In this edition of Fraud Files we take a look at three key states NICB has seen positive anti-fraud legislation results in.
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Here are the top insurance fraud stories for today:
* Car theft victim warns owners of older model Hondas (KOBI 5)
* Eight Florida Residents Arrested for Involvement in PIP Fraud Scam (Insurance Journal)
* Detectives charge Englewood man with running out-of-state car insurance scam on Craigslist (Cliffviewpilot.com)
* Pompano woman sold fake insurance policies to veterans (Sun-Sentinel)
Three individuals in Florida were arrested yesterday for allegedly operating an unlicensed clinic in Orlando that was used as part of a personal injury protection (PIP) fraud scheme.
Dr. Lherisson Domond fronted ownership of the clinic, Unity Pain and Injury Center, from February to December 2012, but the clinic was operated by several non-licensed individuals who offered to pay Domond $1,500 a month for use of his name.
An investigation stated the clinic illegally provided medical treatment and physical therapy to individuals involved in motor vehicle accidents. The treatments then were billed to insurers under the patients’ personal injury protection insurance coverage.
The investigation further revealed that two other individuals, Nesly Loute and Pierre Alex Herisse, allegedly hired clinic staff and managed its operations. The three arrested individuals face felony charges for fraud, operating an unlicensed clinic and grand theft that carry sentences of up to 30 years.
After Leading the Nation with Suspicious PIP Claims, Florida Sees a Decline
The National Insurance Crime Bureau (NICB) has released a new report revealing a decline in Florida’s personal injury protection (PIP) questionable claims (QCs). In 2013, Florida PIP QCs declined by 7.6 percent from 2012. Meanwhile, for the period 2010 through 2013, Florida staged accident QCs decreased by 61.82 percent.
Tighter legislation, enhanced public awareness and a coordinated law enforcement response appear to be having the intended effect on PIP fraud in Florida.
“We are encouraged by the decline in questionable claims that we’ve seen recently, but by no means are we declaring victory in Florida,” said NICB President and CEO Joe Wehrle. “Florida remains a hotbed for fraudulent activity, and we can’t afford to ease up for a moment in our fight against those who would abuse the system and burden Florida consumers.”
Visit the NICB Newsroom to read the full press release.
The following is from an article written by Susan Besze Wallace for FORUM Magazine.
Like the accident, the phone call seemed to come out of nowhere. It was just a fender bender. Luckily no one was injured by the texting teen’s failure to stop her car, but the man who dialed within days of the incident told the owner of the bumped bumper that she was entitled to $10,000 for her accident. “But I’m not hurt,” she said. “It doesn’t matter,” he dangled. “I can get you up to $10,000.” “But nothing is wrong,” she explained. He paused a moment, waiting for a spark of interest. It wasn’t coming. Click.
On this day, the man wouldn’t find someone willing to perpetrate fraud for some quick cash. Instead, he found the wife of the police chief in Hialeah, Fla., a hotbed for insurance fraud and the site of one of seven major medical fraud task forces recently established by the National Insurance Crime Bureau.
“Some people think that in these economic times, ‘Why shouldn’t I get $10,000 if I can?’” says Hialeah Police Chief Mark Overton. “Criminals are appealing to greed and need. They think, ‘Who does it hurt?’ But it hurts us all.”
Read the full article.
NICB’s Legislative Advocacy Department works with NICB member companies, property/casualty insurance trade groups and other anti-fraud organizations to (a) assist in forming legislation and regulations that affect insurance fraud and vehicle theft, (b.) track fraud and theft legislation, and (c.) promote a strong anti-fraud environment nationwide.
Just a few short months ago, our advocacy team exhibited at the NCSL Legislative Summit 2011 in San Antonio, TX. Taking place each summer and with an average attendance of nearly 6,000, the Legislative Summit is the largest gathering of state lawmakers in the nation. For those of you who don’t know about this gathering or about the importance of the discussions that take place there, we discuss laws relating to information sharing and immunity protections, funding for dedicated prosecutors and resources to prevent and prosecute insurance fraud. We met Speaker of the Texas House of Representatives Joe Strauss who stopped by our booth to talk about fraud issues affecting the state of Texas. We also talked with other legislators from around the country. Regardless of where these lawmakers were from, we all shared common stories of our ongoing challenges. Much focus has been placed on no-fault states, a system of automobile insurance where the payment of compensation comes from the victim’s own insurance company. No-fault insurance may be an easy mark for fraud, and the challenge is how to deal with potential issues.
What’s next for us? We’ll continue to engage state insurance regulators and lawmakers at the National Association of Insurance Commissioners (NAIC) and National Conference of Insurance Legislators (NCOIL), whose respective groups meet in various cities around the country during the year. As the primary insurance regulators, states continue to struggle with balancing budgets, protecting consumers and ensuring their states have effective anti-fraud controls in place. We’ll continue to lead and participate in these discussions to assist lawmakers assess their state’s anti-fraud environment. For more information about Legislative Advocacy or to learn more about NICB’s departments, visit us online at www.nicb.org.