...former insurance adjuster Jose Serpa

created fictitious claims and issued checks for

treatment never provided by clinics

operated by his alleged co-conspirators.

Volume 3 - Issue 2 August 2012

The Division of Insurance Fraud (DIF) conducted an investigation into a PIP fraud scheme wherein former insurance adjuster Jose Serpa created fictitious claims and issued checks for treatment never provided by clinics operated by his alleged co-conspirators. As a result, the Miami-Dade State Attorney’s Office Insurance Fraud Unit issued warrants for Serpa and two clinic owners, Abel Hernandez and Jorge Ramos.

MAPFRE Insurance Company of Florida (MAPFRE) completed an internal investigation into the PIP fraud scheme and referred the case to the Division of Insurance Fraud, which conducted an independent investigation confirming that Serpa, Hernandez and Ramos allegedly stole approximately $186,000 by way of fraudulent payments for treatment never provided by Lakes Advantage Rehab, Exclusive Home Health Services and Unique Relief, all located in Miami.

Serpa, 26, worked as a PIP adjuster for approximately six months between November 2010 and April 2011 at MAPFRE in Miami. Stefan Jensen, Vice President with MAPFRE, stated “MAPFRE is and will continue to be vigilant in our efforts to fight insurance fraud and seek prosecution. We completed a thorough internal investigation and shared that evidence with DIF. We truly appreciate their cooperation and dedication to the investigation that led to these arrests.”

Serpa, who was first licensed as an insurance adjuster in 2009, opened a corporation called The Mental Anguished Claimants Group in April 2011 at the same time he left MAPFRE, and tried to handle claims on behalf of persons involved in auto accidents. Abel Hernandez, 34, owned Lakes Advantage Rehab. Jorge Ramos, 46, owner of Exclusive Home Health Services and Unique Relief, is currently in federal custody and has a warrant waiting for him on state charges in this case.

Serpa and Hernandez were arrested by DIF in July. Additional arrests are pending as the investigation continues.

INSIDE THIS ISSUE

1 Clinic Owners,

Adjuster Charged

2 Most Wanted

3 PIP Fraud News

4 Statewide Arrests

6 Statewide Contacts

HEADER HERE Clinic Owners, Former Insurance Adjuster Charged in PIP Fraud Case

Page 2 August 2012

Check out the latest Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/

Most Wanted: Fugitive

The Division of Insurance Fraud (DIF) arrested five subjects for organizing staged accidents in Miami in July.

The cases involved four different staged accidents totaling more than $130,000 in fraudulent claims being filed against five different insurance carriers. The accidents occurred between April 2010 and September 2011. There is no indication that the accidents are connected and all appear to be part of separate rings.

Those arrested included Raul Torres Oliva, 29, Juan Francisco Fernandez, 49, Julio Cesar Nobelo, 28, Juan Francisco Fernandez, 48 and Roger Eduardo Ramos Perez, 41.

The takedown of staged accident rings and their organizers is the focus of DIF, and investigations continue to target the medical providers if the case can be made for fraudulent billing.

Each defendant faces a minimum of two years in prison if convicted of the second-degree felony.

The Division recently entered into a partnership with the Florida Highway Patrol (FHP), which will include the assignment of FHP Troopers to the Miami and Tampa DIF offices to work in the investigation of staged accident ring activity. The FHP also recently launched a website, in collaboration with DIF and the National Insurance Crime Bureau (NICB) to help educate the public to protect themselves from staged crashes. You can visit the website at http://www.flhsmv.gov/fhp/misc/StagedCrashes.htm.

DIF Arrests Staged Crash Organizers in Miami

Lazaro Vigoa Mauri Hispanic Male, 44 years old

6’00”, Brown Eyes, Brown Hair

Warrant Information:

Warrant/Case Number: 209B-MM-113865

Monetary Structuring Transactions, Mail Fraud and Conspiracy to Commit Mail Fraud

Details:

The Florida Department of Financial Services’ Division of Insurance Fraud is attempting to locate Lazaro Vigoa Mauri in reference to the outstanding warrant.

Mauri was indicted by the U.S. Attorney’s Office in July 2011 as part of Operation Sledgehammer for his involvement in a massive insurance fraud / staged accident ring operating in Palm Beach County.

If you know where Mauri can be located, please contact the Division of Insurance Fraud at 800-378-0445.

