...the Division of Insurance Fraud (DIF) arrested four staged

accident organizers in separate, unrelated

cases that resulted in more than $300,000 in fraudulent claims filed against seven different

insurance carriers.

Volume 5 - Issue 3 September 2014

In August, the Division of Insurance Fraud (DIF) arrested four staged accident organizers in separate, unrelated cases that resulted in more than $300,000 in fraudulent claims filed against seven different insurance carriers.

- William Tejeda Mayobanex, 29, was arrested for organizing a staged accident in February 2011. Mayobanex referred the participants to several clinics, A & J Rehabilitation Center and D & J Rehabilitation Center. As a result of Mayobanex’s actions, more than $64,000 in fraudulent claims for property damage and alleged treatment of three participants, including Mayobanex, were filed against United Auto and York Services.

- Roberto Carlos Monzon-Mendez, 39, was arrested for organizing a staged accident in June 2012. Monzon-Mendez paid at least one participant $2,000 and referred participants to several clinics including Gentle Care Rehab, Gonzalez Medical Center and Psychologist Technology. As a result of his actions, more than $55,000 in fraudulent claims for alleged treatment of five participants were filed against Geico and State Farm. Another organizer, Carlos Morales Lastayo, was previously arrested in January 2014. Lastayo is currently a fugitive.

- Elier Valdes Garcia, 33, was arrested for organizing a staged accident in October 2011. Valdes Garcia referred the participants to several clinics, Clarke Medical Services, Emoge Medical Services and New Life Rehab Services. As a result of Valdez Garcia’s actions, nearly $95,000 in fraudulent claims for alleged treatment of five participants were filed against Allstate and United Auto.

- Luis Montero, 61, was arrested for organizing a staged accident in May 2011. Montero referred the participants to several clinics, Blue Medical Network, Torres Rehabilitation Center and Tri R Wellness Center. As a result of Montero’s actions, more than $88,000 in fraudulent claims for alleged treatment of five participants were filed against Imperial, Ocean Harbor, State Farm and United Auto.

INSIDE THIS ISSUE

1 Miami Arrests

2 PIP Fraud News

3 Statewide Arrests

4 Most Wanted

5 Statewide Contacts

HEADER HERE Four Staged Accident Organizers Arrested in Miami Cases

Page 2 September 2014

Man Arrested in Tampa Patient Brokering Sting Operation Jerry Leon Cook, 64, was arrested by the Division of Insurance Fraud (DIF) in August on charges of patient brokering. Cook worked with Marc Neil Blum, a medical doctor and owner of LM Medical Clinic, a Tampa PIP clinic. DIF inititated an undercover investigation after the National Insurance Crime Bureau (NICB) received information about fraud at Blum’s clinic. Blum allegedly offered money to an informant to solicit patients for his clinic. After the patients would come to the clinic and sign paperwork for treatment that was not provided, Blum would refer the informant to Cook, who would pay $500 for each patient. Blum passed away before any charges could be filed against him.

Miami Clinic Owner Arrested in Staged Accident Case Yudeisy Abreu Pena, 25, was arrested by the Division of Insurance Fraud for her involvement in an insurance fraud scheme involving a staged accident that occurred in October 2012. Abreu Pena was an owner of New Life Health Care Medical Center, a PIP clinic located in Miami. Participants from the staged accident were referred to New Life, where Abreu Pena instructed them on what to say to the doctor about their alleged pain and injury, and instructed them to sign blank treatment forms. Nearly $30,000 in fraudulent bills were submitted to Geico as a result of this staged accident. Abreu Pena is the tenth subject charged in this case since the first arrest in June 2013.

Orlando Clinic Owner Arrested for Patient Brokering Osselyn Oreste, 32, was arrested by the Division of Insurance Fraud in August on charges of patient brokering. Oreste, who owns Elite Wellness, a PIP clinic in Orlando, was charged in two cases for offering to pay patients $1,000 to be treated at his clinic. In one case, the patient, who was not injured in the crash, told DIF that he only went to the clinic after Oreste approached him at the scene of the accident and offered him a $1,000 gift card to seek treatment. The patient never received the $1,000, but 21st Century was billed more than $13,000. In the second case, Oreste again promised but never paid two patients who were not injured, and their insurance carrier, Direct Administration, was billed nearly $17,000 for unnecessary treatment.

