Unlicensed Activity Fraud

Transcription

1 April 2011 Volume 1 - Issue 10 HEADER HERE DIF Arrests Orlando Clinic Owner in Unlicensed Activity Fraud The Division of Insurance Fraud (DIF) arrested the owner of US Chiromatrix Centers, Corp last month for unlicensed activity. This case is one of many that DIF is currently investigating that involves unlicensed providers and clinics throughout Florida. Gardy Jeune, 53, who incorporated the clinic in 2005, located at 6444 West Colonial Drive in Orlando, previously held a license with the Department of Health (DOH) as a registered chiropractic assistant (RCA). However, his license is currently identified as null and void on the DOH website, having expired in March The four month investigation by DIF revealed that US Chiromatrix Centers was billing insurance companies for treatment allegedly rendered by Jeune. The clinic was licensed by the Agency for Health Care Administration (AHCA). A chiropractor who previously worked at US Chiromatrix Centers told DIF that when he was hired, Jeune told him that all patients had to be treated at least 36 times, which the chiropractor disagreed with. The chiropractor, who worked at the clinic for about nine months, reviewed patient files and discovered that there were treatments allegedly provided that he did not render, and were signed off on by Jeune as the treating physician. When the chiropractor confronted Jeune about the discrepancies, Jeune laughed and said that was the way it was done. INSIDE THIS ISSUE 1 DIF Arrests Orlando Clinic Owner 2 PIP Fraud in the News 3 PIP Fraud Spotlight on FIFEC 4 5 Statewide Arrests Office Contacts DIF also questioned the medical director, who came to the clinic once a month to review the patient files and billing. In the case filed against Jeune, three patients provided statements that they were treated by Jeune. The investigation revealed that Jeune also allegedly billed for services that were not provided by his clinic to these patients. Jeune admitted to DIF detectives that he worked unlicensed without the supervision of a chiropractor or certified chiropractic physician assistant. This case is one of many that DIF is currently investigating that involves unlicensed providers and clinics throughout Florida. Jeune was charged with unlicensed activity and insurance fraud, and faces up to 10 years in state prison. DIF anticipates additional charges in this case.

2 April 2011 Page 2 PIP FRAUD In The News DIF Arrests Three Clinic Owners For Workers Compensation Fraud in Tampa The Division of Insurance Fraud arrested three clinic owners for failing to obtain workers compensation coverage at their clinics in Tampa. Leticia Leon, owner of Town Medical and Rehab Center; Dean Palestra, owner and office manager of Long Chiropractic & Rehab Center; and chiropractor Hector Vasquez, owner of West Coast Chiropractic & Medical Center; all in Tampa, surrendered once informed that warrants had been issued. Stop work orders were also issued against the clinics by the Workers Compensation Bureau of Compliance (check the agency name), and their offices were closed. Each obtained the necessary insurance coverage and reopened. This action was part of a coordinated effort by DIF to focus on all aspects of potential criminal activity in the Tampa area involving PIP clinics. North Miami Beach PD Arrests Chiropractor for PIP Fraud As a result of a yearlong undercover investigation by the North Miami Beach Police Department, NICB and the assistance of Unitrin Direct Insurance, a local chiropractor was arrested on 03/03/11 for insurance fraud. The 61-year old chiropractor, Eileen G. Dvorkin, who also allegedly owned the Accident Injury and Family Health Care Clinic, was charged with 1 count each of Patient Brokering, Insurance Fraud and an Organized Scheme to Defraud. According to the NMBPD press release, Dvorkin paid runners to go out an find patients and clients to bring back to her clinic and make false claims of injury from staged traffic crashes. Dvorkin then covertly treated these alleged patients for injuries they did not have and then fraudulently billed the insurance company for the treatment. The North Miami Beach Police Department recognizes the severe negative impact these types of crimes have on our community and communities around the country especially during these times of a floundering economy. The North Miami Beach Police Department pledges to continue to aggressively investigate these crimes in partnership with the National Insurance Crime Bureau. NICB - PIP Fraud Increases in Florida In a review of questionable claims submitted in Florida for the years , the National Insurance Crime Bureau (NICB) found an increase of 34 percent during the 3 year period. For the year 2010, Tampa was the top city in Florida, followed by Miami, Orlando, Hialeah, West Palm Beach, Jacksonville, Ft Myers, Ft Lauderdale, Naples and Lehigh Acres. However, when the numbers were broken down by county, Miami-Dade was first, followed by Hillsborough, Orange, Palm Beach, Broward, Lee, Duval, Collier, Pinellas and Polk. The questionable claims for personal auto insurance increased 23 percent from 2009 to 2010, on top of the 15 percent increase in 2009 from Personal Auto Claims account for 87 percent of the questionable claims reported in Florida to NICB during At right is a chart from NICB showing the questionable claims in Florida by County. Clearly, Miami-Dade and Hillsborough County (in red) are the hot spots. The full report is available at: 20Library/Public%20Affairs/Florida-Questionable- Claims pdf

