September 2014 - Florida Department of Financial Services

September 2014
Volume 5 - Issue 3
...the Division of
Insurance Fraud (DIF)
arrested four staged
accident organizers in
separate, unrelated
cases that resulted in
more than $300,000 in
fraudulent claims filed
against seven different
insurance carriers.
INSIDE THIS ISSUE
1
Miami Arrests
2
PIP Fraud News
3
Statewide Arrests
4
Most Wanted
5
Statewide Contacts
HEADER HERE
Four Staged Accident
Organizers Arrested
in Miami Cases
In August, the Division of Insurance Fraud (DIF) arrested four staged
accident organizers in separate, unrelated cases that resulted in more than
$300,000 in fraudulent claims filed against seven different insurance carriers.
- William Tejeda Mayobanex, 29, was arrested for organizing a staged
accident in February 2011. Mayobanex referred the participants to several
clinics, A & J Rehabilitation Center and D & J Rehabilitation Center. As a
result of Mayobanex’s actions, more than $64,000 in fraudulent claims for
property damage and alleged treatment of three participants, including
Mayobanex, were filed against United Auto and York Services.
- Roberto Carlos Monzon-Mendez, 39, was arrested for organizing a staged
accident in June 2012. Monzon-Mendez paid at least one participant $2,000
and referred participants to several clinics including Gentle Care Rehab,
Gonzalez Medical Center and Psychologist Technology. As a result of his
actions, more than $55,000 in fraudulent claims for alleged treatment of five
participants were filed against Geico and State Farm. Another organizer,
Carlos Morales Lastayo, was previously arrested in January 2014. Lastayo
is currently a fugitive.
- Elier Valdes Garcia, 33, was arrested for organizing a staged accident in
October 2011. Valdes Garcia referred the participants to several clinics,
Clarke Medical Services, Emoge Medical Services and New Life Rehab
Services. As a result of Valdez Garcia’s actions, nearly $95,000 in fraudulent
claims for alleged treatment of five participants were filed against Allstate and
United Auto.
- Luis Montero, 61, was arrested for organizing a staged accident in May
2011. Montero referred the participants to several clinics, Blue Medical
Network, Torres Rehabilitation Center and Tri R Wellness Center. As a
result of Montero’s actions, more than $88,000 in fraudulent claims for
alleged treatment of five participants were filed against Imperial, Ocean
Harbor, State Farm and United Auto.
September 2014
Page 2
PIP FRAUD – In The News
Man Arrested in Tampa Patient Brokering Sting Operation
Jerry Leon Cook, 64, was arrested by the Division of Insurance Fraud (DIF) in August on charges of patient brokering.
Cook worked with Marc Neil Blum, a medical doctor and owner of LM Medical Clinic, a Tampa PIP clinic. DIF inititated
an undercover investigation after the National Insurance Crime Bureau (NICB) received information about fraud at
Blum’s clinic. Blum allegedly offered money to an informant to solicit patients for his clinic. After the patients would
come to the clinic and sign paperwork for treatment that was not provided, Blum would refer the informant to Cook, who
would pay $500 for each patient. Blum passed away before any charges could be filed against him.
Miami Clinic Owner Arrested in Staged Accident Case
Yudeisy Abreu Pena, 25, was arrested by the Division of Insurance Fraud for her involvement in an insurance fraud
scheme involving a staged accident that occurred in October 2012. Abreu Pena was an owner of New Life Health Care
Medical Center, a PIP clinic located in Miami. Participants from the staged accident were referred to New Life, where
Abreu Pena instructed them on what to say to the doctor about their alleged pain and injury, and instructed them to sign
blank treatment forms. Nearly $30,000 in fraudulent bills were submitted to Geico as a result of this staged accident.
Abreu Pena is the tenth subject charged in this case since the first arrest in June 2013.
Orlando Clinic Owner Arrested for Patient Brokering
Osselyn Oreste, 32, was arrested by the Division of Insurance Fraud in August on charges of patient brokering. Oreste,
who owns Elite Wellness, a PIP clinic in Orlando, was charged in two cases for offering to pay patients $1,000 to be
treated at his clinic. In one case, the patient, who was not injured in the crash, told DIF that he only went to the clinic
after Oreste approached him at the scene of the accident and offered him a $1,000 gift card to seek treatment. The
patient never received the $1,000, but 21st Century was billed more than $13,000. In the second case, Oreste again
promised but never paid two patients who were not injured, and their insurance carrier, Direct Administration, was billed
nearly $17,000 for unnecessary treatment.
Palm Beach Woman Arrested For Patient Brokering in St. Lucie County
Margaline Pierre Toussaint, 49, of West Palm Beach, was arrested by the Division of Insurance Fraud in August on
charges of patient brokering. Toussaint allegedly attempted to obtain $2,000 from a chiropractor in St. Lucie County for
the referral of a patient. In a recorded conversation with the chiropractor, Toussaint stated that she had worked for “the
firm”, a chiropractor / lawyer team in Palm Beach County, for eight years, and was paid for the referral of patients,
splitting the $2,000 equally with the patient. Toussaint explained to the chiropractor that “once the insurance is checked
and verified, then you pay me the money.” The chiropractor told Toussaint that he did not pay for patients, and she left
his office. The Division of Insurance Fraud was assisted in the investigation by the St. Lucie County Sheriff’s Office.