Palm Beach Woman Arrested For Patient Brokering in St. Lucie County Margaline Pierre Toussaint, 49, of West Palm Beach, was arrested by the Division of Insurance Fraud in August on charges of patient brokering. Toussaint allegedly attempted to obtain $2,000 from a chiropractor in St. Lucie County for the referral of a patient. In a recorded conversation with the chiropractor, Toussaint stated that she had worked for “the firm”, a chiropractor / lawyer team in Palm Beach County, for eight years, and was paid for the referral of patients, splitting the $2,000 equally with the patient. Toussaint explained to the chiropractor that “once the insurance is checked and verified, then you pay me the money.” The chiropractor told Toussaint that he did not pay for patients, and she left his office. The Division of Insurance Fraud was assisted in the investigation by the St. Lucie County Sheriff’s Office.

Florida Hospital Charged Exorbitant Fees For Scans, X-Rays, Lawsuit Claims A pair of unrelated car wrecks in South Florida last year has resulted in what may be a far-reaching lawsuit filed in Tampa. The suit accuses a holding company that owns 80 hospitals across the state, including several in the Tampa area, of grossly overcharging for medical services.

According to the suit, JFK Medical Center and its owner, HCA Holdings, charged exorbitant fees for emergency room radiological services. The overcharges sapped the Personal Injury Protection coverage limits of the patients and left them with thousands of dollars of uncovered bills they had to pay out of their pockets, the suit says.

The four-count, 38-page lawsuit was filed in Hillsborough County Circuit Court and seeks class-action certification.

See the full story at http://tbo.com/news/breaking-news/florida-hospital-charged-exorbitant-fees-for-scans-x-rays-lawsuit-claims-20140902/.

Driver Awareness Involving Auto Accidents and Fraud is Key In numerous reports from the LA Times to Insurance.com, the topic of staged auto accidents is something worth understanding. All too frequently, dishonest people will use schemes against unsuspecting drivers to make bogus insurance claims. These con artists carefully plan and practice their craft so they can accuse and then hold up the other drivers' insurance company for a settlement. There are many ways drivers can be aware of these scams in order to inform their insurance agent and their carrier.

Read the full story at http://www.prweb.com/releases/2014/09/prweb12156756.htm.

PIP FRAUD – In The News

Page 3 The PIP Source

Statewide PIP Arrests – August 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.

Julio Cesar Martes, 49 – staged acct 10/23/10 (driver) $52,355 - NY Medical Rehab (Bristol West / Safeco / Seminole Casualty / State Farm) W

Ashley Nichole Nuttal, 30 - application fraud (Progressive) T

Margie Cunningham, 70 - application fraud (Progressive) O

Guilene Saintard, 32 - false receipt (Nationwide) M

Jerry Leon Cook, 64 - patient brokering - LM Medical Clinic (21st Century) T

Eva M Martinez, 34 - fake ins card (Geico) O

Yolanda Mercedez Vargas, 48 - staged acct 04/22/12 (driver) $14,349 - Indian Rehabilitation Center (Progressive) J Christian A Vargas, 27 - staged acct 04/22/12 (passenger) $12,826 - Indian Rehabilitation Center (Progressive) J

Yulitza Hernandez, 35 - sale of fake ins card (First Acceptance) T

Willdelyn Barbie Hernandez, 24 - staged acct 04/22/12 (passenger) $5,785 - Indian Rehabilitation Center (Progressive) J

Christine Felicia Hogan, 37 - fake ins card (Ocean Harbor) O

William Tejeda Mayobanex, 29 - staged acct 02/27/11 (recruiter) $64,089 - A & J Rehabilitation Center / D & J Rehabilitation Center (United Auto / York Services) M

Yudeisy Abreu Pena, 25 - clinic owner / insurance fraud - $29,492 - New Life Healthcare Medical Center (Geico) M

