“If consumers aren’t going to get the relief

the legislation intended, then the time to repeal has arrived.”

- CFO Atwater spokes-woman Ashley Carr

Volume 6 - Issue 6 December 2015

The state's personal-injury protection auto insurance system, known as "no-fault," would end in 2019 under a set of proposals currently in the Florida Legislature.

Rep. Bill Hager, R-Delray Beach, filed a proposal (HB 997) last week, two months after Insurance Commissioner Kevin McCarty tossed out the idea of, "Let's just repeal PIP and do nothing," as a way to further reduce fraud in the personal-injury protection system.

The repeal idea also appears to have backing from state Chief Financial Officer Jeff Atwater.

Atwater, who along with Gov. Rick Scott championed 2012 changes intended to fight fraud in the no-fault system, maintained as recently as October that time was needed to see the impact of the legislative changes.

On Monday, a spokeswoman for Atwater said that the "time has now passed."

"Ultimately, it's a policy decision for the Legislature to make, but two years after the passage of the PIP legislation, it's time for the insurance industry to bring forward evidence that shows whether or not rates are going to come down," Atwater spokeswoman Ashley Carr said in an email. "If consumers aren't going to get the relief the legislation intended, then the time to repeal has arrived."

Sen. Jeff Brandes, R-St. Petersburg, filed the Senate version (SB 1112) of Hager's proposal on Dec. 11. The identical measures would require motorists to have a minimum of property-damage and bodily-injury liability coverage.

With lawmakers estimating that the average Florida motorist was paying $180 a year for the personal-injury protection portion of their auto coverage, a 2012 law set benchmarks for insurers to lower rates on the coverage. The law also required people involved in crashes to seek treatment within 14 days and allowed up to $10,000 in benefits for emergency medical conditions, while putting a $2,500 cap on non-emergency conditions.

State officials maintained the changes were showing signs of success.

See the full article by Jim Turner at http://www.tampabay.com/news/business/banking/florida-lawmakers-look-at-pulling-the-plug-on-no-fault-auto-insurance/2258663.

INSIDE THIS ISSUE

1 PIP Under Review

2 Most Wanted

3 PIP Fraud News

4 Statewide Arrests

5 Statewide Contacts

HEADER HERE

Florida Legislature Set to Review Ending PIP / No-Fault

Page 2 The PIP Source

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

City of Miami PD Arrests 7 in PIP Fraud Sweep

The City of Miami Police Department Staged Crash Unit, working in conjunction with the Federal Bureau of Investigation (FBI), Miami-Dade State Attorney’s Office, Florida Department of Health (DOH) and National Insurance Crime Bureau (NICB), announced the arrest of seven individuals at three PIP clinics in Miami. The undercover investigation started in April 2015 after authorities learned individuals in the clinics were allegedly involved in staged car crashes and PIP fraud.

“Insurance fraud is an attack on every individual who pays an insurance premium,” commented Miami-Dade State Attorney Katherine Fernandez Rundle. “Insurance fraud scams utilizing staged accidents and fake medical treatments depend on an entire crew of criminals who put our money into their own pockets. The message to such swindlers is that this effective law enforcement team of police and prosecutors is still out there working to shut you down.”

Included in the charges against the seven defendants were staged accident, insurance fraud, grand theft, organized scheme to defraud and patient brokering.

Arrested from Excellent Health Services were clinic owner Marisel Chaviano, receptionist Yuleidy Fonseca and massage therapist Carlos Garmendia Ferrer. The clinic first opened in 2006, and Garmendia Ferrer was first licensed in 2010.

Arrested from AQ Medical & Rehab was massage therapist Yusniel Aguero. The clinic first opened in 2014 and Aguero was first licensed in 2014.

Arrested from RFG Medical Clinic were clinic owner Alberto Lopez, receptionist Yexenia Cantillo and massage therapist Miuriz Diaz De Villegas. The clinic first opened in 2000 and Diaz de Villegas was first licensed in 2011.

The insurance companies involved included Allstate, Infinity, Nationwide, State Farm, United Automobile and Windhaven.

