“This is a great win in the fight

against PIP fraud in Florida.”

- CFO Jeff Atwater

Volume 4 - Issue 5 November 2013

Florida Chief Financial Officer Jeff Atwater announced the conviction of David Rodriguez Lopez, 46, a Tampa clinic owner for orchestrating a large scale personal injury protection (PIP) fraud scheme in Tampa and Jacksonville. Lopez, who will be sentenced in November, faces up to 75 years in prison.

“This is a great win in the fight against PIP fraud in Florida,” said CFO Atwater. “I applaud our fraud investigators in Jacksonville and our dedicated prosecutor at the State Attorney’s Office, because it takes a well coordinated effort from the fraud prevention community to bring a fraud ring leader to justice.”

An investigation conducted by the Florida Department of Financial Services’ Division of Insurance Fraud revealed that Lopez directed the opening of Indian Rehabilitation Center Inc., located at 3636 University Boulevard South in Jacksonville. Lopez previously owned General Rehabilitation Center and Crystal Rehabilitation Center located in Tampa.

Since March 2012, 26 staged accidents have occurred involving more than 60 individuals claiming to have been treated at Indian Rehab Center. The investigation revealed that many claims included treatment involving equipment the facility did not posses or treatments that never took place. Lopez was found to be the lead in securing a straw owner, controlling bank accounts and directing fraudulent clinic operations. Since mid 2012, 60 arrests have occurred involving accident participants, recruiters and office personnel of these fraudulent accident clinics. Investigations continue and additional arrests are expected.

Assistant State Attorney Joe Licandro of the 4th Judicial Circuit prosecuted the charges against Lopez, who was found guilty of schemes to defraud, insurance fraud and participation in a staged accident. The total amount received after billing by the clinic was in excess of $240,000.

See a related story from News4 in Jacksonville at http://www.news4jax.com/news/clinic-owner-convicted-in-auto-insurance-scheme/-/475880/22312986/-/105qeee/-/index.html.

Anyone with information involving suspected insurance fraud is asked to call 1-800-378-0445. Citizens who provide tips can remain anonymous. The Department of Financial Services to date has awarded almost $342,000 to more than 50 citizens as part of its Anti-Fraud Reward Program. The program rewards individuals up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.

INSIDE THIS ISSUE

1 Jacksonville Clinic

Owner Convicted

2 Strike Force DSO

3 PIP Fraud News

6 Statewide Arrests

7 Most Wanted

8 Statewide Contacts

HEADER HERE Jacksonville Clinic Owner Convicted, Faces 75 Years in Prison

Page 2 November 2013

In 2012, the Florida Legislature directed the Department of Financial Services, under CFO Jeff Atwater, to organize the “Automobile Insurance Fraud Strike Force” with the end goal of better protecting consumers by monitoring fraudulent activity in the auto insurance industry and identifying resources to proactively assist law enforcement, prosecutors and other stakeholders in the fight against auto insurance fraud.

The Florida Division of Insurance Fraud established a direct-support organization (DSO), known as the “Automobile Insurance Fraud Strike Force” whose sole purpose is to support the prosecution, investigation and prevention of motor vehicle insurance fraud. The strike force is organized and operated to conduct programs and activities and to raise funds and receive grants to be used exclusively to combat auto insurance fraud. Grants and expenditures by the strike force may include the cost of salaries of fraud investigators, prosecutors or support personnel.

The DSO was established pursuant to Florida State Statute 626.9895.

Read more about Florida’s Insurance Fraud Statute

The perpetrators of insurance fraud have made Florida the top state in the nation for staged automobile crashes. The Miami and Tampa areas have been the most affected by auto insurance fraud due to staged crashes.

The Insurance Information Institute estimates that this type of fraud could cost up to $1 billion annually in the State of Florida.

The number of suspicious auto accidents that are staged or deliberately caused by criminals in Florida has increased dramatically over the past several years and is expanding throughout the state. According to the Division of Insurance Fraud, most recent fraud cases started with a staged vehicle crash.

