Working with the National Insurance

Crime Bureau (NICB), DIF discovered that

more than $712,000 in fraudulent PIP claims

were paid by 14 different insurance

companies during the period the clinic

operated without a license.

Volume 5 - Issue 7 January 2015

Florida Chief Financial Officer Jeff Atwater announced the arrests last month of a Pompano Beach chiropractor and the clinic operator for allegedly conspiring to create a “straw” ownership arrangement to thwart Florida’s clinic licensing laws.

Chiropractor Adam Matthew Strouse, 38, allegedly fronted ownership of Sunnaco Health Center. An investigation by the Division of Insurance Fraud (DIF) determined that Sunnaco Health Center was really owned, operated and managed by non-physician Jean Louis Bernard Celestin, 60.

Arrest warrants were issued and Strouse and Celestin were arrested and booked into the Broward County Jail by DIF detectives in December.

Strouse claimed to be the owner of Sunnaco Health Center, so the clinic operated with a self-proclaimed exemption since its inception in June 2011. Because Strouse held a license with the Department of Health (DOH), he was statutorily exempt from clinic licensing requirements regulated by the Agency for Health Care Administration (AHCA).

Working with the National Insurance Crime Bureau (NICB), DIF discovered that more than $712,000 in fraudulent PIP claims were paid by 14 different insurance companies during the period the clinic operated without a license.

Sunnaco Health Center was originally incorporated by Celestin in June 2011, and he added Strouse as a director in September 2013. Strouse has been licensed as a chiropractor in Florida since 2005.

Strouse and Celestin are charged with organized scheme to defraud first degree and operating an unlicensed health care clinic.

The case is being prosecuted by the Broward County State Attorney’s Office.

INSIDE THIS ISSUE

1 Clinic Owner Arrest

2 Most Wanted

3 PIP Fraud News

4 Statewide Arrests

5 Statewide Contacts

HEADER HERE Chiropractor, Clinic Owner Arrested in Fraud Scheme

Page 2 January 2015

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

New DIF Regional Realignment Announced An update to the reorganization at the Division of Insurance Fraud (DIF).

The regions have been reorganized as follows:

The Panhandle and North Regions, led by Captains David Lindsay and Brian McCoy, respectively, remain unchanged. They join newly promoted Captain Evangelina Brooks, who will lead the new North Central Region, which includes offices in Orlando, Tampa and St. Petersburg. Together they form District I, under the direction of Major Mike Byrne in Tampa.

The South Central Region was also reorganized to include the Broward, Palm Beach and Ft. Myers offices, and is led by Captain Rafael Delgado. The South Central Region joins the South Region, led by Captain Steven Smith, to form District II, under the direction of Major Glen Hughes.

Majors Byrne and Hughes are supervised by Bureau Chief Buddy Hand in Tallahassee.

Huberto Del Sol Puerto White Hispanic Male, 54 years old

5’11”, Brown Eyes, Black Hair

Warrant Information: Warrant/Case #: F13000083

Felony Warrant Charge: Insurance Fraud, Money Laundering, Organized Scheme to Defraud

Details: The Florida Department of Financial Services, Division of Insurance Fraud, DIF is attempting to locate Huberto Del Sol Puerto in reference to the outstanding warrant.

In 2011, Del Sol Puerto allegedly hijacked a Florida corporation that had closed in 2010 in order to submit nearly $900,000 in false diagnostic claims for services that were never provided to patients. Insurance companies paid more than $308,000 to Del Sol Puerto before the scheme was uncovered.

If you know where Del Sol Puerto can be located, please contact the Division of Insurance Fraud at 1-800-378-0445.

Page 3 The PIP Source

The Division of Insurance Fraud (DIF) Announces New Promotions Evangelina Brooks was promoted to Captain of the newly formed North Central Region, made up of the Orlando, Tampa and St. Petersburg offices. Brooks began her law enforcement career in 2002 with the Vero Beach Police Department. She joined DIF in May 2006 and was assigned to a Miami PIP Squad. In 2007, she transferred to the West Palm Beach Workers’ Compensation Squad and in January 2009 she was promoted to Lieutenant of the new West Palm Beach PIP Squad. Brooks was nominated in 2007 for Law Enforcement Detective of the year by FIFEC. Brooks is an active member of the DIF training section and a Certified Fraud Examiner.