Florida Hospital Charged Exorbitant Fees For Scans, X-Rays, Lawsuit Claims
A pair of unrelated car wrecks in South Florida last year has resulted in what may be a far-reaching lawsuit filed in
Tampa. The suit accuses a holding company that owns 80 hospitals across the state, including several in the Tampa
area, of grossly overcharging for medical services.
According to the suit, JFK Medical Center and its owner, HCA Holdings, charged exorbitant fees for emergency room
radiological services. The overcharges sapped the Personal Injury Protection coverage limits of the patients and left
them with thousands of dollars of uncovered bills they had to pay out of their pockets, the suit says.
The four-count, 38-page lawsuit was filed in Hillsborough County Circuit Court and seeks class-action certification.
See the full story at http://tbo.com/news/breaking-news/florida-hospital-charged-exorbitant-fees-for-scans-x-rays-lawsuitclaims-20140902/.
Driver Awareness Involving Auto Accidents and Fraud is Key
In numerous reports from the LA Times to Insurance.com, the topic of staged auto accidents is something worth
understanding. All too frequently, dishonest people will use schemes against unsuspecting drivers to make bogus
insurance claims. These con artists carefully plan and practice their craft so they can accuse and then hold up the
other drivers' insurance company for a settlement. There are many ways drivers can be aware of these scams in
order to inform their insurance agent and their carrier.
Read the full story at http://www.prweb.com/releases/2014/09/prweb12156756.htm.
The PIP Source
Page 3
Statewide PIP Arrests – August 2014
Each issue will provide a list of PIP arrests made by the offices throughout the State. Along with each defendant’s name
and age, we will include: the type of scheme involved; the fraud dollar amount; clinic name(s); victim insurance company
name(s); and the arresting office. If you need additional details on any of these arrests, please contact Capt. Smith.
Julio Cesar Martes, 49 – staged acct 10/23/10 (driver) $52,355 - NY Medical Rehab (Bristol West / Safeco / Seminole Casualty /
State Farm) W
Ashley Nichole Nuttal, 30 - application fraud (Progressive) T
Margie Cunningham, 70 - application fraud (Progressive) O
Guilene Saintard, 32 - false receipt (Nationwide) M
Jerry Leon Cook, 64 - patient brokering - LM Medical Clinic (21st Century) T
Eva M Martinez, 34 - fake ins card (Geico) O
Yolanda Mercedez Vargas, 48 - staged acct 04/22/12 (driver) $14,349 - Indian Rehabilitation Center (Progressive) J
Christian A Vargas, 27 - staged acct 04/22/12 (passenger) $12,826 - Indian Rehabilitation Center (Progressive) J
Yulitza Hernandez, 35 - sale of fake ins card (First Acceptance) T
Willdelyn Barbie Hernandez, 24 - staged acct 04/22/12 (passenger) $5,785 - Indian Rehabilitation Center (Progressive) J
Christine Felicia Hogan, 37 - fake ins card (Ocean Harbor) O
William Tejeda Mayobanex, 29 - staged acct 02/27/11 (recruiter) $64,089 - A & J Rehabilitation Center / D & J Rehabilitation Center
(United Auto / York Services) M
Yudeisy Abreu Pena, 25 - clinic owner / insurance fraud - $29,492 - New Life Healthcare Medical Center (Geico) M
Roberto Carlos Monzon-Mendez, 39 - staged acct 06/14/12 (recruiter) $55,599 - B & A Diagnostic / Doctors Professional Medical /
Flores Chiropractic Group / Gentle Care Rehab / Gonzalez Medical Center / Psychologist Technology / Y & J Chiropractic Center
(Geico / State Farm) M
Jeffery Manuel Chamorro, 21 - application fraud / false claim - $4,933 (Progressive) M
Kathleen Ann Olson, 57 - forgery / false claim (State Farm) T
Margaline Pierre Toussaint, 49 - patient brokering - W
Elier Valdes Garcia, 33 - staged acct 10/05/11 (recruiter) $94,715 - Clarke Medical Services / Emoge Medical Services / New Life
Rehab Services (Allstate / United Auto) M
Sharon Denise Reynolds-Bell, 54 - fake ins card (Occidental Fire & Casualty) O
Alan Dale Mashaw, 38 - staged acct 10/2/13 - $9,932 - Accident & Injury Clinic (State Farm) O
Dayron Miguel Fuentes, 28 - staged acct 02/20/10 (driver) $49,286 - (National Indemnity / Progressive) M
Oscar Rivera Marrero, 50 - staged acct 11/14/11 (driver) $14,256 - Saint Jose Injury Center (Unitrin) J
Luis Montero, 61 - staged acct 05/07/11 (recruiter) $88,336 - Blue Medical Network / D & S Chiro Rehab Center / South Florida
Medical Health Center / Torres Rehabilitation Center / Tri R Wellness Center (Imperial / Ocean Harbor / State Farm / United Auto) M
Guillermo de la Vega, 49 - staged acct 07/27/12 (driver) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic
Center (Esurance / Geico / Infinity / Progressive) J
Omar Santiago Ortega, 37 - staged acct 07/27/12 (driver) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic
Center (Esurance / Geico / Infinity / Progressive) J
Jose A Santos, 49 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center
(Esurance / Geico / Infinity / Progressive) J
Sisy Farinas Mena, 45 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic
Center (Esurance / Geico / Infinity / Progressive) J
Sarita Necole Firlow, 40 - fake ins card (Geico) T
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
September 2014
Page 4
Statewide PIP Arrests – August 2014
Each issue will provide a list of PIP arrests made by the offices throughout the State. Along with each defendant’s name
and age, we will include: the type of scheme involved; the fraud dollar amount; clinic name(s); victim insurance company
name(s); and the arresting office. If you need additional details on any of these arrests, please contact Capt. Smith.