Page 3 The PIP Source

Reforms May Save Florida Drivers Up to 24.6% on PIP Premium Florida’s new no-fault auto insurance law could result in savings of 14 percent up to as much as 24.6 percent for drivers on their personal injury protection premiums. Pinnacle Actuarial Resources Inc., which was hired by the Office of Insurance Regulation to evaluate the new law, reported that changes in the law should translate into premium reductions on average between 14 percent and 24.6 percent. By October 1, all insurers must submit a rate filing reflecting a 10 percent decrease in their PIP rates or they must provide a detailed actuarial reason why they are not cutting them by that much. A similar requirement is due January 1, 2013, for an additional 25-percent decrease.

Florida Insurance Consumer Advocate Robin Westcott believes the longer the law changes are in effect, the more they will change the system and lower costs. “There is going to be a learning curve and that could have a great impact on rates,” said Westcott. “We’ve seen that in medical malpractice and workers’ compensation.”

Chief Financial Officer Jeff Atwater, who was a driving force behind the reforms, said he expects insurers to do their part by lowering PIP premiums. “I am eager to see these projected savings, if not more significant savings, passed on to Florida’s insurance consumers,” said Atwater in a statement. “Recent history has shown us that independent actuarial studies conducted on reforms relating to the workers’ compensation and medical malpractice systems significantly under-estimated the reductions actually realized,” he said.

Read the entire article at http://www.insurancejournal.com/news/southeast/2012/08/24/260563.htm.

New Auto Insurance Fraud Strike Force Holds Initial Meeting in Tallahassee The 2012 Legislature directed the Department of Financial Services to organize the Automobile Insurance Fraud Strike Force with the end goal of better protecting consumers by monitoring fraudulent activity in the marketplace and identifying resources to proactively assist local law enforcement and its partners in the fight against auto insurance fraud. This direct support organization (DSO) was created to provide additional resources to the Division of Insurance Fraud (DIF), the state attorney’s offices, the office of Statewide Prosecution of the Attorney General’s office, the Agency for Healthcare Administration (AHCA) and the Department of Health (DOH). The new Strike Force held its first meeting on August 7, 2012, in Tallahassee and is scheduled to hold its next meeting in December.

The Board of Directors include Peter Antonacci, Chair, State Attorney, 15th Judicial Circuit; Stephen Russell, State Attorney, 20th Judicial Circuit; Donovan Brown, Property and Casualty Insurers Association; Lauren Facemire, Personal Insurance Federation of Florida; Sheriff John Rutherford, Jacksonville Sheriff's Office; Alan Levine, Health Management Associates; Ed Zebersky, Zebersky and Payne LLP, Ft. Lauderdale; Ken Hazouri, deBeaubian, Knight, Simmons Mantzaris & Neal, Orlando; Mark A. Ober, State Attorney, 13th Judicial Circuit; and Lisa Womack, Chief, Lakeland Police Department.

You can learn more about the Strike Force by visiting their website at http://www.myfloridacfo.com/autofraud/.

Read an article by Kathleen Haughney on the first meeting at http://articles.sun-sentinel.com/2012-08-07/news/fl-state-pip-crackdown-group-begins-20120807_1_personal-injury-protection-auto-insurance-insurance-industry.

Mercury Insurance Sponsors PIP Fraud / Staged Accidents Training in Doral In July, the Mercury Insurance Special Investigation Unit, in conjunction with the State of Florida Division of Insurance Fraud (DIF) and the National Insurance Crime Bureau (NICB), teamed up to present a seminar at the Dade County Police Benevolent Association in Doral, Florida, on PIP fraud and staged automobile accidents.

Mercury Insurance SIU Supervisor Edward Lopez coordinated the efforts with NICB Supervisory Special Agent Fred Burkhardt and Captain Steven Smith as the featured speakers. The seminar’s objective was to enhance the knowledge and skills in "Fighting fraud in this state by educating ourselves and striving to the highest investigative standards." More than 60 insurance investigators and law enforcement personnel attended.

Miami Judge Facing State Ethics Investigation Loses Bid For Re-election Judge Ana Maria Pando, under state scrutiny for lending the prestige of judicial office for a private interest, lost her bid for re-election in August. Pando came under fire after writing a letter on her official stationary on behalf of a chiropractor, the owner of several clinics who regularly appear before her in court.

The Florida Judicial Qualifications Commission, which investigates complaints regarding sitting judges, filed the charges in March 2012. You can read the story at http://www.miamiherald.com/2012/03/19/2702596/state-hialeah-judge-violated-judicial.html.

PIP FRAUD – In The News

Page 4 August 2012

Statewide PIP Arrests – July 2012

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.