3 The PIP Source Page 3 PIP FRAUD SPOTLIGHT ON FIFEC This month we take a look at FIFEC, the Florida Insurance Fraud Education Committee, as they prepare for their Annual Conference which will take place June 8-10, 2011 in Orlando. It is a fun time, but informative as well, where fraud folks gather to network, attend training sessions, and share war stories about insurance fraud. The conference is well attended by law enforcement, insurance investigators and professionals, members of IASIU (International Association of Special Investigative Units) and NSPII (National Society of Professional Insurance Investigators). According to their website, the Florida Insurance Fraud Education Committee began its existence as the DIF/SIU Annual Training Seminar representing the Florida Department of Insurance s Division of Insurance Fraud and the Special Investigations Unit (SIU) community in DIF hosted this first seminar, which was actually a one-day open forum-type workshop held in Altamonte Springs, with no agenda other than to foster a favorable working environment between the public and private sectors involved in the fight against insurance fraud. A bold idea, but the beginnings were small, with only about attendees at the initial meeting. But it was a good start for a great relationship that would grow through the years. At that first meeting, the audience asked about making fraud referrals, what DIF would do with them, and record keeping, among other topics. The idea was deemed a positive beginning to a relationship the Division of Insurance Fraud believes is essential in the fight against fraud. So the conference became an annual event, growing each year, with attendance last year at the 2010 event numbering more than 600. This year, Florida Chief Financial Officer Jeff Atwater will make his first appearance at the conference as the Keynote Speaker on opening day. In addition to the informative courses and networking opportunity, the Conference presents awards in three categories. The 2010 winners included Jim Halliday from Sentry Insurance as the Insurance Investigator of the Year; Dennis Mensch was given the Jerry Zappolo Distinguished Service Award; and six officers from the Hillsborough County Sheriff s Office, Jose Morales, Ronnie Cooper, Anthony Mannarino, Kevin Patrick O Brien, Robert Gogolin and Matthew Carter were named the Law Enforcement Detectives of the Year. This year's conference will again be held at the Caribe Royale Orlando All-Suites Hotel and Convention Center, located at 8101 World Center Drive in Orlando, where it has been since Scheduled among this year s offerings are the following PIP related courses: - Its No Wonder That Truth is Stranger Than Fiction. Fiction Has to Make Sense. Uncovering The True Clinic Owner - Recent Case Law & PIP Claims - Advanced Techniques in the Detection and Investigation of Suspected Staged Accidents - Current Trends and Case Law Update in PIP Litigation - Accident Reconstruction Top Ten - Profile of Runners & How the Fraudulent Providers Prepare Against the Insurance Industry - PIP Fraud as a Business Practice - Finding and Proving It - Minor Accident Reconstruction & Biomechanics - Staged Accidents - Deputy, Detective & SIU Perspectives - Interviewing Doctors & Health Care Providers - Fraud Referrals to the Division of Insurance Fraud Fighting Insurance Fraud through Education and Commitment. Join the crowd in a gathering that is both fun and educational. For more information, go to their website at Thanks to Partners State Farm and NICB We would like to thank our partners at State Farm Insurance Company for their donation to our agency of two undercover vehicles which will be used by the Division of Insurance Fraud to fight fraud in the East Central Region, which covers eleven counties stretching from West Palm Beach to Orlando and the Space Coast. State Farm is also donating electronic surveillance equipment which will bolster our ability to conduct undercover investigations of the accident clinics that commit fraud in our State. We also want to thank our partners at the National Insurance Crime Bureau (NICB) for their assistance in facilitating the donation process. Pictured from left to right are: Fred Burkhardt, NICB; unidentified DIF officer; and Alan Edwards, State Farm.

