Consumer eViews
FLORIDA CHIEF FINANCIAL OFFICER TOM GALLAGHER'S WEEKLY NEWSLETTER

Volume 2, Number 30, July 25, 2005   

Once a year the window of opportunity opens for self-employed individuals in Florida to apply for guaranteed-issue health coverage. 

This enrollment period comes only once a year, so the month of August is the time to purchase health insurance or review a current health insurance policy.

Basic and standard policies are offered by insurers without regard to health status, and health maintenance organizations offer guaranteed-issue plans, too.

Health savings accounts and health reimbursement arrangements are available to help Floridians pay for out-of-pocket health costs with pre-tax dollars and empower consumers with the ability to make wise financial decisions about medical care. These accounts will help lower overall costs in the market and provide self-employed Floridians seeking health care coverage another option. 

Small businesses are the backbone of this state's economy, and that's why I want them to have every opportunity to access health coverage. 

For more information read the article below on this issue.

                     -- Tom Gallagher
 


SELF-EMPLOYED FLORIDIANS QUALIFY FOR GUARANTEED-ISSUE HEALTH COVERAGE DURING AUGUST

Self-employed Floridians in need of health insurance can obtain it through an open enrollment period during the month of August, Florida’s Chief Financial Officer Tom Gallagher said.

The open enrollment period requires insurance companies and Health Maintenance Organizations (HMOs) to offer applications for coverage to the self-employed on a guaranteed-issue basis from August 1 to August 31 each year, with a plan start date of October 1.  The open enrollment period enables individuals without health coverage to obtain insurance.  Additionally, it provides self-employed Floridians that currently have health coverage the opportunity to switch to another insurance plan. 

“We need to get the word out that the window of opportunity only comes once a year for the self-employed seeking guaranteed-issue health coverage,” Gallagher said.  “We want to help ensure that Floridians gain access to health care coverage.  This enrollment period comes only once a year for the self-employed seeking guaranteed-issue health coverage, so now is the time to get insurance or review your current policy.” Small employers are eligible if they have just one employee who qualifies for coverage, and if they did not go into business primarily for the purpose of buying health insurance.  A sole proprietor, independent contractor or self-employed individual is considered a small employer only if all of the conditions and criteria established in the law are met.

A list of insurance companies offering coverage is posted on the Department of Financial Services’ website at this link: Small Group Market Carriers. For available benefits, go to this link: Florida Small Employer Benefit Plan.

Guaranteed-issue means insurers and HMOs must offer coverage without regard to health status.  Companies that write coverage for individuals are required to offer only “basic” or “standard” plans.   

With the passage of the Affordable Healthcare for Floridians Act last year, new coverage options for employers include health savings accounts (HSAs) or health reimbursement arrangements (HRAs).  HSAs, which operate like Individual Retirement Accounts (IRAs), allow people to save their own money in a tax-free account for use on health related expenses. If the money is not spent, it will roll over annually and continue to accumulate until the policyholder is age 65 at which time the money can be used for any purpose.

“These accounts will help Floridians pay for out-of-pocket health costs with pre-tax dollars and empower them to make wise financial decisions about their medical care,” said Gallagher, who co-chaired the Governor’s Task Force that suggested many of the new choices.  “These accounts will not only help lower overall costs in the market, but they provide Floridians seeking health care coverage another option.  Additionally, young, healthy individuals who so often choose to go without insurance will be more inclined to purchase this type of coverage.  The goal is to provide all Floridians access to affordable health care.”

Self-employed Floridians who apply for coverage must show certain documentation verifying that they are operating an active business, including tax forms, license information and business receipts.

Gallagher encourages consumers to contact the department’s toll-free consumer helpline at 1-800-342-2762 to request a free copy of our health insurance consumer guide.

 


22 CHARGED WITH HEALTH CARE FRAUD INVOLVING OVER $8 MILLION IN FALSE CLAIMS

22 individuals and entities, including chiropractors, massage therapists, and four medical clinics, have been indicted by a federal grand jury in a multi-million dollar health care fraud scheme, based on an investigation by the Department of Financial Services and several other agencies. The indictment charges the defendants with conspiracy to commit health care fraud, health care fraud, false statements relating to health care matters, and conspiracy to commit money laundering.

