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Two South Florida Men Charged with Organizing $1.5 Million Fraudulent Health Care Billing Scheme

5/28/2002

TALLAHASSEE - The Florida Department of Insurance, working with numerous state and federal law enforcement agencies, has concluded a four-year investigation of an elaborate health insurance billing scheme with the arrests late Friday of two suspected organizers.

Nine others were previously arrested in the scheme, which allegedly billed dozens of insurance companies more than $1.5 million from 1997 to 2001 for health care services that were never rendered.

It has been estimated that health care billing fraud costs Floridians more than $4 billion a year. Because of the growing complexity of health insurance fraud schemes, the department's Division of Insurance Fraud has coordinated a multi-agency task force that will be activated to help with such investigations.

The task force 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 United States Postal Inspection Service; the U.S. Department of Labor, Office of Inspector General; the United States Postal Service, Office of Inspector General; as well as a commitment from the Miami-Dade County State Attorney's Office, Organized Crime Unit and Economic Crime Unit.

"Pooling resources should help us take quick and aggressive action against this kind of fraud," Florida Treasurer and Insurance Commissioner Tom Gallagher said. "Leveraging the efforts and expertise of these law enforcement agencies will enable us to more effectively nab criminals who bilk the system and force the rest of us to pay more in premiums."

Angel Navid Brioso, 36, and Jorge Mao Anesto, 37, were each charged with racketeering, unlawful financial transactions, grand theft and insurance fraud. Brioso, identified as the organization's leader, was transferred from the Leon County Jail, where he was charged in fraudulent Medicaid billings, to the Palm Beach County Jail. Anesto, accused of laundering more than $636,000 worth of insurance payment checks, was booked into the Broward County Jail.

Brioso allegedly controlled dozens of bogus "drop boxes" or "store fronts" throughout the state which he used to collect insurance checks paid on the false billings. Investigators said members of Brioso's organization used high-tech counter-surveillance equipment to avoid detection while picking up the checks.

Investigators with the department's Division of Insurance Fraud said health insurance claims were sent to the insurance companies for treatments the insureds never received, using the names of non-existent doctors. The insurance company checks were then collected at rented mail boxes or store fronts by various runners.

The Division of Insurance Fraud conducted the investigation with the assistance of the U.S. Postal Inspection Service; the U.S. Department of Defense; Defense Criminal Investigative Service, Office of Inspector General; U.S. Office of Personnel Management, Office of Inspector General; the U.S. Department of Veterans Affairs, Office of Inspector General; U.S. Postal Service, Office of Inspector General; U.S. Department of Labor, Office of Inspector General and the Office of Statewide Prosecution, which is handling the prosecution.

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.