Yordanis Alonso, 36 - staged acct 12/2/10 (passenger) $32,458 - Bird Road Physical Therapy (Geico / Republic West) M

Raul Torres Oliva, 29 – staged 06/27/11 (recruiter) $34,382 - Brothers Taylor /C & C Rehab / Dade Wellness / MG Therapeutic / (21st Century / Geico) M

Juan Francisco Fernandez, 49 – staged acct 05/08/10 (recruiter) $49,934 - Angel Rehabilitation Medical Center / Absolute Health Center, Corp / RT Diagnostic / Dade Health Care (State Farm) M

Damarys Rodriguez Delgado, 43 – staged acct 05/25/10 (passenger) $23,648 – HealthCare’R Us (Allstate) W

Julio Cesar Nobelo, 28 – staged 06/27/11 (recruiter) $34,382 - Brothers Taylor /C & C Rehab / Dade Wellness / MG Therapeutic / (21st Century / Geico) M

Crystal J Davis, 34 – jump-in - $4,401 - Synergy Medical Wellness (Allstate) W

Mario Rodriguez, 32 - staged acct 05/25/10 (driver) $23,648 – HealthCare’R Us (Allstate) W

Abel Hernandez, 34 - clinic owner - grand theft / money laundering - $186,000 – Lakes Advantage Rehab / Unique Relief (Mapfre) M

Nichalene Jean Stevens, 22 – staged acct 11/08/10 (passenger) $13,564 - Alpha Medical Center / American Relax (Equity) T

Raul Hernandez, III, 32 – staged acct 09/29/10 (passenger) $24,990 - La Vida Health Care Corp (Omni / Progressive / RepWest) O

Maria M Velez, 46 - staged acct 09/29/10 (passenger) $24,990 - La Vida Health Care Corp (Omni / Progressive / RepWest) O

Digno Garcia-Portalatin, 57 - staged acct 09/29/10 (driver) $24,990 - La Vida Health Care Corp (Omni / Progressive / RepWest) O

Melissa Marie Meeks, 29 - staged acct 11/08/10 (passenger) $17,025 - Alpha Medical Center / American Relax (USAA) T

Samuel Figueroa Lopez, 37 - staged acct 09/29/10 (driver) $24,990 - La Vida Health Care Corp (Omni / Progressive / RepWest) O

Elexis Kim Garcia, 46 – PIP patient / false claim - $30,654 - 911 Pain Management Group (Farmers / Geico) B

Jose Manuel Serpa, Jr, 26 – insurance adjuster - grand theft / money laundering - $186,000 – Exclusive Home Health Services / Lakes Advantage Rehab / Unique Relief (Mapfre) M

Markus C Shaw, 24 – fake ins card (National Specialty) W

Roberto Davila Serrano, 59 – staged acct 02/21/12 (driver) $13,852 - Royal Diagnostic Center / Xtreme Care Rehabilitation Center (Allstate / RepWest) F

Selina Echartea Cardenas, 36 - staged acct 11/08/10 (driver) $19,393 - Alpha Medical Center / American Relax (RepWest) T

Jonathan Abiel Soto, 27 - staged acct 02/21/12 (passenger) $13,852 - Royal Diagnostic Center / Xtreme Care Rehabilitation Center (Allstate / RepWest) F

Juan Rivas, 35 - staged acct 02/21/12 (driver) $13,852 - Royal Diagnostic Center / Xtreme Care Rehabilitation Center (Allstate / RepWest) F

Ronald Samedifede, 42 – PIP patient – false claim - $11,225 – First Care Rehabilitation Center (Geico) F

Li Franc Safaite, 55 - PIP patient – false claim - $11,225 – First Care Rehabilitation Center (Geico) F

Johnson Safite, 24 - PIP patient – false claim - $11,225 – First Care Rehabilitation Center (Geico) F

Jeannette Pierre, 17 - PIP patient – false claim - $11,225 – First Care Rehabilitation Center (Geico) F

Roberto Larzaro Azua, 47 – runner / solicitation – Context Medical Group (United Auto) M

Enrique Flores Sanchez, 40 - staged acct 02/21/12 (passenger) $13,852 - Royal Diagnostic Center / Xtreme Care Rehabilitation Center (Allstate / RepWest) F

Juan Francisco Fernandez, 48 – staged acct 04/07/10 (recruiter) $34,274 - Alpha Medical Rehab Center / Hadera Health Center / We Care Medical Services (Progressive / State Farm / US Security) M

Eddy Tapia, 41 – massage therapist – false billing – $3,187 - Performance Health & Wellness (Allstate) W

Code – B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) P (Pensacola) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)

Page 5 The PIP Source

Statewide PIP Arrests – July 2012

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.