Sandra Fitzsimons was promoted to Lieutenant of the Division of Insurance Fraud’s Pensacola field office. Prior to joining DIF in 2000, Fitzsimons served six years with the Santa Rosa County Sheriff’s Office. She has been presented the prestigious “Bronze Eagle” award four times by the United States Attorney’s Office for her work with the Healthcare Task Force since 2009 and also received the 2009 Investigation of the Year award from the National Healthcare Anti-Fraud Association. Fitzsimons is also a Certified Fraud Examiner.

Sledgehammer Defendant Sentenced in Cargo Theft Ring Case Alien Moya, 30, was sentenced to 44 months in prison after previously pleading guilty to an Information charging him with conspiracy to steal goods valued in excess of $1,000. Moya was previously arrested May 2013 for his role in Operation Sledgehammer. Moya was a recruiter of participants for staged accidents in the scheme. Moya had been sentenced to 58 months in federal prison and was prepared to testify against co-defendants in separate trials when he was arrested in this new case.

See the full press release at http://www.fbi.gov/miami/press-releases/2014/four-men-sentenced-on-charges-of-participating-in-a-cargo-theft-ring.

Chiropractor Lovell Loses Appeal in Federal Court, 60-Month Sentence Affirmed Chiropractor Stephen Mark Lovell, 57, lost the appeal of his sentence for his February 2013 conviction in federal court. In September 2014, the U.S. Court of Appeals for the Eleventh Circuit affirmed his sentence of 60 months for his role in Operation Whiplash. (See the March 2013 issue of the PIP Source for details.)

Lovell argued that the district court clearly erred in applying a four-level enhancement for his role as an organizer or leader in the health care fraud conspiracy, given that he was merely a straw owner of the clinic operated by the co-conspirators. Lovell contends that, while he received a small sum for permitting the clinic to use his chiropractic license, his co-conspirators developed the idea for the clinic; performed the work to create the clinic’s legal and physical existence; hired all of the employees and set their salaries; maintained all bookkeeping for the clinic; and received nearly all of the clinic’s profits.

In assessing a defendant’s role in the offense, district courts consider the following factors: 1 - the exercise of decision making authority 2 - the nature of participation in the commission of the offense 3 - the recruitment of accomplices 4 - the claimed right to a larger share of the fruits of the crime 5 - the degree of participation in planning or organizing the offense 6 - the nature and scope of the illegal activity 7 - the degree of control and authority exercised over others The court stated that the evidence indicates that Lovell had a significant degree of participation in planning and organizing the conspiracy. Lovell met with the other co-conspirators to discuss how to form the clinic, agreed to the continued use of his license to open and operate the clinic, incorporated the clinic and served as its sole legal owner, loaned the clinic $20,000 to fund its opening, signed the clinic’s lease, and opened the clinic’s bank account. Moreover, Lovell appointed Jackson the clinic’s office manager, and hired and paid the salary of the clinic’s only chiropractor. His exertion of control over at least one other person in the conspiracy qualifies him as an organizer or leader.

The court found that Lovell exercised some decision making authority in the conspiracy, such as instructing his co-conspirators to form shell corporations to launder money without raising suspicion. The fact that co-conspirators made daily business decisions for the clinic and controlled the clinic’s finances did not negate Lovell’s organizational or leadership role in the conspiracy, because there can be more than one organizer or leader of a conspiracy.

See the full court ruling at https://www.courtlistener.com/opinion/2732118/united-states-v-stephen-m-lovell/.

PIP FRAUD – In The News

Page 4 January 2015

Statewide PIP Arrests – December 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.

Gilda Arelis Rondon, 31 - staged acct 05/22/12 (driver) $8,258 - Gate Parkway Diagnostic Center / Wellness Rehab Services (Peachtree) J

Oriana Curvelo, 26 - staged acct 05/22/12 (passenger) $14,650 - Gate Parkway Diagnostic Center / Wellness Rehab Services (Peachtree) J

Marc Anthony Rivera, 34 - staged acct 12/03/13 (passenger) $27,018 - Broward Manual Rehab (Geico) B

Maicon Velasquez, 22 - fake ins card (Gainsco) W

Shakieya Monique Williams, 32 - fake ins card (Seminole Casualty) T

Patrick Phillip Mowry, 38 - application fraud (Esurance) P

Sady Gomez Garcia, 42 - staged acct 09/14/12 (driver) $29,993 - Brilliant Medical Center (Knight Management Insurance Services / United Auto) M

