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The Florida Department of Financial Services’ Division of Insurance Fraud arrested Giselle Avila, vice president of The Valenti Group Insurance, Inc. in Miami, for insurance fraud after she knowingly misled a consumer in order to obtain a higher commission payout. Investigators also determined that Avila prepared and issued a fictitious notice of reinstatement for the consumer’s homeowner insurance policy in an attempt to conceal that it had been canceled.
An investigation conducted in coordination with the Department’s Division of Agent and Agency Services revealed Avila, a licensed insurance agent, quoted a homeowner insurance policy premium price with inflated discounts to make the premium appear desirable. Avila assured the consumer that the quoted price included a discount for a completed wind mitigation inspection. However, Avila failed to forward the wind mitigation documents to the insurance company and when confronted by the consumer, she provided inaccurate documentation to cover her misdeeds.
As a result, the premium discount was never applied and the consumer received notification that her premium price increased. Avila continued to mislead the consumer by convincing her that she did not need to pay the increased price, which ultimately led to policy cancellation for nonpayment. Concerned about the cancellation notice she received, the consumer immediately contacted Avila, who continued her lies by stating the cancellation was a clerical error by the insurance company. To continue her cover-up, Avila gave the consumer a falsified notice of reinstatement.
However, after growing suspicious, the consumer contacted the insurance carrier directly and learned that the policy remained cancelled. While Avila gained a monetary commission, the consumer remained cheated and without insurance coverage. The company ultimately made the consumer whole by reinstating the policy and honoring the discounts that had been promised.
Giselle Avila faces up to five years in prison, if convicted. Her case will be prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle. Pending disposition of the criminal case, the Department’s Division of Agent and Agency Services, which licenses insurance agents in Florida, aims to take administrative action against her insurance license.
Investigators believe Avila may have scammed additional consumers. In an abundance of caution, consumers who have conducted business with Giselle Avila are encouraged to contact their insurance carrier to confirm that coverage is in place. This is especially important given the upcoming start of the 2015 hurricane season on June 1st. During this time, it is imperative that all consumers have an accurate accounting of their insurance coverage.
CFO and State Fire Marshal Jeff Atwater, alongside Miami-Dade State Attorney Katherine Fernandez Rundle, announced 30 more arrests made during the second wave of a collaborative state and local operation known as “Operation Flames and Floods.” The investigation exposed an extensive scheme in which a Miami public adjuster named Jorge Espinosa recruited homeowners to stage fire and water damage claims in residential homes in order to defraud multiple insurance companies. Previously arrested in February 2014 for crimes related to this fraud ring, investigators have since uncovered 25 more fraudulent claims tied to Espinosa, representing total losses of more than $14 million.
“It is clear that this scheme was driven by greed, and unfortunately, it is the honest policyholders in our state who are left on the hook to cover the millions of dollars that were stolen,” said CFO Jeff Atwater. “I am proud of the work of our investigators, and I am grateful for the support of the Miami-Dade Police Department’s Arson Unit and Miami-Dade County State Attorney Katherine Fernandez Rundle for helping us to hold these individuals accountable.”
"These insurance thieves were making their money by reaching into the wallets of every honest citizen of Florida", said Miami-Dade State Attorney Katherine Fernandez Rundle. "Their profits come from our pain and hard work. That is why these arrests are so important."
Operation Flames and Floods began in November 2012 as a joint investigation between the Florida State Fire Marshal’s Office and the Miami-Dade Police Department’s Arson Unit. In February 2014, 14 people were arrested after 13 homes were intentionally set on fire and five more reported staged water damage. As a result of the fraud, multiple insurance carriers incurred more than $7.6 million in reported losses.
Further investigative efforts uncovered 25 more claims tied to this fraud scheme, representing an additional $6.7 million in fraudulent claims paid by the following insurance companies: Tower Hill Insurance Group, Citizens Property Insurance, Federated National Insurance Company, GEICO, Bankers Insurance Group, Southern Fidelity, Mercury Insurance, State Farm, Florida Peninsula, Ascendant Commercial Insurance, United Property and Casualty, Ark Royal Insurance and Southern Oak Insurance.
“Insurance fraud is not a victimless crime,” said Tower Hill Insurance Group President Don Matz. ”In fact, it impacts insurance policyholders around the state through increased rates that are required to recoup the funds stolen through these fraudulent acts.”
“We applaud the efforts of CFO Atwater’s office and the Miami-Dade State Attorney Katherine Fernandez Rundle, and we are glad to have played a part in this investigation,” said Joseph Theobold, Citizens Director of Special Investigations. “Insurance fraud translates into millions of dollars in costs paid by our policyholders. We must remain diligent in rooting out fraud.”
The Sarasota, Lee, Collier and Highlands County Sheriffs’ Offices assisted with this week’s arrests, along with the Florida Fish and Wildlife Conservation Commission.
The Florida Department of Financial Services’ Division of Insurance Fraud announced the arrests of Rafael Pietri, owner of Empire Bail Bonds in Kissimmee, and Victor Ortiz, a company employee. Pietri was arrested for employing a known convicted felon, Victor Ortiz, to work within his bail bond business. By law, convicted felons are barred from working within the bail bond industry. Ortiz has been arrested and sentenced on multiple drug and battery charges in several Florida counties.
