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Two-Year Insurance Fraud Investigation Lands Multiple PIP Fraud Arrests

8/13/2015

Contact: Ashley Carr
(850) 413-2842
 
Two-Year Insurance Fraud Investigation Lands Multiple PIP Fraud Arrests
~Fraudulent Billings Top $100,000~
 
TALLAHASSEE, Fla.  – The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) today 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.

The investigation into Kirkman Family Chiropractic revealed an organized plot to circumvent clinic licensure requirements set by the Agency for Health Care Administration. Because licensed health care professionals can operate clinics without the necessity of an additional clinic license, co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only.
 
To date, more than $100,000 in fraudulent claims has been paid by multiple insurance carriers.

Those who were arrested include:

• Shona S. Johnson
• Dieufort Irilus
• Evelyne Franclin
• Barry Sutphin
 
Charges are varied based upon each individual’s alleged role and include: Patient Brokering, Conspiracy to Commit Patient Brokering, False and Fraudulent Insurance Claims, Solicitation, Grand Theft, Organized Scheme to Defraud and Conspiracy to Commit Insurance Fraud. All subjects, if convicted, face anywhere from 5-30 years in prison and could face fines as large as $10,000.

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Chief Financial Officer Jeff Atwater, a statewide elected official, oversees the Department of Financial Services. CFO Atwater’s priorities include fighting financial fraud, abuse and waste in government, reducing government spending and regulatory burdens that chase away businesses, and providing transparency and accountability in spending. Follow the activities of the Department on Facebook (FLDFS) and Twitter (@FLDFS).