.

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Fort Lauderdale residents arrested for PIP Fraud

The Florida Department of Financial Services’ Division of Insurance Fraud announced on March 19, 2015 the arrest of two Fort Lauderdale Residents for PIP fraud following a staged accident. Kendrick Callins and Lashaunda Gibbs were arrested for staging auto accident, patient brokering and personal injury protection insurance fraud.

The Division of Insurance Fraud, Federal Bureau of Investigation, Broward County Sheriff’s office and the Fort Lauderdale Police Department investigation revealed that Callins and Gibbs organized and participated in a staged accident on September 22, 2012, in Fort Lauderdale. The staged accident involved participants, recruited by Callins and Gibbs, who intentionally drove a rented U-Haul truck into a passenger vehicle occupied by arrestees. The arrestees submitted fraudulent insurance claims which were paid by the insurers. Callins and Gibbs each face a maximum sentence of 25 years.

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Insurance Bill addresses issues with Assignment of Benefits

Florida House of Representative, John Tobia of the 53rd district, has introduced CS/HB 669 which addresses consumer issues related to “Assignment of Benefits”. The bill is still alive after a hearing on March 19, 2015 in front of the House Insurance and Banking Subcommittee. The bill addresses insurance-claims issues regarding AOB’s dealing with property insurance. An AOB occurs when a policyholder has a loss and signs a contract with a third party to reconcile the damage. Once the AOB is signed the contract allows for the third party to be assigned the proceeds from the homeowner’s insurance policy. AOB’s are currently a hot topic with property insurance carriers and for years have been the keystone of PIP/No Fault Litigation.

CS/HB 669

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Florida’s Fight Against Insurance Fraud Rings Featured on ABC’s Nightline

Florida's Fight Against PIP Fraud Rings on ABC's Nightline

Florida’s Fight Against PIP Fraud Rings on ABC’s Nightline

Specialists in Florida’s Department of Financial Services, who have been trained to trace Personal Injury Protection (PIP) insurance fraud, will often spend months following paper trails, pursuing suspects, and managing surveillance. While not the most high-profile job in law enforcement, the goal is to arrest alleged medical clinic owners, physicians, therapists and phony accident victims who are part of intricate fraud schemes organized to fraudulently collect millions in insurance payments.

According to an October 23 story on ABC’s Nightline, it is estimated that personal injury fraud may cost Florida $1 billion a year, a loss that is passed along to consumers in the form of rising insurance premiums. Click on the link to watch the video.

Agents say that a typical set up includes car accidents involving “victims,” who are not actually injured. These victims go to personal injury clinics allegedly established by fraudulent clinic owners, where they are paid. Employees at the clinic then make an insurance claim for services that were never performed, filing up to $10,000 per “victim,” the Nightline story reported.

The fraudsters “want to make sure that they create visible damage so the police will write up a report,” said Lt. Rafael Delgado, an agent with the state’s Department of Financial Services, who talked to reporter Matt Guttman.

As a result, one car with four passengers could generate $40,000 in claims, and two cars involved in a fake collision could double the amount.

“It’s volume, keep pumping them in, volume, volume, volume,” Delgado said in the piece. “The more billings you do to the insurance companies, a bunch of it is going to get through, some of it’s not going to get through. It’s all volume. It’s all about making as much money as possible.”

One of the rings Delgado pursued was in Miami, the capital of this type of crime wave. Along with other agents and the Miami police, the group recently busted a fraud operation encompassing four clinics, two owners, and various employees who allegedly organized the staged accidents and the people involved as paid passengers.

Delgado said the suspects staged six car accidents, ultimately costing insurance companies more than $400,000.

The 20 individuals taken into custody were arraigned on insurance fraud charges, and according to their defense attorneys and court documents, all have entered pleas of ‘not guilty.’ Insurance fraud, up to $20,000, carries a maximum sentence of five years in prison if found guilty.

Because the money is so easy and the stakes are so low, insurance scams will continue to be carried, agents say, regardless of the outcome from arrests.

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