Sweet stated that he was surprised he didn’t have carpal tunnel after signing so many fraudulent forms, he sat at his desk and falsified medical treatment forms all day long, Monday through Friday, 9AM through 6PM. Volume 4 - Issue 3 September 2013 The Division of Insurance Fraud arrested clinic owner Dailin Rojas Perez, 30, and massage therapist Devin Sweet, 27, for their involvement in a major insurance fraud scheme at a Tampa accident clinic. Rojas Perez was charged with racketeering and money laundering involving more than $340,000 in fraudulent proceeds. Sweet was charged with insurance fraud for his role in falsifying treatment records at Medical Therapy Practitioners, a clinic that operated from 2009 - 2011. Medical Therapy Practitioners fraudulently obtained an exemption from the Agency for Health Care Administration (AHCA) when chiropractor Anthony Esposito claimed to be the 100% owner when he was not. This allowed Medical Therapy Practitioners to operate unlawfully. Esposito told DIF detectives that he was recruited to be the straw owner of the clinic by Daysi Rojas, sister of Dailin. The investigation by DIF found that Medical Therapy Practitioners worked in concert with two straw companies to bill insurance carriers for services not rendered; services procured as a result of staged automobile crashes; services for patients who had no injuries; and services not compensable because the business license was obtained fraudulently. The two straw companies were identified as Global Solutions Plus, owned by Yanely Campillo Hernandez, and Today’s Medical Marketing, LLC, owned by Rojas Perez. Medical Therapy Practitioners tried to circumvent insurance carrier SIU inspections by requiring them to make an appointment, which allowed the owner time to remove pre-signed treatment forms from the patient’s folder. The clinic also tried to avoid billing for undercover law enforcement officers by checking patients before accepting them against a list that contained suspected undercover officers. Allegedly, other clinics in the area would call Medical Therapy Practitioners to check patient names on the list. In a search warrant executed at the clinic, DIF detectives seized evidence including therapy sheets signed by patients for treatment that was alleged to have occurred over subsequent weeks. Therapist Sweet told DIF detectives that he had only treated 30 patients a total of approximately 50 times during his six weeks of employment, and estimated he filled out approximately 5,000 fraudulent therapy forms for patients he never saw. Sweet stated he was surprised he didn’t have carpal tunnel after signing so many fraudulent forms, he sat at his desk and falsified medical treatment forms all day long, Monday through Friday, 9AM through 6PM. Arrest warrants for racketeering conspiracy and money laundering have been issued for clinic manager Armando Diaz Tomas, 34, and his wife, billing clerk Yanely Campillo Hernandez, 31. Campillo Hernandez is believed to be in Cuba. See page 3 for more information on Tomas. INSIDE THIS ISSUE 1 Tampa Arrests 2 PIP Fraud News 3 Most Wanted 4 Statewide Arrests 6 Statewide Contacts Clinic Owner, Therapist Arrested in Tampa Accident Clinic Fraud Scheme
Transcript
Sweet stated that he was surprised he didn’t have
carpal tunnel after signing so many
fraudulent forms, he sat at his desk and falsified
medical treatment forms all day long,
Monday through Friday, 9AM through 6PM.
Volume 4 - Issue 3 September 2013
The Division of Insurance Fraud arrested clinic owner Dailin Rojas Perez, 30, and massage therapist Devin Sweet, 27, for their involvement in a major insurance fraud scheme at a Tampa accident clinic. Rojas Perez was charged with racketeering and money laundering involving more than $340,000 in fraudulent proceeds. Sweet was charged with insurance fraud for his role in falsifying treatment records at Medical Therapy Practitioners, a clinic that operated from 2009 - 2011.
Medical Therapy Practitioners fraudulently obtained an exemption from the Agency for Health Care Administration (AHCA) when chiropractor Anthony Esposito claimed to be the 100% owner when he was not. This allowed Medical Therapy Practitioners to operate unlawfully. Esposito told DIF detectives that he was recruited to be the straw owner of the clinic by Daysi Rojas, sister of Dailin.