Florida CFO Tom Gallagher stated, "We are all victims of those who commit fraud. As consumers we pay for it every time we pay our insurance premiums. We will continue to fight insurance fraud to protect Floridians."

Other agencies involved were the Florida Department of Law Enforcement, the National Insurance Crime Bureau (NICB), and the Sunny Isles Beach Police Department.  Insurance companies involved in this investigation included Gainsco Company, Ocean Harbor Insurance, GEICO, State Farm, Liberty Mutual, MetLife, Direct, United Auto Insurance, and Federated Insurance.

Among those charged in the 33 count indictment were: Boris Royzen, his wife, Eva Royzen, Dmitry Rakovsky, Drs. Enrique Gonzalez-Pujol, Ambroise Forte, and Norma Roche, chiropractors, massage therapists and a receptionist who were owners and employees of the four defendant medical clinics. The clinics charged in the Indictment are Vista Mar Medical Rehab Corp., Plantation Medical Recovery Center, Inc., Romana Medical, Inc., and Dial Medical Rehab, Inc.

As set forth in the indictment, from November 2003 through July 2005 the defendants conspired to commit health care fraud by submitting fraudulent health insurance claim forms to private insurance companies for services that were not medically necessary and/or were not rendered.

The fraudulent claims were submitted under personal injury protection (PIP) provisions for alleged victims of automobile accidents. Boris Royzen and Dmitry Rakovsky paid runners to solicit victims and alleged victims of automobile accidents to become patients of the clinics.

In addition, Boris Royzen and Dmitry Rakovsky caused fraudulent applications to be filed with the State of Florida, falsely stating that the defendant clinics were 100% owned by licensed medical practitioners when, in fact, the medical practitioners named on the applications were employees of the clinics.

The indictment lists 30 private insurance companies, including State Farm, GEICO, Allstate, Ocean Harbor Insurance, Liberty Mutual, MetLife, Direct, Federated Insurance and United Auto Insurance, to which the defendants submitted fraudulent claims. The defendant medical clinics received over $8.5 million in insurance payments as a result of this fraudulent activity.

With regard to the money laundering charges, the indictment alleges that the defendant clinics employed management companies owned by Boris Royzen, Eva Royzen and Dmitry Rakovsky through which funds were channeled back to those defendants.

If convicted on the health care fraud conspiracy counts, the defendants face a maximum statutory term of five years imprisonment. If convicted of the related health care fraud counts, the defendants named in those counts face a maximum statutory sentence of 10 years. If convicted on the charge of making false statement relating to health care matters, those defendants will face a maximum statutory term of five years imprisonment. The money laundering conspiracy and its related substantive money laundering charges are all punishable by a maximum penalty of 20 years in prison.
 


THE STATE UNCLAIMED PROPERTY AUCTION IN FORT LAUDERDALE IS SATURDAY, JULY 30

Jewelry, coins, antiques and collectibles will be among approximately 40,000 items to be auctioned by the state to benefit Florida’s public schools.  Among the items are a 14-karat gold purse, a 5-carat sapphire ring, and an 1889 CC Morgan silver dollar. The net proceeds of the auction will be deposited directly into the Principal State School Trust Fund for the benefit of Florida’s public schools.

Florida’s Chief Financial Officer Tom Gallagher is inviting interested Floridians to participate. The auction will be held at the Wyndham Hotel, 1870 Griffin Road, near the airport in Ft. Lauderdale.  The preview will be held Friday, July 29 from 9 a.m. to 5 p.m. and the auction will begin at 9 a.m. on Saturday, July 30. 

"Please visit the unclaimed property website and you'll be surprised at the great selection of items you can bid on. There are many rare and collectible pieces." Gallagher said.

There will be an online simulcast of the auction to enable citizens who cannot attend the live auction to participate in the bidding process. If you would like more information, or to register for online bidding, please visit www.fisherauction.com.  Bidders may place an absentee bid by contacting Fisher Auction Co. at info@fisherauction.com 

The items offered for sale are unclaimed contents from safe deposit boxes. If a safe deposit box rental is not paid, Florida law requires financial institutions to make a diligent effort to locate the owner of the box. If the owner is not located, the institution sends the contents of the box to the Florida Department of Financial Services, Bureau of Unclaimed Property. Attempts are made to locate unclaimed property owners using various methods, including the Internet and database searches. When the owner (or heir) of the auctioned items comes forward to claim the property after the auction, he or she can claim the net proceeds from the sale at any time.