Elvis Homen aka Elvis Mario Homen Chaviano White Hispanic Male, 28 years old 5’6”, 170 lbs, Brown Eyes, Brown Hair Warrant Information: Warrant/Case #: W612945049 Felony Charges: Staged Accident, Grand Theft, Insurance Fraud Details: The Florida Department of Financial Services, Division of Insurance Fraud (DIF) is attempting to locate Elvis Homen in reference to the outstanding warrant. Homen is wanted for his role in organizing a staged accident and the filing of fraudulent insurance claims. Homen has yet to be found since his warrant was issued in February 2015. His warrant is full extradition. Homen was last known to be in the Tampa area. If you know where Homen can be located, please contact the Division of Insurance Fraud at 1-800-378-0445.

Page 3 December 2015

Family-Run Healthcare Fraud Ring Dismantled by Feds Hendris Castillo Morales, one of the leaders of a family-run ring that tried to rip off more than $100 million in healthcare insurance payments by the city of Miami, Miami-Dade County Public Schools and numerous major companies was sentenced to 10 years in prison last month.

More than $15 million was paid to the healthcare network which operated about 35 clinics in Hialeah, Doral and Miami between 2012 and 2015, according to the indictments. Among the bilked entities: Pepsi Co., Macy's, RadioShack, BJ's Wholesale Club, Lincoln Property Company, Nextera Energy and Southeast Frozen Foods Company.

Prosecutors charged a total of 18 defendants, including Danny Jacomino Bordon, with trying to steal $130 million from the public entities, private companies and major insurers, namely Blue Cross Blue Shield, United Healthcare and Cigna. Jacomino Bordon also ran a Miami rehab clinic. Three defendants, Reynaldo Castillo, Ezequiel Servero Casas and Jose Gerardo Gonzalez, fled to Cuba.

See the full article by the Miami Herald’s Jay Weaver at http://www.miamiherald.com/news/local/community/miami-dade/article41857827.html.

30 Arrested by Feds in Massive Indiana Staged Crash Fraud Ring Thirty-six people were indicted on federal charges after a two-year investigation of an apparently well-known Evansville "crime family," who were the ringleaders of an alleged "massive" fraud operation that involved staging at least 12 car crashes to collect insurance money. The illegal scheme netted the group at least $600,000.

Federal prosecutor Josh Minkler, who called the investigation the largest white collar crime investigation in Evansville's recent history, stated "Over a six-year period from 2008 to 2014, the Burris family recruited individuals to participate in a series of staged car crashes, the filing of false police reports, (and) the filing of false insurance claims for injuries that were either faked or self-inflicted."

See the full article by the Courier and Press’ Richard Gootee at http://www.courierpress.com/news/crime/federal-indictments-in-massive-crash-fraud-case-to-be-announced-2430a69a-b45e-64fb-e053-0100007f0dc8-344815932.html.

Louisiana Arrests 9 in New Orleans For Staged and Jump-In Crashes Louisiana State Troopers arrested nine suspects and were looking for nine more involved in staged and/or “jump-in” crashes as a means to defraud insurance companies. The warrant roundup resulted from nearly a dozen independent investigations conducted by the Louisiana State Police Insurance Fraud/Auto Theft Unit New Orleans field office. Detectives worked closely with numerous insurance companies including Repwest, Progressive, State Farm, Imperial Fire and Geico.

Total financial exposure as a result of the fraudulent claims is estimated to be more than $165,000.

More information on this story is available at http://www.wwl.com/Troopers-Obtain-18-Arrest-Warrants-in-New-Orleans-/22139937.

Farmers and Geico Donate Undercover Vehicles to Division of Insurance Fraud In November 2015, Farmers and Geico each donated a surveillance vehicle to the Division of Insurance Fraud (DIF) to assist in their efforts in the fight against insurance fraud. These donations were made with the assistance of Special Agent Terra Rush, National Insurance Crime Bureau (NICB). Thank you to Farmers and Geico for their continued efforts.

Pictured below at left: Ian Oliver, Farmers Insurance SIU Manager, SA Terra Rush, NICB and DIF Major Mike Byrne.

Pictured at right: DIF Major Mike Byrne; SA Terra Rush, NICB; Gary Hodge, Geico SIU Supervisor and Michael Zuhars, Geico Auto Damage Field Supervisor. .

PIP FRAUD – In The News

Page 4 The PIP Source

Statewide PIP Arrests – November 2015

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.