The “Automobile Insurance Fraud Strike Force” was established to safeguard the residents and visitors of Florida and their assets by working in collaboration with the Division of Insurance Fraud and its stakeholders. Its mission is to provide needed resources from private sources to enable its partners to be able to reduce and eliminate fraudulent activities related to Personal Injury Protection (PIP) Insurance. These partners/stakeholders include law enforcement agencies, State Attorneys’ Offices, Statewide Prosecutor, Agency for Healthcare Administration and the Department of Health. In this era of limited resources, it is necessary to establish public/private partnerships in order to effectively combat fraudulent criminal activity. Extremely limited law enforcement resources need a force multiplier that can come from the private sector’s assistance. This assistance will bolster law enforcement efforts to combat automobile insurance fraud.

Read more at: Mission to Combat and Reduce PIP Fraud

Anyone in the Florida insurance industry who is interested in assisting and willing to help support the Automobile Insurance Fraud Strike Force, please contact Sheriff Al Lamberti (Ret.), Chairman of the “Strike Force”.

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Sheriff Al Lamberti (Ret.) is the Chairman of the Florida Auto Insurance Fraud Strike Force. For more information regarding the “Strike Force” contact Sheriff Lamberti at 954-340-0005 or by email at alamberti@mcfarlanedolanlaw.com.

A Word from the Auto Insurance Fraud Strike Force - by Chair Al Lamberti

Page 3 The PIP Source

Three More Sledgehammer Defendants Sentenced to Federal Prison Three more defendants from Operation Sledgehammer were sentenced earlier this month. Chiropractor Aaron Freedlander, 51, clinic owner Luis Ivan Hernandez, 40, and staged accident recruiter and participant Daviel Castro, 27, were sentenced on November 4, 2013 by U.S. District Judge Kenneth A. Marra for their participation in an PIP fraud scheme involving staged automobile accidents. Freedlander was sentenced to 40 months in prison; Hernandez was sentenced to 108 months in prison; and Castro was sentenced to 58 months in prison. Hernandez was the owner of six clinics involved in the scheme.

In addition, Freedlander was ordered to pay $900,697.92 in restitution; Hernandez was ordered to pay $4,232,248.04 in restitution and Castro was ordered to pay $1,359,208.73 in restitution. Freedlander will also be required to surrender his chiropractic license.

To date, 92 defendants have been charged for their participation in this automobile insurance fraud scheme, 56 of which have been charged federally by the U.S. Attorney's Office, resulting in court-ordered restitution of more than $5 million to the defrauded insurance companies. The other 36 defendants have been charged by the Palm Beach County State Attorney's Office.

Operation Sledgehammer is a joint investigation by the FBI, IRS-CI, the Division of Insurance Fraud (DIF), the Palm Beach County State Attorney's Office, the Greater Palm Beach County Health Care Fraud Task Force, the National Insurance Crime Bureau (NICB) and the U.S. Attorney’s Office.

See the full press release at http://www.justice.gov/usao/fls/PressReleases/131105-01.html.

Jacksonville Chiropractor Arrested For Unlicensed Practice Donald Warren Lowery, 49, was arrested by the Division of Insurance Fraud (DIF) for unlicensed practice. The Florida Department of Health (DOH) suspended Lowery’s license in December 2012. Lowery was working for Doc Tony’s Northside Chiropractice while his license was suspended. Lowery told DIF detectives that he thought there was an administrative hold on his license, and believed he could still treat patients. Lowery’s license was suspended for non-payment of child support.

Steve Burgess Named Florida Insurance Consumer Advocate CFO Jeff Atwater announced the appointment of Steve Burgess as Florida’s Insurance Consumer Advocate.

Burgess, 65, of Tallahassee, previously served as Florida’s Insurance Consumer Advocate from 1990 to 1997 and 2004 to 2007. He most recently served as the staff director of the Florida Senate’s Committee on Banking and Insurance, and he has also served as an associate and deputy public counsel. Burgess received his bachelor’s degree in accounting and his law degree from Florida State University.

