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Four Charged with Filing 160 False PIP Claims

4/6/2001

MIAMI - An ongoing personal injury protection (PIP) fraud investigation in Dade County, that last June led to the arrests of more than 50 accident participants and numerous runners and clinic owners, this week snared four more people suspected of filing some 160 fraudulent PIP claims, Florida Treasurer and Insurance Commissioner Tom Gallagher announced today.

Beatriz Alvarez, 62, and Roman Diaz, 66, both of Miami, and Jesus Castro, 37, and Caridad Marce, 40, both of Hialeah, each face one charge of filing a false or fraudulent insurance claim. If convicted, they each face up to five years in prison and a $5,000 fine.

Department of Insurance investigators said the four allegedly signed PIP claims for about 40 medical treatments each following a 1998 auto accident, but further investigation revealed they made only one or two visits each. The filing of these fraudulent claims, investigators said, led to Allstate Insurance Co. and Windsor Insurance Co. paying a total of more than $20,000 in PIP benefits.

The claims were filed by two Hialeah clinics - Lyme Medical Group, Inc., and M.P.V. Mobile Diagnostic, Inc., both closed but formerly located at 4294 Palm Ave. - who investigators said filed millions of dollars worth of fraudulent PIP claims between 1997 and 1999. The owner and two operators of Lyme Medical Group were convicted and ordered to pay restitution. The accountant is still being sought.

"PIP fraud is out of hand. Reforms currently being considered by the Legislature cannot come too soon," said Gallagher, who earlier this year forwarded to the Legislature a host of recommendations to combat PIP fraud such as strengthening penalties and making it harder for runners to get police reports they so often rely on to solicit accident victims.

Following an auto accident in August 1998, Alvarez, Diaz, Castro and Marce went to Lyme Medical and M.P.V. Mobile for treatment of injuries they claimed to have sustained. After initial visits, the four signed insurance claims for dozens of treatments they never received, investigators said.

Lyme Medical, which investigators said did not even have a licensed doctor on the premises, is suspected of filing some $4 million in fraudulent PIP claims between May 1997 and April 1999. The ongoing investigation that led to this week's arrests evolved after the execution of a search warrant in April 1999 at Lyme Medical and the subsequent arrests of several runners, including one investigators said illegally provided 146 "patients" to the clinic. Investigators said the runners were being paid cash kickbacks of $500 to $700 for each referred patient. Both patient brokering and solicitation of auto accident victims are third-degree felonies under Florida law.

The Department of Insurance, 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 is offered for information leading to a conviction.