Osselyn Oreste, 32 - clinic owner - patient brokering - Elite Wellness (21st Century) O
Osselyn Oreste, 32 - clinic owner - patient brokering - Elite Wellness (Direct Administration) O
Jason Kevin Jasmin, 29 - staged acct 12/30/12 (driver) $11,271 - North Beach Pain Health Center (Geico / RepWest) M
Jennie Flores, 35 - false claim - $12,000 (USAA) O
Jana Lynn Velazco, 40 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic
Center (Esurance / Geico / Infinity / Progressive) J
Emmanuel Lundi, 34 - solicitation - Accumed Wellness & Rehabilitation Center (Allstate) B
Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)
Manuel Acosta
Hispanic Male, 50 years old
5’09”, 165 lbs, Brown Eyes, Brown Hair
Warrant Information:
Warrant/Case #: 482010CF0032720
Felony Warrant Charge: Insurance Fraud / Staged Accident
Details:
The Florida Department of Financial Services, Division of Insurance
Fraud, DIF is attempting to locate Manuel Acosta in reference to the
outstanding warrant.
Acosta has been a fugitive since March 2010 for the above charges. He
recruited subjects to rent vehicles and then participate in staged motor
vehicle accidents to personally gain from the resulting personal injury
protection benefits.
If you know where Acosta can be located, please contact the Division of
Insurance Fraud at 1-800-378-0445.
Check out the DFS Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/
The PIP Source
Page 5
Statewide PIP Contacts
PANHANDLE REGION
Counties: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf,
Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty,
Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton,
Washington
Pensacola Field Office - 850.453.7802
Capt. David LINDSAY
Tallahassee Field Office - 850.413.3115
Lt. Ernie STOLL
NORTH REGION
Counties: Alachua, Baker, Bradford, Citrus, Clay, Columbia,
Dixie, Duval, Flagler, Gilchrist, Hamilton, Levy, Marion,
Nassau, Putnam, St. Johns, Sumter, Suwannee, Union
Jacksonville Field Office - 904.798.5802
Capt. Brian McCOY
Lt. Kevin JONES
WEST CENTRAL REGION
Counties: Charlotte, Collier, DeSoto, Glades, Hardee, Hendry,
Hernando, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk,
Sarasota
Tampa Field Office - 813.972.8602
Capt. Michael BYRNE
Lt. Carlos ROSARIO
Fort Myers Field Office - 239.278.7527
Lt. Mark FRITZ
Copy goes her.
Editor’s
Corner
On page 1, we cover the arrests of four staged
accident organizers in Miami.
On page 2, we report on PIP Fraud in the News
which includes the arrests of three subjects on
patient brokering charges, in Tampa, Orlando
and St. Lucie County.
On page 4, we feature another fugitive in
Insurance Fraud’s Most Wanted.
As always, we report the latest PIP-related
arrests.
EAST CENTRAL REGION
Counties: Brevard, Lake, Orange, Osceola, Seminole, Volusia
Orlando Field Office - 407.835.4402
Capt. Glen HUGHES
Lt. Laquanda GREEN
Lt. John SAVINO
SOUTH CENTRAL REGION
Counties: Broward, Highlands, Indian River, Martin,
Okeechobee, Palm Beach, St. Lucie
Plantation Field Office - 954.958.5402
Capt. Rafael DELGAGO
Lt. Bill LEE
West Palm Beach Field Office - 561.837.5601
Lt. Evangelina BROOKS
SOUTH REGION
Counties: Dade, Monroe
Miami Field Office - 305.536.0302
Capt. Steven SMITH
Lt. Violeta SERRANO
Lt. Stanley JEAN-FELIX
Lt. Missael DIAZ
South Florida Major Medical Fraud Task Force
Supervisory Special Agent Fred Burkhardt 847.544.7141
Central Florida Major Medical Fraud Task Force
Supervisory Special Agent Jose Olivier 813.558.6387