Erica Renee Burks, 28 - lost wages - $4,000 (Esurance) J

Terrell Leenard Sharp, 27 - fake ins card (Progressive) TL

Terrell Leenard Sharp, 27 - ID theft / fraudulent claim (Progressive / Zurich) TL

Brian Allen Ford, 29 - jump-in 04/05/15 - $2,500 (Direct General / Progressive) T

Brandee Lee Smith, 33 - false vehicle theft - $2,052 (United Auto) B

Braulio Valenzuela, 74 - false claim pedestrian - $14,789 (United Auto) M

Silvia Vanessa Diaz-Lemus, 40 - staged acct 12/15/11 (driver) $55,561 - Gate Parkway Diagnostic Center / Wellness Rehab Services (Farmers) J

Wuilmar Dony Escalante Velasquez, 29 - fake ins card (MGA) W

Pedro Miguel Rodriguez, 35 - staged acct 12/15/11 (recruiter) $55,561 - Gate Parkway Diagnostic Center / Wellness Rehab Services (Farmers) J

Yeritza Ramos, 34 - staged acct 02/22/11 (passenger) $8,837 - Baymeadows Injury Center (Progressive) J

Jose Joaquin Palma, 56 - staged acct 03/14/12 (recruiter) $50,765 - Sunshine Medical Services (United Auto) M

Ashley Nicole Agenat aka Ashley Ulysse, 30 - operating unlicensed clinic - $116,026 - Palmetto Chiropractic, LLC (Allstate / Assurance America / Direct General / Farmers / First Acceptance / Geico / Infinity / Ocean Harbor / Peachtree / Progressive / Sentry / State Farm / Travelers / Windhaven) T

Nixon Lordeus, 46 - operating unlicensed clinic - $116,026 - Palmetto Chiropractic, LLC (Allstate / Assurance America / Direct General / Farmers / First Acceptance / Geico / Infinity / Ocean Harbor / Peachtree / Progressive / Sentry / State Farm / Travelers / Windhaven) T

Catalina Velez aka Ana Neira, 32 - staged acct 02/22/11 (driver) $2,639 (State Farm) J

Djoodmy Elie, 45 - operating unlicensed clinic - $116,026 - Palmetto Chiropractic, LLC (Allstate / Assurance America / Direct General / Farmers / First Acceptance / Geico / Infinity / Ocean Harbor / Peachtree / Progressive / Sentry / State Farm / Travelers / Windhaven) T

Herlen Luis Guerra Gonzalez, 21 - false statement in support of vehicle theft - $18,850 (Allstate) M

Elvie Smith, 61 - false receipts - $13,537 (Allstate) O

Eilyn Morera, 18 - false statement in support of claim (Allstate) M

Vivian Lucia Monzon, 48 - application fraud (21st Century) M

Leandro Fernandez, 22 - staged acct 03/22/11 (driver) $39,474 - Baymeadows Injury Center (Allstate) J

Miguel Lojano, 36 - staged acct 03/22/11 (driver) $21404 (Sentry) J

Shayawntae Ashante Lambert, 33 - unlicensed agent / application fraud (Geico) 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)

Copy goes her. Editor’s Corner On page 1, we report that the Legislature is set to review ending PIP / No-Fault in Florida.

On page 2, we feature another fugitive in Insurance Fraud’s Most Wanted.

As always, we report on PIP Fraud in the News and the latest PIP-related arrests.

Page 5 December 2015

DISTRICT I Major Michael BYRNE

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 Lt. Sandra FITZSIMONS Tallahassee Field Office - 850.413.3115 Acting Lt. Michael SMITH

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

NORTH CENTRAL REGION Counties: Brevard, Hillsborough, Lake, Orange, Osceola, Seminole, Volusia

Orlando Field Office - 407.835.4402 Capt. Evangelina BROOKS Lt. Laquanda GREEN Lt. John SAVINO

WEST CENTRAL REGION Counties: DeSoto, Hardee, Hernando, Manatee, Pasco, Pinel-las, Polk, Sarasota

Tampa Field Office - 813.972.8602 Capt. Darrell WILSON Lt. Carlos ROSARIO St Petersburg Field Office - 727.563.1142 Lt. Carl LANE

DISTRICT II Major Rafael DELGAGO

SOUTH CENTRAL REGION Counties: Broward, Charlotte, Collier, Glades, Hendry, Highlands, Indian River, Lee, Martin, Okeechobee, Palm Beach, St. Lucie

West Palm Beach Field Office - 561.837.5601 Capt. Ted PADICH Lt. James FEENEY Ft. Lauderdale Field Office - 954.958.5402 Lt. Bill LEE Ft. Myers Field Office - 239.278.7527 Lt. Glen CLASEN

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 847.282.7404

Statewide PIP Contacts