Roberto Carlos Monzon-Mendez, 39 - staged acct 06/14/12 (recruiter) $55,599 - B & A Diagnostic / Doctors Professional Medical / Flores Chiropractic Group / Gentle Care Rehab / Gonzalez Medical Center / Psychologist Technology / Y & J Chiropractic Center (Geico / State Farm) M

Jeffery Manuel Chamorro, 21 - application fraud / false claim - $4,933 (Progressive) M

Kathleen Ann Olson, 57 - forgery / false claim (State Farm) T

Margaline Pierre Toussaint, 49 - patient brokering - W

Elier Valdes Garcia, 33 - staged acct 10/05/11 (recruiter) $94,715 - Clarke Medical Services / Emoge Medical Services / New Life Rehab Services (Allstate / United Auto) M

Sharon Denise Reynolds-Bell, 54 - fake ins card (Occidental Fire & Casualty) O

Alan Dale Mashaw, 38 - staged acct 10/2/13 - $9,932 - Accident & Injury Clinic (State Farm) O

Dayron Miguel Fuentes, 28 - staged acct 02/20/10 (driver) $49,286 - (National Indemnity / Progressive) M

Oscar Rivera Marrero, 50 - staged acct 11/14/11 (driver) $14,256 - Saint Jose Injury Center (Unitrin) J

Luis Montero, 61 - staged acct 05/07/11 (recruiter) $88,336 - Blue Medical Network / D & S Chiro Rehab Center / South Florida Medical Health Center / Torres Rehabilitation Center / Tri R Wellness Center (Imperial / Ocean Harbor / State Farm / United Auto) M

Guillermo de la Vega, 49 - staged acct 07/27/12 (driver) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center (Esurance / Geico / Infinity / Progressive) J

Omar Santiago Ortega, 37 - staged acct 07/27/12 (driver) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center (Esurance / Geico / Infinity / Progressive) J

Jose A Santos, 49 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center (Esurance / Geico / Infinity / Progressive) J

Sisy Farinas Mena, 45 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center (Esurance / Geico / Infinity / Progressive) J

Sarita Necole Firlow, 40 - fake ins card (Geico) 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 4 September 2014

Statewide PIP Arrests – August 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.

Osselyn Oreste, 32 - clinic owner - patient brokering - Elite Wellness (21st Century) O

Osselyn Oreste, 32 - clinic owner - patient brokering - Elite Wellness (Direct Administration) O

Jason Kevin Jasmin, 29 - staged acct 12/30/12 (driver) $11,271 - North Beach Pain Health Center (Geico / RepWest) M

Jennie Flores, 35 - false claim - $12,000 (USAA) O

Jana Lynn Velazco, 40 - staged acct 07/27/12 (passenger) $22,194 - Arlington Rehabilitation Services / Gate Parkway Diagnostic Center (Esurance / Geico / Infinity / Progressive) J

Emmanuel Lundi, 34 - solicitation - Accumed Wellness & Rehabilitation Center (Allstate) 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)

Manuel Acosta Hispanic Male, 50 years old

5’09”, 165 lbs, Brown Eyes, Brown Hair

Warrant Information:

Warrant/Case #: 482010CF0032720

Felony Warrant Charge: Insurance Fraud / Staged Accident

Details:

The Florida Department of Financial Services, Division of Insurance Fraud, DIF is attempting to locate Manuel Acosta in reference to the outstanding warrant.

Acosta has been a fugitive since March 2010 for the above charges. He recruited subjects to rent vehicles and then participate in staged motor vehicle accidents to personally gain from the resulting personal injury protection benefits.

If you know where Acosta 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 arrests of four staged accident organizers in Miami.

On page 2, we report on PIP Fraud in the News which includes the arrests of three subjects on patient brokering charges, in Tampa, Orlando and St. Lucie County.

On page 4, we feature another fugitive in Insurance Fraud’s Most Wanted.

As always, we report the latest PIP-related arrests.

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 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. Rafael DELGAGO 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. 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