Gregory St Fleur, 50 - staged acct 12/30/12 (driver) $12,619 - North Beach Pain Health Center (Geico / RepWest) M

Luis Rosa, 40 - false claim - $1,633 - L & K Transmission (USAA) J

Raymond Harold Delong, Jr, 46 - false claim - $1,633 - L & K Transmission (USAA) J

Michel Monterno de la Cruz, 26 - staged acct 10/14/12 (recruiter) $17,215 - K & J Medical Center (Ocean Harbor) M

Michel Monterno de la Cruz, 26 - staged acct 09/19/12 (driver) $29,005 - Med Life Medical Services / TGC Services (USAA) M

Noel de Jesus Moreno, 25 - staged acct 08/04/12 (passenger) $84,917 - Doral Health Center / Faillo Care Therapy Center / YH Imaging (Geico / United Auto / Windhaven) M

Jeffery Wayne Smith, 49 - staged acct 07/22/12 (passenger) $31,101 - One Touch Therapy Center (Direct General / Esurance / Geico) J

Willie Lee Thomas, 57 - staged acct 07/22/12 (driver) $31,101 - One Touch Therapy Center (Direct General / Esurance / Geico) J

Adam Matthew Strouse, 38 - chiropractor / straw owner unlicensed clinic - $711,948 - Sunnaco Health Center (21st Century / Allstate / Bristol West / Direct / Esurance / Geico / Infinity / MGA / Metropolitan / Mercury / Progressive / State Farm / USAA / Windhaven) B

Jean Louis Bernard Celestin, 60 - unlicensed clinic - $711,948 - Sunnaco Health Center (21st Century / Allstate / Bristol West / Direct / Esurance / Geico / Infinity / MGA / Metropolitan / Mercury / Progressive / State Farm / USAA / Windhaven) B

Mario Cesar Saez Ferrer, 40 - staged acct 09/19/11 (driver) $69,904 – B & A Diagnostics / Doctors Professional Medical Center / M & N Rehabilitation Center / (Geico / RepWest / United Auto) M

Wilfredo Romero, 39 - staged acct 11/10/11 (driver) $13,488 - Emed Primary Care & Walk In Clinic / Physicians Medical Centers / Saint Jose Injury Center (Gainsco) J

Maykel Rodriguez, 34 - fugitive / staged acct 02/20/07 (recruiter / passenger) $2,040 - Complete Care Rehabilitation (Geico) M

Yusney Rodriguez, 38 - PIP patient - $7,250 - Columbus Rehabilitation Center (Allstate / Geico) T

Carlos Rodriguez Martinez, 56 - staged acct 08/04/12 (passenger) $84,917 - Doral Health Center / Faillo Care Therapy Center / YH Imaging (Geico / United Auto / Windhaven) M

Mayken Perez Menendez, 35 - staged acct 08/04/12 (driver) $84,917 - Doral Health Center / Faillo Care Therapy Center / YH Imaging (Geico / United Auto / Windhaven) M

Alexis Sanchez Venero, 25 - staged acct 10/09/10 (passenger) $19,241 – Angels Diagnostic Center / Millennium Medical Center (Progressive / RepWest) M

Osvaldo L Arocha, 46 - fake ins card (Geico) T

Sonyalice Soliveras-Alicea, 38 - staged acct 05/08/12 (driver) $41,037 - Gate Parkway Diagnostic Center (Direct General / Geico / State Farm) J

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 cover the arrests of a clinic owner and a chiropractor in Broward County.

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.

We wish everyone a Happy New Year and look forward to good things in 2015.

Page 5 The PIP Source

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 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

NORTH CENTRAL REGION Counties: Brevard, DeSoto, Hardee, Hernando, Hillsborough, Lake, Manatee, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia

Tampa Field Office - 813.972.8602 Major Michael BYRNE Lt. Carlos ROSARIO Orlando Field Office - 407.835.4402 Capt. Evangelina BROOKS Lt. Laquanda GREEN Lt. John SAVINO

SOUTH CENTRAL REGION Counties: Broward, Charlotte, Collier, Glades, Hendry, Highlands, Indian River, Lee, 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 Major Glen HUGHES Lt. Vacant Ft. Myers Field Office - 239.278.7527 Lt. Mark FRITZ

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

Statewide PIP Contacts