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Volume 4, No. 8 - August 2015

News You Can Use

- Updating you on what's going on

 

South Florida Insurance Agent Arrested for Stealing Nearly $150,000 from Client

The Florida Division of Insurance Fraud announced the arrest of Shane Kelley, 31, of Lantana on grand theft charges after he allegedly stole $145,000 from a client’s annuity account while working as an insurance agent for Metropolitan (MetLife) Insurance Company.

In the spring of 2014, a MetLife client accused Kelley of stealing from his trust annuity account, and Kelley was fired after failing to cooperate during an internal investigation of the matter. MetLife then contacted the Department’s Division of Insurance Fraud and an investigation uncovered multiple cashed checks as well as checks written from the client’s account that were not authorized by the client. Records indicated that Kelley used the funds for personal use and purchased multiple cars on the client’s dime.

Kelley was arrested and booked into the Martin County Jail where he faces a first degree felony grand theft charge. The case will be prosecuted by the office of Palm Beach State Attorney Dave Aronberg. The Department’s Division of Agent and Agency Services, Bureau of Investigation, also participated in the investigation and aims to take administrative action against Kelley’s insurance license.

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Former Miami Insurance Representative Arrested for Diverting Premium Funds

The Florida Division of Insurance Fraud announced the arrest of Tania Michel, 41, for failing to notify the Department of Financial Services of a federal fraud conviction, continuing to work in the insurance industry after her license expired, and knowingly misappropriating premium funds while working at an insurance agency.

For a period of nine months, Michel worked at a North Miami Beach insurance agency with an expired professional license and with an unreported federal felony conviction. By failing to reapply for her license, she was able to further conceal the felony fraud conviction that would cause her to become permanently barred from the insurance industry. She was fired by the insurance agency owners for suspected misappropriation of funds and sought employment at another Miami insurance agency where she continued the same unlawful behavior of diverting, or stealing, clients’ monthly premium payments for personal use.

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Four Miami PIP Fraud Conspirators Arrested

The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced four South Florida arrests of individuals on charges related to their involvement in three separate personal injury protection (PIP) fraud schemes that resulted in the billing of more than $145,000 in fraudulent insurance claims.

Nayef Casas Diaz, owner of Miami PIP clinic M & N Rehabilitation Center, was arrested after allegedly organizing a staged accident scheme. Diaz reportedly paid each participant in the staged vehicle accident $1,000 to receive treatment from M & N and another clinic, Magic Hands Medical Service, for phony injury claims. As a result, fraudulent claims in excess of $63,000 were filed against the two insurance carriers.

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Office Announces 2016 PPACA Individual Market Health Insurance Plan Rates to Increase 9.5% on Average

The Florida Office of Insurance Regulation announced that premiums for Florida individual major medical plans in compliance with the federal Patient Protection & Affordable Care Act (PPACA) will increase an average of 9.5% beginning January 1, 2016. Per federal guidelines, a total of 19 health insurance companies submitted rate filings for the Office’s review in May with final rate determinations due by August 25, 2015. These rate filings consisted of individual major medical plans to be sold both on and off the Exchange. Following the Office’s rate filing review, the average approved rate changes on the Exchange range from a low of -9.7% to a high of 16.4%. This information can be located in the “Individual PPACA Market Monthly Premiums for Plan Year 2016” document.

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Miami Couple Arrested For Generating Fraudulent Public Assistance Accounts for Profit

The Florida Department of Financial Services’ Division of Public Assistance Fraud (DPAF) announced the arrest of former Department of Children and Families employee, Clara T. Builes, 54, and her husband, Gonzalo A. Builes, 56, on charges of grand theft and public assistance fraud among many after Mrs. Builes allegedly used her official position with DCF to misappropriate public assistance benefits for a total more than $19,000 between May 2011 through April 2015.