An investigation by the Division of Insurance Fraud found that Empire Bail Bonds was utilized to bond Ortiz out of jail following several Osceola County arrests. The Department’s Division of Agent and Agency Services, which licenses bail bond agents in the state of Florida, provided assistance in the investigation and is seeking to suspend Pietri’s bail bond agent license.
Pietri and Ortiz both face up to 5 years in prison, if convicted. The case will be prosecuted by the office of 9th Judicial Circuit State Attorney Jeffrey Ashton.
The Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of Miami Lakes insurance agent Patricia Dawn Fernandez for stealing insurance premium funds from an elderly 70-year-old client. In February 2013, while working as the agent in charge at a North Miami Beach insurance agency, Fernandez accepted a premium payment in full from the victim but kept the money and signed the individual up for a payment plan without his authorization.
The victim became aware of the theft when he contacted his insurer after receiving a cancellation notice for non-payment. The victim’s insurer, Citizens Property Insurance, informed him of the payment plan Fernandez had arranged and that payments had not been made. After the victim provided proof of payment, Citizens contacted the Division of Insurance Fraud to investigate. The Department’s Division of Agent and Agency Services, which licenses insurance agents in the state of Florida, also provided assistance in the investigation and is seeking to suspend Fernandez’s insurance agent license.
Fernandez faces up to 5 years in prison, if convicted. The case will be prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle.
Chief Financial Officer Jeff Atwater announced the arrests of eight Broward County residents for PIP (personal injury protection) fraud. An investigation by the Department of Financial Services’ Division of Insurance Fraud revealed the arrested individuals staged a motor vehicle accident in Fort Lauderdale using a hotel van filled with passengers who participated in the scam.
Ronie Petidos of Corals Springs, Patrick Logene of Tamarac and Marc La Pierre of Pompano Beach were arrested for organizing the accident and sending the participants to clinics they controlled. The participants were also instructed and agreed to file fraudulent insurance claims and begin unnecessary therapy treatments.
The arrested van passengers include Shaeronda Jackson and Jeffrey Louis of Fort Lauderdale and Jean Regisma of Lauderhill. Stephen Blanc of Lauderdale Lakes and Kennsly Giles of Fort Lauderdale, who were also arrested, were recruited to ride in the at fault vehicle that crashed into the van.
The case is being prosecuted by the office of 17th Judicial Circuit State Attorney Michael J. Satz.
Accident organizers Petidos and La Pierre were previously arrested in 2014 for their role in another staged accident that occurred in 2012 in Hollywood, Florida. This criminal case is still pending in the Broward Judicial Court system.
The Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of Roxana Suarez La Rosa on charges related to PIP (personal injury protection) fraud. In 2012, the Saint Jose Injury Center in Jacksonville, which Suarez La Rosa owned and operated, generated more than 50 insurance claims. During this time, at least three cooperating witnesses have indicated that they participated in staged automobile crashes. Each stated that Suarez La Rosa had participants sign for treatments they never received in order to fraudulently bill their insurance companies.
Suarez La Rosa faces charges of fraud and racketeering and up to 50 years in prison if convicted. Additional cases related to the Saint Jose Injury Center are pending. The case is being prosecuted by office of 4th Judicial Circuit State Attorney Angela Corey.
The Florida Department of Financial Services’ Division of Insurance Fraud announced the arrest of Miami Gardens insurance agent Ulricka Filisena Lebrun on charges related to the sale of a fake insurance policy. The victim reported the case to the Department after he went months without being able to contact Lebrun and without receiving documentation pertaining to the actual insurance policy he purchased.
An investigation assisted by the Department’s Division of Agent and Agency Services revealed that no coverage was ever placed by Lebrun on behalf of the victim. Instead, she kept the victim’s down payment and cut off communication with him. Furthermore, the proof of insurance Lebrun provided to the victim listed an insurance company that discontinued offering property insurance in the U.S. after Hurricane Katrina in 2005. The Division of Agent and Agency Services, which licenses insurance agents in Florida, was able to arrange for the victim’s money to be returned and is seeking to suspend Lebrun’s insurance agent license.
Lebrun faces up to 15 years in prison, if convicted. The case is being prosecuted by the office of Miami-Dade County State Attorney Katherine Fernandez Rundle.
We highly recommend that licensees routinely check their MyProfile account(s) for messages from the Department. We send an email notification at the same time to remind you to check your MyProfile account but on rare occasions you may not receive that email. For that reason, we suggest you add our domain MyFloridaCFO.com to your email software's Trusted or Safe Senders List to ensure you are able to receive email notifications from us. Licensees who have a valid email address on file with the Department, as required by law, are sent important email notifications when something that affects their application, license, continuing education, or appointment(s) occurs. Additionally, we will keep you informed with warnings regarding new schemes and scams being marketed to licensees. You can update your contact information through your MyProfile account. We want to keep you informed in a timely manner of pertinent information. You are still required to abide by the Florida Insurance Code regardless of whether you read the information we provide or attempt to provide.