At a press conference today in Miami, Florida's Chief Financial Officer Jeff Atwater joined Miami-Dade County State Attorney Katherine Fernandez Rundle to announce the results of Operation Dark Horizon, the largest Personal Injury Protection (PIP) bust since the CFO took office in January. The Miami-based investigation by Florida's Division of Insurance Fraud resulted in the arrests of 17 individuals including a clinic owner, doctors, clinic employees and staged accident recruiters. Eight additional individuals have been charged and are being sought by investigators.

According to the Insurance Information Institute, on average Floridians pay an additional $100 for two cars in the driveway to cover auto insurance fraud. According to CFO Atwater, “If you multiply that by the 11 million cars in our state it amounts to a nearly billion dollar fraud tax.”

The 25 individuals charged so far in Operation Dark Horizon face 142 various charges including racketeering, staging an accident, insurance fraud, grand theft and organized scheme to defraud, and now collectively face up to 1,115 years in jail. Those charged with staging an accident face a minimum mandatory sentence of two years in prison, if convicted on the charge, and up to 30 years in prison if convicted of organized scheme to defraud. Additional arrests are anticipated.

The arrests stem from fraudulent billings filed by five clinics, including New Horizon Practice in Miami, Medico de la Familia in Hialeah, Coral Way Rehabilitation Services, Therapium Health Corp., and AB Diagnostic.

Fraud detectives' investigation uncovered that New Horizon Practice owner, Elsa Terrero, allegedly solicited the staging of accidents and directed the participants where to go for treatment, and Dr. Gerald Amado signed documents for follow-up visits that never occurred and treatments that patients never received. At Medico de la Familia, employees recruited and paid patients to come to the clinic, and coached patients on how to commit fraud by advising they go through at least one treatment so they know what is involved should the insurance company ask questions. Dr. Gustavo Acosta signed documents for examinations he allegedly never provided. Employees at all of the clinics involved obtained or created fraudulent documentation that was then submitted to insurance companies for payment.

The special investigation units of each of the insurance companies targeted in this fraud scheme, Gainsco, Imperial Fire & Casualty, Mercury Insurance, Geico, and State Farm, provided substantial assistance in the operation, along with the U.S. Secret Service Miami Electronic Crimes Task Force and the National Insurance Crime Bureau (NICB).

According to the NICB, Florida has three of the top five cities nationally for questionable medical claims associated with staged accidents —Tampa, Miami and Orlando. During the upcoming legislative session, CFO Atwater is recommending several policy solutions to strengthen billing practices, create civil penalties and tighten requirements for clinic ownership to help bolster the fight against PIP fraud.

Special Reports /

Florida PIP Fraud Investigation Nets 17 Arrests

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