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CFO Atwater’s Fraud Team Busts Accident Clinic Operator For Filing Claims on Behalf of a Dead Doctor

8/26/2011

Contact: Alexis Lambert 
(850) 413-2842

TALLAHASSEE- Florida Chief Financial Officer Jeff Atwater today announced the Division of Insurance Fraud on Wednesday arrested Hialeah accident clinic operator Daysi Puigros on more than 30 felony counts stemming from allegations that she filed more than $200,000 in fraudulent Personal Injury Protection (PIP) claims using the name of a deceased doctor.

Puigros used her clinic, Better Life Medical Center LLC, to submit physical evaluations allegedly performed by Juan Julio Hernandez Pombo, a doctor who she knew had died. She is charged with 15 counts of insurance fraud, 15 counts of grand theft (3rd degree), one count of operating a clinic without a license and one count of an organized scheme to defraud. 

“I have no tolerance for masterminds of these types of egregious crimes,” said CFO Atwater.  “We need to look at tightening laws and reforming PIP in Florida so our citizens don’t have to foot the bill for these outrageous schemes.”

Puigros owned the clinic from late 2007, until it was dissolved in late 2009.  Sworn statements indicate that employees of the clinic knew the doctor had died, but Puigros continued to use his name for reports and billing and instructed the employees to do so as well.  Employees were also told to make patients sign blank forms which were then fabricated by Puigros in order to fraudulently bill for medical services never rendered.

Puigros never applied for or received a license to operate the clinic, as indicated by the Agency for Health Care Administration (AHCA), nor had she applied for a license with the Department of Health (DOH). It is a third degree felony to operate without a license. Puigros was booked into the Miami-Dade County Jail and released after posting a $160,000 bond.

In an effort to develop policy ideas to combat PIP fraud, Florida’s Insurance Consumer Advocate Robin Westcott, appointed by CFO Jeff Atwater, will be forming a PIP working group to help formulate solutions in response to the escalating rates burdening Florida’s consumers, especially in urban areas.

Anyone with information regarding suspected insurance fraud is asked to call 1-800-378-0445. Individuals who provide tips can remain anonymous and are eligible for a reward of up to $25,000 for information that directly leads to an arrest and conviction in an insurance fraud scheme.  The Department of Financial Services to date has awarded almost $250,000 to approximately 40 citizens as part of its Anti-Fraud Reward Program.

Chief Financial Officer Jeff Atwater, a statewide elected official and officer of the Florida Cabinet, oversees the Department of Financial Services including the Division of Insurance Fraud.  CFO Atwater’s priorities include fighting financial fraud, abuse and waste in government, reducing government spending and regulatory burdens that chase away businesses, and providing transparency and accountability in spending.