Florida’s Largest PIP Bust Lands 17 Arrests

Investigators in the Miami-Dade area now have over a dozen more arrests under their belts in the fight again insurance fraud. In the states largest-ever auto personal injury protection (PIP) insurance bust, identified as “Operation Deep Horizon,” 17 people –which include a clinic owner, clinic employees, staged recruiters and doctors –have been taken into custody. 

 As stated in the Insurance Journal, the arrests are the result five clinics submitting fraudulent claims. These clinics include New Horizon practice, Medico de la Familia, Coral Way Rehabilitation Services, Therapium Health Corporation and AB Diagnostic. Investigators said that employees at these clinics were involved with obtaining and creating false claims that were submitted to insurance companies for payment.

 According to Chief Financial Officer Jeff Atwater, “this case is just one example of the hundreds of similar fraud schemes run daily by accident clinics operating throughout Florida. The fraud schemers bill insurance companies for procedures that never happened and we all get stuck with the bill through increased auto insurance premiums.”

 Elsa Terrero, whom Investigators say is the owner of the New Horizon practice, would allegedly help arrange staged accidents and then direct the participants where to go for treatment. Dr. Gerald Amado would then sign documents for follow-up visits and treatments that had never actually occurred.

At Medico de la Familia, clinic employees would supposedly recruit and pay individuals, who would then be coached on how to commit fraud by being told how to respond to insurer questions. Dr. Gustavo Acosta would then sign documents for examinations he allegedly didn’t perform.

“When professional healers become professional criminals in order to make some easy cash we all lose and this insurance fraud scheme could not have worked without medical professionals claiming serious injuries where none existed,” said Miami-Dade State Attorney Katherine Fernandez Rundle. “Lies upon lies led to dollars upon dollars for all the parties charged today.”

 Gainsco, Imperial Fire & Casualty, Mercury Insurance, Geico and State Farm Insurance also helped out state investigators and were commended for providing assistance to the operation. Investigators also applauded the work of the U.S. Secret Service Electronic Crimes Task Force and the National Insurance Crime Bureau (NICB).

Florida is currently ranked highest in the nation for staged accidents, with Miami in the third highest position for questionable claims, according to The NICB. As reported by the Insurance Information Institute, the typical Florida family with two cars will pay $100 annually in higher premiums due to fraud.

“If you multiply that by 11 million cars in our state, it amounts to nearly a billion dollar fraud tax,” said Atwater.

Along with the 17 individuals arrested, investigators are still looking for eight others. These 25 individuals face 142 various charges including racketeering, staging an accident, insurance fraud, grand theft and organized scheme to defraud. Under state law, staging an accident includes a mandatory minimum sentence of two years in prison and up to 30 years if convicted. Collectively, they could face up to 1,115 years in jail.

These are merely allegations as there have been no convictions.  All parties are innocent until proven guilty.