Roger Eduardo Ramos Perez, 41 - staged acct 09/17/11 (recruiter) $12,100 – All X-Ray Diagnostic Services / Quality Rehabilitation Services (Infinity) M

Arrested in October 2011

Jesse Espinosa, 21 - staged acct 11/08/10 (driver) $0 (RepWest) T

Arrested in Jan 2012

Midaly Sanchez, 39 - PIP patient - $9,823 - Personal Outreach Rehabilitation (21st Century) T

Osmany Aguilar, 27 - PIP patient - $0 - Personal Outreach Rehabilitation (Geico) T

Barbara D Marzo, 41 - PIP patient - $22,605 - Personal Outreach Rehabilitation (York Group Services) T

Alexander Reyes Murillo, 32 - PIP patient - $0 - Personal Outreach Rehabilitation (Infinity) T

Felipe Cruz, 39 - PIP patient - $0 – Personal Outreach Rehabilitation (Direct General) T

Arrested in Feb 2012

Erick Marcos, 38 - PIP patient - $0 – Personal Outreach Rehabilitation (Liberty Mutual) T

Michel Delgado-Martinez, 27 - PIP patient - $9,802 – Personal Outreach Rehabilitation (Allstate) T

Angel Rogelio Delgado, 61 - PIP patient - $10,000 – Personal Outreach Rehabilitation (Allstate) T

Carlos Sanchez, 62 - PIP patient - $10,000 – Personal Outreach Rehabilitation (Allstate) T

Odalys Rodriguez, 52 - PIP patient - $10,000 – Personal Outreach Rehabilitation (State Farm) T

Luis Antonio Santana, 28 - PIP patient - $8,027 – Personal Outreach Rehabilitation (21st Century) T

Alexander Avila Martinez, 39 - PIP patient - $0 - Personal Outreach Rehabilitation (ELCO Administrative Services) T

Ana Hilda Burgos Toro, 42 - PIP patient - $0 - Personal Outreach Rehabilitation (ELCO Administrative Services) T

Mary Ellen Padron, 31 - PIP patient - $8,219 – Personal Outreach Rehabilitation (Farmers) T

Leoner Rodriguez Garcia, 48 - PIP patient - $7,000 - Personal Outreach Rehabilitation (Amica) T

Ricardo Lorenzo Govea, 42 - PIP patient - $9,873 - Personal Outreach Rehabilitation (Allstate) T

Yamila Diaz, 38 - PIP patient - $36,374 - Personal Outreach Rehabilitation (Allstate) T

Libaldo Valdes, 44 - PIP patient - $9,875 - Personal Outreach Rehabilitation (Safeco) T

Arrested in March 2012

Yanet Maria Rivera, 25 - PIP patient - $7,300 - Personal Outreach Rehabilitation (Progressive) T

Yarisel Carmenate Crespo, 26 - PIP patient - $2,834 - Personal Outreach Rehabilitation (Allstate) T

Yusnier Chirino Placeres, 28 - PIP patient - $2,834 - Personal Outreach Rehabilitation (Allstate) T

Edy Valentina Padron Delgado, 45 - PIP patient - $7,766 - Personal Outreach Rehabilitation (21st Century) T

Arrested in April 2012

Jose Luis Lezcano Ledesma, 41 - PIP patient - $2,836 - Personal Outreach Rehabilitation (Geico) T

Raymond Wayne Ramos, 61 - PIP patient - $0 – Personal Outreach Rehabilitation () T

Tammy L Gardiner, 46 - PIP patient - $0 – Personal Outreach Rehabilitation () 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)

Copy goes her. Editor’s Corner On page one, we cover the story of an insurance company PIP adjuster working with two clinic owners to steal approximately $186,000.

We then share our latest Most Wanted fugitive on page two.

In the latest PIP Fraud in the News, we cover a report on potential PIP savings to consumers and the newly formed Automobile Insurance Fraud Strike Force. We will cover the new Strike Force in depth in the coming months.

As always, we provide the latest information on PIP fraud related arrests around the state.

Enjoy the last days of Summer.

Page 6 August 2012

PANHANDLE REGION Counties: Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, Washington

Tallahassee Field Office - 850.413.3115 Capt. Robert BRONGEL Pensacola Field Office - 850.453.7802 Lt. Joseph HOLOKAN

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 Lt. Darrell WILSON

Fort Myers Field Office - 239.278.7527 Lt. Mark FRITZ

EAST CENTRAL REGION Counties: Brevard, Lake, Orange, Osceola, Seminole, Volusia

Orlando Field Office - 407.835.4402 Capt. Glen HUGHES Lt. Jewel CAMERON Lt. Paul MEYERS

SOUTH CENTRAL REGION Counties: Broward, Highlands, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

Plantation Field Office - 954.321.2902 Capt. John DYGON 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. Rafael DELGADO

South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt 954.329.7427 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Jose Olivier 813.558.6387

Statewide PIP Contacts