4 April 2011 Page 4 Statewide PIP Arrests March 2011 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 Captain Smith. Anthony Darius, 25 paper accident 08/23/10 (passenger) $18,671 - Lorena de Jesus Rehabilitation (State Farm) M Leticia Leon, 38 clinic owner / no workers comp coverage Town Medical and Rehab Center T Dean Palestra, 43 - clinic owner / no workers comp coverage Long Chiropractic & Rehab Center T Hector Vasquez, 42 - chiropractor / no workers comp coverage West Coast Chiropractic & Medical Center T Erich Robles, 26 staged acct 11/05/09 (passenger) $0 (Assurance America) T Rebecca Jennings, 59 staged acct 06/24/09 (driver) $7,681 Brandon Chiropractic (Geico) T Odalys Roque, 41 jump-in 04/11/10 - $20,014 Margate Pain and Rehabilitation (Geico) B Aaron Sanchez, 21 - staged acct 11/11/09 (passenger) $98 - Medical Therapy Practitioners (Allied Property & Casualty) T Jesus Iluminado Guerrero, 28 staged 11/03/09 (recruiter) $91,856 - ORD Medical Center (Allstate / Budget / Progressive) M Michelle Capers, 20 staged acct 03/18/10 (driver) $5,669 - Massage Health Clinic (Assurance America) T Quinyanna Capers, 23 - staged acct 03/18/10 (passenger) $5,566 - Massage Health Clinic (Assurance America) T Boquasha Wimbush, 19 - staged acct 03/18/10 (passenger) $5,734 - Massage Health Clinic (Assurance America) T Luis Hernaiz, 33 - staged acct 03/18/10 (jump-in driver) $607 Crystal Rehabilitation Clinic (Hallmark) T Nesly LeFrance, 43 staged acct 12/17/09 (driver) $40,000 Kim Habibi, DC (State Farm) B Adel Ostreal, 42 - staged acct 12/17/09 (passenger) $40,000 Kim Habibi, DC (State Farm) B Armando Junco, 54 - paper acct 08/20/10 (driver) $4,359 - Healing Mental Care / Oasis Diagnostic Center (State Farm) M Magaly Junco, 53 - paper acct 08/20/10 (passenger) $4,359 - Healing Mental Care / Oasis Diagnostic Center (State Farm) M Anthony Fedd, 55 false statement in support jump-in 07/12/10 - $6,000 - (Direct General / Geico) J Isiah Darrell Arce, 21 staged acct 12/01/09 (driver) $0 - (Geico) T Alberto Correa, 40 staged acct 07/01/10 (recruiter) $26,636 - Care Resources Group, LLC (Republic Western / Progressive) M Yasmany Consuegra, 31 staged acct 07/20/10 (recruiter) $57,773 Psychologist Technology / V & R Medical (Allstate / Progressive) M Yasmany Consuegra, 31 staged acct 07/28/10 (recruiter) $11,439 - Continental Rehabilitation Center (State Farm) M Carlos Begueria Gonzalez, 36 staged acct 07/01/10 (driver) $26,636 Care Resources Group, LLC (Progressive / Republic Western) M Yilimilaidy Placeres, 29 - staged acct 07/01/10 (passenger) $26,636 Care Resources Group, LLC (Progressive / Republic Western) M Sharronda Sweet, 25 staged acct 08/17/10 (driver) $14,801 Choice Medical Center (Assurance America) B Allen Blanco, 23 staged acct 09/14/10 (passenger) $14,936 Doral Center Rehab (Unitrin Direct) M Gardy Jeune, 53 unlicensed clinic owner - $5,444 US Chiromatrix Centers Corp (Progressive) O Office Code B (Broward) F (Ft Myers) J (Jacksonville) M (Miami) O (Orlando) TL (Tallahassee) T (Tampa/St Pete) W (West Palm Beach)

5 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 Captain Buddy HAND 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 Captain Brian McCOY Lt. Kevin JONES WEST CENTRAL REGION Counties: Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Lee, Manatee, Pasco, Pinellas, Polk, Sarasota Tampa Field Office Captain Michael BYRNE Lt. Carlos ROSARIO Lt. Darrell WILSON Fort Myers Field Office Lt. J.D. SALOME EAST CENTRAL REGION Counties: Brevard, Indian River, Lake, Martin, Okeechobee, Orange, Osceola, Palm Beach, Seminole, St. Lucie, Volusia West Palm Beach Field Office Major Simon BLANK Captain Glen HUGHES Lt. Evangelina BROOKS Orlando Field Office Lt. Jewel CAMERON SOUTH REGION Counties: Broward, Dade, Monroe Miami Field Office Captain Steven SMITH Lt. Violeta SERRANO Lt. John DYGON Lt. Stanley JEAN-FELIX Plantation Field Office Lt. Bill LEE NICB Contact Info South Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt Central Florida Major Medical Fraud Task Force Supervisory Special Agent Fred Burkhardt Copy goes her. Editor s Corner We want to thank our readers for sharing the PIP Source with your friends and co-workers. We feel we have an important message for everyone that is affected by PIP fraud in Florida. We apologize, but we had to delay presenting our new PIP Outreach program until next month. We encourage our fellow fraud fighters to join us at FIFEC in Orlando this June. It is always a good time to share tales of encouragement and success in the battle against insurance fraud. We hope to see our old friends as well as meet new ones. Spring is here and the Florida Legislature is geared up and working on many bills, and we hope you are playing your part in helping with the fight against fraud. Get involved - call or write your legislator and share your voice about the issues that affect you. Join in the fight against insurance fraud. A good place for a photo or graphic