An independent appraiser identifies and determines the value of the items. The 'opening bid price' is a minimum or reserve bid price and is not meant to be the 'fair market value' or 'replacement value' of the items. The lots sold at the unclaimed property auction might sell for double or triple the opening bid price. Bids must begin at minimum value for a lot or item to be sold.

To enter the inspection/preview of the lots, as well as to bid on an item up for auction, potential bidders will be required to register with the auctioneer.  Registration requires a refundable $200 cash deposit and valid driver’s license providing full name and current address.

Purchases can only be made with certified funds - cash, travelers checks, certified checks or most debit cards. If you plan to use a debit card, please check with your bank regarding your withdrawal limit. Most banks put a limit on debit purchases.

A catalog of the items to be auctioned is available for download on the auction website in PDF format. A printed version will be available at the preview and the auction.
 
Claiming money or property turned over to the state is free, and at any time owners or their heirs can claim the money the items earn at auction.  The website,  www.FLtreasurehunt.org, is easy to check to see if the state is holding your unclaimed property.  Or call 1-88-VALUABLE for assistance by phone.


GALLAGHER ANNOUNCES CLAIM FRAUD ARRESTS

Suspects accused of filing fraudulent hurricane claims

Florida’s Chief Financial Officer Tom Gallagher announced today that detectives with the Department of Financial Services’ Division of Insurance Fraud (DIF) have arrested four individuals accused of filing fraudulent claims in the aftermath of the 2004 hurricane season.  The investigation has uncovered more than $170,000 in fraudulent claim filings, and further arrests are anticipated. 

“With thousands of Floridians still working to recover from four storms, it is inconceivable that individuals would seek to illegally profit from the 2004 hurricane season,” said Gallagher, who oversees the department.  “Those who choose to commit fraud and drive up premiums will be prosecuted to the fullest extent of the law.”

Investigators found that Julio Iriarte, a licensed public adjuster in Miami, submitted falsified contractor agreements that caused overpayment of claims by more than 20 percent.  CONTINUED

Joyce Chandler, of Miami, is accused of authoring a letter on behalf of a Miami resident and representing herself as the property owner’s minister, claiming the home was destroyed as a result of a tornado.  This claim was denied and Chandler subsequently acquired the property and filed a hurricane claim for more than $94,000 in property damage and additional living expenses. 

Two other individuals were arrested for filing fraudulent claims and are being charged with insurance fraud and grand theft.  Other arrests are anticipated.

The Department of Financial Services, Division of Insurance Fraud, investigates various forms of fraud in insurance, including health, life, auto, property and workers' compensation insurance.  Anyone with information about this case or another possible fraud scheme should call the department's Fraud Hotline at 1-800-378-0445.  A reward of up to $25,000 may be offered for information leading to an arrest and conviction.

CLAIM FRAUD ARRESTS

Julio Iriarte:  DOB 06/08/79; 20001 NW 78th Court, Miami, FL; Booked in Turner Guillford Knight Jail; Charged with 2 counts Insurance Fraud 3rd degree; 2 counts Grand Theft 3rd degree, 1 count Organized Scheme to defraud.

Debra Anita Kelly:  DOB 02/18/1964, 3100 NW 48 Terrace, Miami, FL; Booked in Dade County Jail; Charged with 1 count Grand Theft 3rd degree and 1 count Insurance Fraud 3rd degree.

Adrianna Kelly Francis:  DOB 02/25/47, 3100 NW 48 Terrace, Miami, FL; Booked in Dade County Jail; Charged with 1 count Grand Theft 3rd degree and 1 count Insurance Fraud 3rd degree.

Joyce Chandler:  DOB 03/05/1951, 3055 New York Street, Coconut Grove, FL  33133, Booked in Turner Guillford Knight Jail; Charged with 1 count Grand Theft 2nd degree, 1 count Insurance Fraud 2nd degree, 1 count Insurance Fraud 3rd degree. 
 



Consumer Services HelpLine
(800) 342-2762.