The investigation by DIF found that Medical Therapy Practitioners worked in concert with two straw companies to bill insurance carriers for services not rendered; services procured as a result of staged automobile crashes; services for patients who had no injuries; and services not compensable because the business license was obtained fraudulently.
The two straw companies were identified as Global Solutions Plus, owned by Yanely Campillo Hernandez, and Today’s Medical Marketing, LLC, owned by Rojas Perez.
Medical Therapy Practitioners tried to circumvent insurance carrier SIU inspections by requiring them to make an appointment, which allowed the owner time to remove pre-signed treatment forms from the patient’s folder. The clinic also tried to avoid billing for undercover law enforcement officers by checking patients before accepting them against a list that contained suspected undercover officers. Allegedly, other clinics in the area would call Medical Therapy Practitioners to check patient names on the list.
In a search warrant executed at the clinic, DIF detectives seized evidence including therapy sheets signed by patients for treatment that was alleged to have occurred over subsequent weeks. Therapist Sweet told DIF detectives that he had only treated 30 patients a total of approximately 50 times during his six weeks of employment, and estimated he filled out approximately 5,000 fraudulent therapy forms for patients he never saw. Sweet stated he was surprised he didn’t have carpal tunnel after signing so many fraudulent forms, he sat at his desk and falsified medical treatment forms all day long, Monday through Friday, 9AM through 6PM.
Arrest warrants for racketeering conspiracy and money laundering have been issued for clinic manager Armando Diaz Tomas, 34, and his wife, billing clerk Yanely Campillo Hernandez, 31. Campillo Hernandez is believed to be in Cuba. See page 3 for more information on Tomas.
INSIDE THIS ISSUE
1 Tampa Arrests
2 PIP Fraud News
3 Most Wanted
4 Statewide Arrests
6 Statewide Contacts
HEADER HERE Clinic Owner, Therapist Arrested in Tampa Accident Clinic Fraud Scheme
Page 2 September 2013
Division of Insurance Fraud Arrests Subjects For Sale of Fake Insurance Cards The Division of Insurance Fraud (DIF) in Tampa arrested six subjects in August for selling fake insurance cards, including several cases involving sales to undercover detectives. One of the subjects was an insurance company employee in Tampa, who was not an agent, but used the office computer system to search for policies in order to construct fraudulent insurance cards, and sold the fake card for $100 to the undercover officer. A sixth subject was charged in West Palm Beach.
Florida is one of the top five states for uninsured drivers. According to Insure.com, that is one of the reasons Floridians pay an average of $1,500 a year for auto insurance.
Arrested for the sale of fraudulent insurance cards were Latoya Nicole Bridges, 29, Lashawnta Deonn Melton, 29, Dana Kareem Harmon, 28, Louise Lashawn Reynolds, 31, Stephanie Lynn Dunbar, 27, all of Tampa, and Lernia Colin, 28, of West Palm Beach.
See the related news stories from WTSP 10 News in Tampa at http://www.wtsp.com/news/article/331429/34/25-percent-of-Florida-drivers-dont-have-insurance and http://www.wtsp.com/news/article/331616/34/Insurance-fraud-arrest-follows-10-News-Investigation.
National Insurance Crime Bureau / Division of Insurance Fraud Provide Training The National Insurance Crime Bureau (NICB) teamed up again with the Division of Insurance Fraud to provide Personal Injury Protection (PIP) fraud training at the Florida Highway Patrol (FHP) academy.
NICB Special Agent Herb Price (pictured at right) and DIF’s Captain Steven Smith presented training on PIP fraud and staged accidents to recruits at the FHP for the second time, and they plan to present to each subsequent recruit class moving forward. They first provided the training in September 2012.
State troopers are often the first responder to accident scenes, some of which are staged by criminals attempting to steal money from insurance companies through the PIP benefits. CFO Jeff Atwater has made it a priority to work with other agencies to provide support in the larger fight against insurance fraud in Florida. Captain Smith stated “It is our goal to share our experience and do what we can to help state troopers identify staged accidents at the scene.”
