90% of Dade County PIP Clinics Probed Deemed to have “Irregularities”3, Insurance Fraud — By Trace America on January 11, 2012 at 6:32 PM
Everyone should be able to assume that there are many decent clinics in Miami-Dade County that treat automobile accident victims. What you might not know however, is that state investigators are considering criminal charges after they found regulatory violations in almost 90% of the clinics that were recently obvserved.
According to the Insurance Journal and a report by the Agency for Health Care Administration, during a recent 3-day probe, investigators discovered irregularities in 43 of 49 clinics. In one case, an insurance company providing personal injury protection (PIP) coverage was charged $19,000 for massage therapy.
During the checks, investigators witnessed only 17 patients, while employees at some of the clinics noted that they have never even seen one. As one clinic staff stated, they hadn’t even seen the owner or medical director in six months.
Spokeswoman Shelisha Coleman said the report will prompt the agency to take action and revoke the licenses of several entities and possibly file criminal charges. While the agency’s investigation is wrapping up, the state’s Division of Insurance Fraud is continuing the probe.
Florida lawmakers have struggled unsuccessfully for years in their attempts to fix PIP, and they are now being challenged by Governor Rick Scott to find a solution to an obviously broken system. The ideas being mentioned range from providing emergency care only within three days of an accident to doing away with the program entirely.
The investigation found that most of the Dade County clinics treated auto accident victims exclusively and that the primary treatment billed by them was for massage therapy. Investigators also found that many clinic owners had no prior health care experience and reported they opened auto crash clinics after learning they could be a lucrative business venture.
Many of the clinics also had advertisements for law firms and attorneys who specialize in traffic accident litigation displayed, while in numerous instances some of the medical professionals at the clinics were employed without the required background screening. One man even kept his job despite being deemed ineligible after his background check.
PIP was adopted back in 1972 to make sure that anyone who is injured in an auto accident would quickly get money to treat their injuries. The legislation states that a driver’s insurance company will pay up to $10,000 to cover medical bills and lost wages after an accident, no matter who is at fault.
Insurance fraud scammers have turned Florida into the top state for staged accidents, particularly in the Miami and Tampa areas. Last year, lawmakers heard testimony that it has become such a profitable scam that organized crime has gotten involved.
All Florida drivers are required to carry PIP insurance.
The Insurance Information Institute is estimating that such fraud could cost up to $1 billion in the Sunshine state this year.
This post is authored by Trace America.