Division of Insurance Fraud Regional Offices

MIAMI REGION

The Miami office was the original Headquarters of the Division of Insurance Fraud when it was first created in 1976, located in Virginia Gardens.  We relocated to downtown Miami in the late-80s after the Headquarters was moved to Tallahassee.

Miami Region Commander

Captain Steven Smith

Captain Smith, who has been with the agency since 1988, supervises the office.  Captain Smith started as an investigator / detective, was promoted to Lieutenant in November 2000 and then promoted to Captain in January 2002.  Captain Smith has more than 28 years of service with the State of Florida.

Case Statistics

The 2007-08 fiscal year was another good year for the Miami Region Office.  The focus was again on PIP fraud, which took up most of the attention.  During the 2007-08 fiscal year, the Miami Region received more than 2600 referrals, down approximately 13% from the more than 3000 referrals in 2006-07.  211 new cases were opened during this period.  Our arrests in 2007-08 totaled 192, with 222 convictions and approximately $1.3 million ordered in restitution.

General Information

The Miami Regional Office investigates all types of insurance fraud.  There are currently four squads, two dedicated to Personal Injury Protection (PIP) fraud, one dedicated to Workers Compensation fraud, and one dedicated to general fraud.  A third PIP squad will be added shortly.

PIP Fraud Squads

The PIP Fraud squads, supervised by Lieutenant Violeta Serrano and Lieutenant Jerry Brown, continue to excel.  Combined, the squads made 104 arrests.  Leading each squad were Detectives Ray Diaz, with 24 arrests and Carlos Dorta with 22 arrests.  PIP remains a hot topic in South Florida, and the category in which we receive most referrals.  According to the AHCA (Agency for Health Care Administration) website, between 30% - 40% of Florida’s clinics are located in Miami-Dade County, and we suspect there are hundreds of clinics committing insurance fraud at any given time.  We maintain a very positive working relationship with the insurance company SIUs, the NICB (National Insurance Crime Bureau), the FBI and local police departments.  The Division works with a dedicated PIP prosecution unit at the Miami-Dade State Attorney’s Office.  Prosecutors Thomas Sadler and Suzy Sostmann handle the bulk of the PIP fraud cases filed in Miami-Dade County.

Workers' Compensation Fraud Squad

The workers compensation squad, led by Lieutenant Mike Shea, made 39 arrests.  Leading his squad was Detective Carlos Rodriguez, who had 16 arrests.  Workers compensation fraud is another pervasive insurance crime that costs businesses millions of dollars each year.

General Fraud Squad

The General Fraud squad, led by Lieutenant Bill Santner, made 49 arrests.  Leading his squad were Detectives Joe Shepherd and Carlos Losada, who had 11 arrests each.  The general fraud squad handles all other types of insurance fraud, including homeowners, vehicle theft, medical fraud, licensees, and hurricane claims.

Case Highlights

“Operation TGIF” - started in kicked off in February 2007 with a phone call to the Fraud Hotline after a radio appearance by Fraud detectives.  The phone call initiated an investigation that uncovered a staged accident ring that had been operating for several years.  Using informants to infiltrate the ring, fraud detectives identified ten staged accidents and more than $328,000 in fraudulent PIP claims.  Nearly 40 participants were arrested, four search warrants were executed and more than $200,000 was seized from target bank accounts.  Most of the participants have entered pleas, but several are still pending plea or trial.

“Kitchen Fires” - This investigation involves public adjusters who have admitted to setting up numerous kitchen fires with homeowner’s knowledge and involvement, in order to profit from the insurance money.  In October 2007, we arrested two subjects who were charged with working with the public adjusters to set the fires in question.  The resulting claim was in excess of $120,000.  One of the arsonists was convicted by jury trial and the other is a fugitive from justice.

“Worst Case of Misrepresentation and Fraud” -  The subject filed a medical malpractice lawsuit in Miami-Dade County against two hospitals and a group of doctors, alleging that as a result of their deviation from the standard of care, she went from an individual with back pain and weakness in the lower extremities and an inability to support herself on her legs on occasion, to being paralyzed.  The subject gave a deposition, arriving in a wheelchair, and stated that she was left paralyzed and could not walk.  Subsequent video surveillance was conducted where the subject was observed to walk without the use of a wheelchair, using only a cane.  A subsequent deposition was taken and the subject again stated that she is unable to stand up from a sitting position or remain standing without assistance and is unable to clean house.  She also says that she is unable to go into the bathroom because her wheelchair won’t fit through the door and has to use a bedside commode.  She also states that she cannot get out of a car without assistance.  The malpractice insurance carrier offered to settle the case out of court and give the subject $250,000.00 for her injury, which was rejected.  The Circuit Court Judge dismissed the case with prejudice. The Judge stated in open court that this was the worst case of misrepresentation and fraud that she had seen in 22 years.  The subject was arrested and charged with Insurance Fraud and Grand Theft.

In Memoriam:

Lt. John Haczynski was killed on January 15, 2006, when his motorcycle was struck by a pickup truck in North Miami.  John had worked for the Division of Insurance Fraud for four years and had just been promoted to Lieutenant in December 2005.  John had retired from the New York Police Department after 20 years.  As a detective in the NYPD’s organized crime unit, he investigated corruption in private sanitation companies, was part of a task force that investigated Russia7n mobsters and, as part of an FBI-NYPD task force, he helped arrest members of the Genovese crime family in 2001.  In his spare time, John was an avid boater and motorcycle enthusiast.  John was one of the most productive employees at DIF and will be sorely missed.  John was 49.

Detective Mike Schulgen died on June 28, 2002, shortly after being diagnosed with Leukemia.  Mike had worked for the Division of Insurance Fraud for more than four years.  Mike was a former Marine, FBI fingerprint technician and Metro-Dade Police Department Robbery Detective before coming to investigate insurance fraud in 1998.  He had also worked for the Florida Division of Licensing for 9 years.  Mike was 55.