MetLife Donates Vehicle to Broward County Sheriff’s Office In August, MetLife donated a bait/surveillance vehicle to the Broward County Sheriff's Office. The donation was made with the assistance of Supervisory Special Agent Tony Fernandez from the National insurance Crime Bureau (NICB).
Law enforcement is grateful for the support from insurance companies in the fight against insurance fraud. We thank MetLife and NICB.
Pictured L to R: Sgt. Frank Heitmann and Det. Joel Rivero, Broward County Sheriff ‘s Office; George Hodge, MetLife SIU Manager; Nancy Jensen, MetLife SIU Field Supervisor; NICB SSA Tony Fernandez; Victor Uribe, MetLife SIU Investigator; and Lt. Jackowski - Broward County Sheriff‘s Office.
Massage Therapist Surrenders License in Operation Dark Horizon case Massage therapist Maritza Ruano, 54, who was arrested in June 2012 by the Division of Insurance Fraud (DIF) as part of the Operation Dark Horizon investigation, surrendered her license to the Department of Health (DOH) as part of the plea in her criminal case. Ruano was charged for her involvement in the organized scheme in which she was a straw owner of Coral Way Rehabilitation Center, one of the accident clinics that operated without the necessary license from the Agency for Health Care Administration (AHCA). Ruano obtained an exemption from AHCA which Coral Way Rehabilitation Center used to operate. The case against the true owner, Daisy Sarmiento, is still pending in the Miami-Dade County Court system. Ruano received one year of community control followed by 10 years probation.
Other PIP Links - http://www.sun-sentinel.com/news/palm-beach/fl-lake-worth-staged-crash-20130820,0,5413121.story
Check out the DFS Most Wanted at http://www.myfloridacfo.com/PressOffice/MostWanted/
Most Wanted: Fugitive
Division of Insurance Fraud (DIF) detective Dwight Murphy from the Jacksonville office, was given the Public Service Award for 2013 by the International Association of Special Investigation Units (IASIU), who posted this narrative on their website at http://iasiu.org/enews/2013Q3_seminar_b_index.
In 2011, the town of Jacksonville, Florida began to see an increase in PIP clinics involved in staged accidents, many run by experienced personnel originating from Tampa and Miami. During the height of this activity in 2012, there were 10 associated clinics actively billing insurance carriers on hundreds of questionable claims. Detective Dwight Murphy focused his investigations on these clinics and worked with the insurance industry to share information when new clinics opened to facilitate the identification of the claims warranting further investigation.
Murphy initiated multiple clinic investigations, including surveillance to identify the parties running the clinics and alleged claimants. He used the evidence to interview staged-accident participants and solicit confessions, which helped move investigations forward. While insurance carriers had completed individual surveillance assignments, this was the first time law enforcement secured their own surveillance at multiple clinic locations.
Murphy’s investigation was able to determine that, in some instances, the listed owner of a clinic was not the actual owner but was being paid for the use of their license. This led the investigation to Houston, Texas, and the identification of the individuals providing the funds, which led to additional arrests.
To date, these investigations have resulted in charges against 57 individuals with 45 arrests and 12 outstanding warrants. Several parties have pled guilty and have been ordered to pay restitution to the insurance carriers and to contribute to a newly created “strike fund” to combat insurance fraud.
DIF Detective Receives IASIU Public Service Award
Armando Diaz Tomas Hispanic Male, 34 years old
5’05”, 180 lbs, Brown Eyes, Brown Hair
Warrant Information: Warrant/Case #: 22116332 Hillsborough County
The Florida Department of Financial Services, Division of Insurance Fraud (DIF) is attempting to locate Armando Diaz Tomas in reference to the outstanding warrant issued in Hillsborough County.
Tomas was the office manager of an unlicensed accident clinic that operated in Tampa where he allegedly paid patients from staged accidents for which the clinic then billed insurance carriers for services not rendered.