“Steve’s career experience and his understanding of the insurance industry will help further our efforts to hold insurance companies accountable and ensure that Floridians are being treated fairly,” said CFO Atwater. “He is a proven advocate for Florida consumers and I am confident he will represent the best interests of Florida families.”

You can visit the ICA website at http://www.myfloridacfo.com/ica/ICAWestcott.asp.

PIP FRAUD – In The News

Page 4 November 2013

Between November 3-9, 2013, businesses and organizations around the country and globe participated in Fraud Awareness Week. The goal is to promote awareness, detection and prevention of these often hard-to-spot crimes.

As Florida’s Chief Financial Officer, it is my top priority to fight to help keep your hard-earned money in your pocket where it belongs. Unfortunately, there is a segment of Florida’s population that is working just as hard to empty your pockets - fraudsters and scam artists. Their frauds and scams range from Personal Injury Protection (PIP) fraud, workers’ compensation fraud, home improvement scams, debt reduction scams, fake lotteries and many more.

Recognizing frauds and scams is the most important step to avoid becoming a victim. In an effort to help inform, empower and protect Florida’s families, seniors in particular, against financial scams, we have been hosting a series of workshops across the state. Our tips to avoid fraud include advice such as:

Be suspicious of something that sounds too good to be true.

Don’t pay upfront fees to companies or organizations you are unfamiliar with.

Only buy insurance from licensed companies and agents.

Don’t provide personal or confidential information by email, phone, or text to someone you don’t trust.

Don’t post your travel plans online.

Do not wire money in response to any threats.

I am proud to say that insurance fraud related arrests are up nearly 55 percent since 2010. The success of our dedicated and tireless employees to fight fraud and abuse in our state is incredible, yet the fight against fraud remains an ongoing battle.

If you suspect fraud, reporting it is easy and just a phone call away. Please call 1-800-378-0445 to report suspected fraud and help curb this growing problem that is driving up the cost of living for all Floridians. Citizens can remain anonymous, and tips that lead to an arrest and conviction in an insurance fraud scheme can even collect up to $25,000 as part of our Anti-Fraud Reward Program. To date, we’ve awarded nearly $350,000 to more than 50 citizens.

Do not allow yourself to become a victim. Take charge and learn what you can do to protect yourself and your loved ones. For more information about fraud and consumer protection, visit our website at http://w w w . m y f l o r i d a c f o . c o m / D i v i s i o n / C o n s u m e r s /fraudscams.htm.

PIP FRAUD SPOTLIGHT ON – Fraud Awareness Week

Page 5 The PIP Source

In December of 2009, Division of Insurance Fraud (DIF) detective Billy Brantley initiated an investigation into Medical Therapy Practitioners (MTP), an accident clinic located in Tampa. Brantley quickly developed evidence that led to the execution of a search warrant at the clinic. The investigation showed that MTP was involved in a scheme to stage accidents, pay patients to treat at the clinic and falsely bill insurance carriers for services not rendered. Brantley discovered how this clinic liquidated their income by laundering money through straw companies, personal bank accounts and cash withdrawals at or below the banking reporting requirements.

During the investigation Detective Brantley developed evidence that MTP had obtained a fraudulent exemption from the Agency for Health Care Administration (AHCA), using a chiropractor to file an application attesting he was 100% owner of the clinic when he was not.

Brantley’s investigation and analysis of bank records provided him with evidence to document an organized criminal network operating in Hillsborough County. This criminal enterprise involved in excess of 42 subjects and 18 clinics with a combined income of over $20 million. These clinics created straw companies which in concert laundered more than $6 million. Additionally, a substantial amount of money was laundered through private bank accounts, enlarging the layer of concealment.

Brantley developed evidence that nine members of the criminal enterprise purchased eight high end homes in the same Tampa development with proceeds from their operation of the fraudulent clinics. During the course of the investigation, seven of the properties were sold for more than $2 million.

