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Two South Florida Men Facing Charges of 400 Counts Each of Insurance Fraud, Grand Theft

7/5/2002

TALLAHASSEE - Two South Florida men have been charged with more than 400 counts each of grand theft and insurance fraud for allegedly organizing a medical insurance billing scheme in which they sought to defraud at least 30 health insurers out of $850,000, Florida Treasurer and Insurance Commissioner Tom Gallagher announced today.

James Mor, 34, of Davie, and Julio Gomez, 74, of Miami, were previously arrested on similar charges last November in an ongoing investigation of the same alleged billing scheme. Investigators said the scheme, which occurred between January 1999 and December 2001, involved insurance billings for respiratory-related and injection-type medical services that the named insureds never received.

Gomez, of 130 S.W. 22nd Ave., Miami, is charged with 214 counts of insurance fraud and 214 counts of grand theft. Mor, whose last known address is 3110 S.W. 139th Terrace, Davie, is facing the same charges as well as an additional count of grand theft. Investigators said the two men collected around $35,000 from insurers as a result of the fraudulent claims.

The new charges are the result of a multi-agency task force investigation, led by the Department of Insurance, Division of Insurance Fraud, which identified five additional business entities Mor and Gomez are believed to have operated and used as a cover for fraudulent billings.

When Mor and Gomez were previously arrested on Nov. 20, each was charged with insurance fraud and grand theft after they were caught picking up insurance checks at a storefront operation that investigators said was opened for the exclusive purpose of collecting the fraudulently derived insurance checks. Mor was driving a stolen Porsche at the time. The storefront, located at 7211 S.W. 62nd Ave., Suite 201, South Miami, was purported to be a durable medical equipment operation doing business as Peninsula Medical.

The additional fraudulent storefronts identified by the task force were:


· Peninsula Medical, 1150 S.W. 22nd St., Suite 20, Miami.


· MDD International, 6915 Red Rd., Suite 212A, Coral Gables.


· Atlas Health Services, 4471 N.W. 36th St., Suite 232, Virginia Gardens.


· Atlantic Health Systems, 2355 Salzedo St., Suite 310, Coral Gables.


· ATL Health Services, 2355 Salzedo St., Suite 310, Coral Gables.

As a result of the initial arrests, investigators were able to secure and execute a search warrant at a Miami clinic managed by Mor's brother, Eddie Mor. According to investigators, James Mor was using an office in the clinic as the operation center for his billing scheme.

While executing the search warrant, investigators seized billing lists, hundreds of health insurance claim forms, computer software, printers and envelopes in the process of being mailed to insurance companies, all of which allegedly linked Mor and Gomez to the five additional storefronts.

The multi-agency task force that conducted this investigation includes agents from the U.S. Defense Criminal Investigative Service, Office of Inspector General; the U.S. Office of Personnel Management, Office of Inspector General; the U. S. Postal Inspection Service; the U.S. Department of Labor, Office of Inspector General; the U. S. Postal Service, Office of Inspector General. The prosecution is being handled by the Miami-Dade County State Attorney's Office, Organized Crime Unit and Economic Crime Unit.

These types of fraudulent medical schemes can eat away at the lifetime benefits of the insureds whose information is used in the fraudulent billings. Consumers are urged to protect themselves by always carefully reviewing the explanations of benefits (EOBs) insurance companies issue when they have paid or denied a claim. To report a suspicious billing, consumers should call their insurance company or the Department of Insurance Fraud Hotline at 1-800-378-0445.

The Department of Insurance, Division of Insurance Fraud, investigates various forms of fraud in insurance, including health, life, auto, property and workers' compensation insurance. A reward of up to $25,000 is offered for information leading to a conviction.