Tomas was arrested in Jacksonville earlier this year. Tomas may also be involved in other PIP clinics.
If you know where Tomas can be located, please contact the Division of Insurance Fraud at 1-800-378-0445.
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.
Mario Lozano, 32 – massage therapist / straw owner - $20,007 – Unique Relief (Geico) M
Mario Lozano, 32 – massage therapist / straw owner - $10,000 – Unique Relief (Mapfre) M
Latoya Nicole Bridges, 29 – sale of fake ins card (First Acceptance) T
Lashawnta Deonn Melton, 29 – sale of fake ins card (Geico) T
Elizabeth Velazquez, 48 – staged acct 03/30/12 (recruiter) $58,920 - Med Care Medical Center / Well-Care Rehab Services (Imperial Fire / Ocean Harbor) M
Noel Rodriguez Miralle, 44 – staged acct 04/02/12 (recruiter) $60,938 - Integral Medical Rehab / Well-Care Rehab Services (Allstate / Geico) M
Alysson Queiroga, 38 – staged acct 02/01/10 (recruiter) $127,351 – Pompano Family Chiropractic (Farmers / Progressive / Security National) M
Amado Ramos Bouso, 24 - staged acct 10/25/11 (recruiter) $75,541 – B & A Diagnostic / Clarke Medical Services / Emoge Medical Services / Magic Hands Medical Services (Geico / United Auto) M
Veldra Deniece Cain, 58 – false statement (Acceptance) O
Alain Amarran Reyes, 33 – staged acct 01/12/12 (recruiter) $94,051 - Magic Hands Medical Services / New Life Rehab Services (Geico / United Auto) M
Dwane Henry Joshua, 25 – application fraud (Progressive) J
Alexander Meleis Garcia, 44 – staged acct 06/04/12 (driver) $41,465 - One Touch Therapy (Kemper) J
Anthony Ryan Bremser, 27 – staged acct 09/03/11 (driver) $20,000 – Injury Treatment Center of Coral Springs (Geico) B
Denise Lashonne Saltmarch, 35 – staged acct 08/22/10 (driver/recruiter) $1,771 - Sunshine Medical Rehab (Geico) T
Vladimir Amores, 51 – staged acct 10/23/12 (passenger) $55,073 - LMG Medical / New Life Medical Center (Geico / State Farm) M
Elsa L Perez, 50 – staged acct 10/23/12 (driver) $55,073 - LMG Medical / New Life Medical Center (Geico / State Farm) M
Terrell Jamarcus Jones, 28 – fake ins card (Direct) T
Dana Kareem Harmon, 28 – fake ins card (Assurance America) T
Ernypher Ginsy Perez, 35 – staged acct 11/7/11 (recruiter/driver) $15,242 - Health Matters (Nationwide / RepWest / Titan) O
Sharah Simone Manning, 33 – jump-in - $14,073 - Delray Chiropractic & Wellness Center (Liberty Mutual) W
Jose Roberto Maldonado Melenez, 42 – staged acct 11/7/11 (driver) $15,242 - Health Matters (Nationwide / RepWest / Titan) O
Yoel Bravo Navarro, 33 – staged acct 12/23/08 (passenger) $19,985 - Forest Hill Rehab Center / New York Medical Rehab Center / Viva X-Ray Medical (AIG) W
Lernia Colin, 28 – fake ins card (Ocean Harbor) W
Ana Maria Lamas, 55 – staged acct 08/13/12 (driver) $55,610 - Emanuel Therapeutic Massage / Miami Medical Care Corp / Palmetto West Rehab (Esurance / Windhaven) M
Devin Sweet, 27 – massage therapist - $342,456 - Medical Therapy Practitioners (Bristol West / Direct General / Infinity / Nationwide / Sentry) T
Anyelo J Batista, 41 – application fraud (Geico) M
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 5 The PIP Source
Statewide PIP Arrests – August 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.