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Florida CFO Jeff Atwater Secures Multi-Million Dollar Settlement
in Large-Scale State Contract Investigation

Chief Financial Officer Jeff Atwater announced that a $15.5 million settlement has been secured as a result of a contract investigation involving U.S. Foods, Inc. The investigation conducted by the Department of Financial Services’ Office of Fiscal Integrity concluded that U.S. Foods falsely inflated its prices for supply food services to the Florida Department of Corrections (DOC) between 2008 and 2014. Through this deceitful billing practice, U.S. Foods wrongly collected millions in state dollars.

“Stealing from the State of Florida takes money from the pockets of all taxpayers in Florida, and it’s absolutely intolerable,” said CFO Atwater. “Demanding greater accountability from those who do business with our state is a top priority of mine, and we will continue our efforts to weed out the bad actors.”

During the six-year period that U.S. Foods was under contract with the DOC, invoices for food products contained prices that were inconsistent with contract terms. The contract required U.S. Foods to pass along certain discounts received from suppliers to the DOC. Investigators concluded that U.S. Foods failed to do so, causing their costs to remain inappropriately inflated.

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Miami-Dade Duo Arrested in Alleged Investment Scheme

The Florida Office of Financial Regulation (OFR) announced the arrests of Odalys Cordero-Romero and Richard Steiner. The two are charged with organized fraud and grand theft in connection with an alleged Colorado-based gold-mining investment scheme that bilked $60,000 out of at least one Florida investor.

“The fraudsters allegedly falsified information about their involvement in a lucrative gold-mining operation, which caused at least one Floridian to lose his hard-earned savings,” said OFR Commissioner Drew J. Breakspear. “The Florida Office of Financial Regulation will continue to fight fraud and seek justice for those impacted by these crimes.”

“I am proud of our investigative team and their diligent efforts in this case,” said OFR Bureau Chief of Financial Investigations Robert Kynoch. “Identifying and halting these schemes is our highest priority.”

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Two-Year Insurance Fraud Investigation Lands Multiple PIP Fraud Arrests

The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) announced multiple arrests related to a large-scale personal injury protection (PIP) fraud scheme spanning across Central Florida. Five individuals have been arrested for their various roles in the scheme, and arrest warrants have been issued for three additional individuals whose arrests are pending. Three related arrests have been made in the Fort Myers area.

DIF partnered with the Federal Bureau of Investigation (FBI) to conduct investigations into two personal injury clinics, First Medical Rehab of Bradenton (FMRB) and Kirkman Family Chiropractic Care (KFCC) in Orlando, after insurance carriers and former patients raised allegations of potential illegal activities.

In the early months of 2014, a DIF detective successfully infiltrated the Bradenton clinic by going undercover and posing as a patient. As a direct result, investigators were able to prove that FMRB was billing for medical treatments on injuries that did not exist.

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CFO Jeff Atwater: We’re Here to Help as Tampa Area Manages Flood Water Damage

As flood waters in the Tampa area slowly begin to recede, many residents now face a multitude of insurance-related issues as they survey damages to their homes and vehicles. CFO Jeff Atwater is offering assistance to area residents as they navigate the insurance claims process.

“Rapidly rising flood waters can wreak havoc and quickly cause thousands of dollars in damage,” said CFO Atwater. “My thoughts and prayers remain with the Tampa community as they continue to deal with the after effects of the recent flood waters. We stand ready and willing to answer any insurance questions residents may have.”

During this time, it is important for policyholders to understand their rights during the claims process. Residents are encouraged to download a copy of the homeowner claims bill of rights, which outlines in plain language what is expected of an insurance carrier once a claim is filed.

Click here to read the press release >>

Niceville Hotel Fire Believed to be Arson

The Florida State Fire Marshal’s Office believes that a recent Niceville fire was intentionally set and is looking to the community for information. On August 4th, the Niceville Fire Department responded to a fire at the closed hotel attached to the old Tisa’s Pizzaria located at 626 W. John Sims Parkway in Niceville and requested the assistance of the State Fire Marshal’s Office.

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