Based on the magnitude of the investigation and the potential of forfeiture and seizures, DIF sought assistance from federal prosecutors. While the matter was being reviewed by federal authorities, Brantley developed several spin-off cases resulting in the arrest of eight subjects on charges of insurance fraud and money laundering. In the summer of 2013, a federal case was deemed unlikely and DIF turned to the Hillsborough County assistant state attorney Michael Lennon, who had prosecuted the spin-off cases, to now target the top level defendants.

Up against the statute of limitations, ASA Lennon worked tirelessly with Brantley and filed RICO and money laundering charges against four subjects in August 2013. Two subjects have been arrested and two remain at large.

West Central region Captain Mike Byrne believes this investigation has had a significant impact on insurance fraud relating to PIP clinics in Hillsborough County and is a contributing factor for a reduction in PIP fraud in that area, which has seen a 50% decline in referrals since 2009-10. As a result, Capt. Byrne presented Brantley with the Detective of the Year award, and also presented ASA Lennon with the Prosecutor of the Year award.

Capt. Byrne also presented Detectives Robert Nichols and Christian Menzel (pictured at right) with the Detective of the Quarter award for the West Central region as a result of their outstanding work in the undercover investigation of a PIP fraud scheme that operated in Lee and Charlotte counties, which resulted in the arrests of nine subjects last month (see front page story in the October 2013 PIP Source). The nine arrested included clinic owners, a chiropractor and a massage therapist. The scheme involved staged accidents, patient brokering and solicitation at two clinics, Evans Rehab Center in Fort Myers and Charlotte Wellness and Rehab Center in Port Charlotte.

Their investigation also revealed that Charlotte Wellness and Rehab Center was operating without the required license from the Agency for Health Care Administration (AHCA).

DIF West Central Region Recognizes Outstanding Work by Detectives, Prosecutor

Det. Billy Brantley and ASA Mike Lennon

Dets. Robert Nichols and Christian Menzel

Page 6 November 2013

Statewide PIP Arrests – October 2013

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.

Ricardo Concepcion, 40 – staged acct 02/09/12 (driver) $57,810 – Diagnostic Radiology / Fast Rehab / Xtreme Medical (Geico / State Farm / United Auto) M

Yaneisy Trimino Aranda, 23 – staged acct 09/19/12 (passenger) $69,725 – B & A Diagnostic / Doctors Professional Medical / Gentle Care Rehab Services / Psychologist Technology / South Florida Medical Health Corp / YH Imaging (Geico / United Auto) M

Michelle Anne Castillo, 31 – staged acct 09/17/12 (driver) $3,273 - (Progressive / Repwest) J

Bernard Andrew Ethier, 21 – staged acct 09/17/12 (jump-in) $3,273 - (Progressive / Repwest) J

Paulesky Eric Mauney, 41 – fake ins card (Hartford) F

Julio Angel Vargas Rodriguez, 36 – staged acct 03/31/11 (driver) $1,487 - Clearview Open MRI / Recovery Rehabilitation Services (RepWest) T

Paulesky Eric Mauney, 41 – sale of fake ins cards (MGA) F

Destin Sanon, 38 – staged acct 05/13/11 (recruiter) $21,980 – First Choice Chiropractic (Allstate / Kingsway Amigo / Permanent General) O

Tarvis Terrell Sabb, 22 – staged acct 05/19/12 (driver) $26,322 – Cintex Urgent Care / High Definition Mobile MRI / Metric Diagnostic (RepWest / Responsive) B

Marc Christopher Bryant, 26 – staged acct 05/19/12 (recruiter) $26,322 – Cintex Urgent Care / High Definition Mobile MRI / Metric Diagnostic (RepWest / Responsive) B

Ariel Martinez, 37 – staged acct 10/14/12 (driver) $32,725 – K & J Medical Center (Ocean Harbor) M

Donald Warren Lowery, 48 – chiropractor / unlicensed activity – Doc Tony’s Northside Chiropractic (Geico) J

Laura Esther Broche Diaz, 44 – PIP patient - $3,793 – Columbus Rehabilitation Center (Geico) T