Jean Edrice Dorestant, 38 – staged acct 05/01/11 (recruiter / driver) $32,558 - KJ Chiropractic Clinic / Wellness Pain and Rehab (Farmers / Gainsco / Geico) O
Stephanie Marie Rivas, 22 – staged acct 04/10/11 (passenger) $20,394 – Excellent Rehab and Medical Center (State Farm) B
Natalie Rivas, 26 – staged acct 04/10/11 (passenger) $20,394 - Excellent Rehab and Medical Center (State Farm) B
Yaslier Ricardo Martinez Gonzalez, 23 – staged acct 04/10/11 (driver) $20,394 - Excellent Rehab and Medical Center (State Farm) B
Alfredo Linares, 50 - staged acct 12/23/08 (driver) $19,985 - Forest Hill Rehab Center / New York Medical Rehab Center / Viva X-Ray Medical (AIG) W
Luandi Lazaro Munzos Cuevas, 26 – staged acct 03/14/12 (driver) $33,867 – Gate Parkway Diagnostic Center / Indian Rehabilitation Center (Geico) J
Lawrence Eric Schechtman, 45 - chiropractor - mail fraud / money laundering W
Hermann Javier Diehl, 44 - chiropractor - mail fraud / money laundering W
Chuck J Peters, 48 – staged acct 02/05/13 (recruiter) $26,237 - Health & Rehab Services of S Florida #2 / MRI Express Corp (Gainsco / RepWest) M
Louise Lashawn Reynolds, 31 – sale of fake ins card (Geico) T
Stephanie Lynn Dunbar, 27 – sale of fake ins card (Progressive) T
Ismaray Leiva, 25 – staged acct 12/23/08 (passenger) $19,985 - Forest Hill Rehab Center / New York Medical Rehab Center / Viva X-Ray Medical (AIG) W
Mazon Jerrard Kelly, 34 – staged acct 08/22/10 (passenger) $3,961 - Sunshine Medical Rehab (Geico) T
Clarence Michael Major, 22 – staged acct 10/04/10 (recruiter / passenger) $10,453 - Austin Health Center (Geico / Liberty Mutual / State Farm / USAA) T
Chad Alexander Foster, 22 – staged acct 10/04/10 (driver) $10,453 - Austin Health Center (Geico / Liberty Mutual / State Farm / USAA) T
Caitlin Skye Richmond, 22 – staged acct 08/26/10 (passenger) $0 - Austin Health Center (Allstate / Progressive / USAA) T
Cedric Noel Moxey, 23 – staged acct 08/22/10 (passenger) $8,641 - Florida Injury Care (Hallmark) T
Antonio Armando Hernandez Oliver, 49 – massage therapist - $42,350 - Magic Therapy Rehabilitation Corp (Allied / Titan) T
Vincent Reniard Stanley, 49 – jump-in - $0 - Broward Rehab Center (Allstate) B
Heriberto Lemus, 23 – staged acct 03/12/12 (recruiter) $61,729 – All Future Medical Center / Benefica Health Center (United Auto) M
Dailin Rojas Perez, 30 – clinic owner / racketeering / money laundering - $342,456 - Medical Therapy Practitioners / Today’s Medical Marketing (Bristol West / Direct General / Infinity / Nationwide / Sentry) T
Lucinda Nichols, 38 – application fraud (Infinity) T
Arrested in June 2013
Johnny Alejandro Nunez, 24 – staged acct 08/26/10 (passenger) $0 - Austin Health Center (Allstate / Progressive / USAA) 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)
Copy goes her. Editor’s Corner On page 1, we cover the arrests of a clinic owner and massage therapist in a major fraud scheme at an accident clinic in Tampa.
On page 2, we highlight the latest in PIP related news.
On page 3, we feature another fugitive in Insurance Fraud’s Most Wanted, and proudly congratulate DIF detective Dwight Murphy who received the Public Service Award from IASIU.
As always, we provide information on all the latest PIP-related arrests.
Page 6 September 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
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