Three FL Clinic Employees Arrested for PIP Fraud

March 6^th was the last day of work for three Florida clinic employees –from CPS Medical Clinic, who were arrested and charged with insurance fraud and patient brokering for their roles in connection with a personal injury protection (PIP) fraud scheme.

According to the press release from Florida Chief Financial Officer Jeff Atwater’s office, the clinic’s manager, Danilo Ardian Gonzalez-Alfonso, 37, Lydia Merlo-Fernandez, 23, a licensed massage therapist, and Yennier Gutierez Obregon, 23, an employee, all allegedly solicited a confidential source to play a role in a scheme and file fraudulent claims for services that were never provided.

“These fraud clinics have become an albatross around the neck of Florida’s consumers—driving up insurance rates across Florida and lining their pockets with the hard-earned dollars of honest Floridians,” CFO Atwater said. “My office will remain diligent in the fight against accident fraud while continuing to seek legislative reforms in the final days of the 2012 Legislative Session to curb this costly crime.”

During an investigation by the Florida Department of Financial Services’ Division of Insurance Fraud, the confidential source met with Obregon and accompanied him to the clinic. At several of the visits there, Gonzalez-Alfonso and Merlo-Fernandez instructed the source to sign blank therapy sheets and leave the clinic without receiving the treatment.

CFO Atwater has been pushing for reforms that will target staged accident fraud, strengthen the billing practices so that the appropriate services are provided to those who need it, and tighten requirements for clinic ownership and result in rate relief for Florida’s consumers.

Based on a report by the Insurance Consumer Advocate, while the number of Florida drivers has remained stable, and the frequency of those crashes has declined from 2006 to 2010, the number of PIP claims opened or recorded during the same time increased by 28%. During that same time period, the payment on PIP claims also increased by 66%.

“PIP fraud creates a $1 billion annual tax on Floridians, and that is a burden we cannot and should not tolerate,” CFO Atwater said.

Anyone with information regarding suspected insurance fraud is asked to call 1-800-378-0445. Individuals who provide tips can remain anonymous and are eligible for a reward of up to $25,000 for information if it directly leads to an arrest and conviction in an insurance fraud scheme. To date, the Department of Financial Services has awarded almost $250,000 to approximately 40 citizens as part of its Anti-Fraud Reward Program.

All three of the above suspects were booked into the Hillsborough County Jail and are awaiting bond.  If convicted, they could each face up to 10 years in prison.