Yoel Sotolongo Caro, 40 – PIP patient - $3,793 – Columbus Rehabilitation Center (Geico) T

Ismel Sotolongo Broche, 20 – PIP patient - $3,793 – Columbus Rehabilitation Center (Geico) T

Pedro Pablo Montes, 42 – staged acct 02/09/12 (passenger) $57,810 – Diagnostic Radiology / Fast Rehab / Xtreme Medical (Geico / State Farm / United Auto) M

Luz Maria Perez, 54 – paper acct 01/04/09 (driver) $37,197 – Choice Medical Center (State Farm) F

Verimond Atellus, 29 – staged acct 05/13/11 (driver) $21,980 – First Choice Chiropractic (Allstate / Kingsway Amigo / Permanent General) O

Jill Lori Scott, 58 – massage therapist / false claim - $5,800 (Amica) O

Frenel David, 50 – application fraud (Amica) O

Nadine Laurent, 52 – clinic owner / fraudulent claim - $1,335 – Optimum Medical Care (Security National) W

Andre Saleem Worrell, 28 – PIP patient / false claim - $15,000 – Central Florida Medical & Chiropractic Center (Auto Owners) O

Alisha Londe Lamb, 34 – lost wages - $0 (USAA) TL

Samantha Lee, 34 –fake ins card (Peak Property and Casualty) T

Desmond Darryl Hanna, 26 – fake ins card (United Auto) B

Alfredo Cortes, Jr, 55 – staged acct 06/14/11 (driver) $27,366 – Excellent Rehab (State Farm) B

Corey Antwon Hastey, 26 – staged acct 02/05/13 (passenger) $26,237 – Health & Rehab Services of South Florida #2 / MRI Express Corp (Gainsco / RepWest) M

Lois Jean Walker, 58 – paper acct 10/17/10 (driver) $37,507 – Personal Medical Center (Geico / Sentry) 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)

Page 7 The PIP Source

Statewide PIP Arrests – October 2013

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.

Renesha Marie Williams, 32 – fake ins card (Ocean Harbor) T

Deborah Yvette Burney, 43 – sale of fake ins card (Equity) T

Gloria Moraima Feliz, 31 – clinic employee - $ - Evans Rehab Center (Nationwide / Titan) F

Andres Bravo, 52 – massage therapist – Evans Rehab Center (Nationwide / Titan) F

Josue Daniel Tolento, 25 – fake ins card (Ocean Harbor) W

Enrico Gedeon Scutt, 26 – staged acct 09/03/11 (recruiter) $20,000 - Injury Treatment Center of Coral Springs (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)

Most Wanted: Fugitive

Frine Tovar aka Frine Trimpin Colon White Female, 58 years old

5’04”, 130 lbs, Brown Eyes, Black Hair

Warrant Information: Warrant/Case #: 2010-CF-17110-0

Felony Warrant Charge: Organized scheme to defraud / conspiracy

Details: The Florida Department of Financial Services, Division of Insurance Fraud (DIF) is attempting to locate Frine Tovar. in reference to an outstanding warrant.

Tovar was involved in a scheme to defraud where she and others conspired to set up a straw owner of a PIP clinic in Orlando, using a licensed physical therapist. This concealed the true ownership of the clinic by obtaining a false certificate of exemption from the Florida Agency for Health Care (AHCA). Tovar has been involved in the PIP clinic business for many years, mostly in the Orlando area.

If you know where Tovar 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/

Copy goes her. Editor’s Corner On page 1, we cover the conviction of a Jacksonville clinic owner.

On page 2, we present the Auto Insurance Fraud Strike Force Chair Al Lamberti who explains how the Direct Service Organization (DSO) works.

On page 4, we spotlight Fraud Awareness Week.

On page 7, 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 8 November 2013

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

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. 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 847.544.7141 Central Florida Major Medical Fraud Task Force Supervisory Special Agent Jose Olivier 813.558.6387

Statewide PIP Contacts