Division of Insurance Fraud Regional Offices

REGIÓN DE MIAMI

La oficina de Miami era la oficina central original de la División de Fraude de Seguros cuando se creó en 1976, ubicada en Virginia Gardens.  Nos mudamos a downtown Miami a finales de la década del 80 después de que la oficina central se trasladara a Tallahassee.

Comandante de la Región de Miami

Capitán Steven Smith

Captain Smith, who has been with the agency since 1988, supervises the office.  Captain Smith started as an investigator / detective, was promoted to Lieutenant in November 2000 and then promoted to Captain in January 2002.  Captain Smith has more than 28 years of service with the State of Florida.

Estadísticas de Casos

The 2007-08 fiscal year was another good year for the Miami Region Office.  The focus was again on PIP fraud, which took up most of the attention.  During the 2007-08 fiscal year, the Miami Region received more than 2600 referrals, down approximately 13% from the more than 3000 referrals in 2006-07.  211 new cases were opened during this period.  Our arrests in 2007-08 totaled 192, with 222 convictions and approximately $1.3 million ordered in restitution.

Información General

The Miami Regional Office investigates all types of insurance fraud.  There are currently four squads, two dedicated to Personal Injury Protection (PIP) fraud, one dedicated to Workers Compensation fraud, and one dedicated to general fraud.  A third PIP squad will be added shortly.

 

Brigadas de Fraude de PIP

Las brigadas de Fraude de PIP, supervisadas por la Teniente Violeta Serrano and Lieutenant Jerry Brown, continue to excel.  Combined, the squads made 104 arrests.  Leading each squad were Detectives Ray Diaz, con 24 arrestos y Carlos Dorta with 22 arrests.  PIP remains a hot topic in South Florida, and the category in which we receive most referrals.  According to the AHCA (Agency for Health Care Administration) website, between 30% - 40% of Florida están ubicadas en Condado Miami Dade, and we suspect there are hundreds of clinics committing insurance fraud at any given time.  We maintain a very positive working relationship with the insurance company SIUs, the NICB (National Insurance Crime Bureau), the FBI and local police departments.  The Division works with a dedicated PIP prosecution unit at the Miami-Dade State Attorney’s Office.  Prosecutors Thomas Sadler and Suzy Sostmann handle the bulk of the PIP fraud cases filed in Condado Miami Dade.

Brigada de Fraude de Compensación Legal por Accidentes de Trabajo

The workers compensation squad, led by Lieutenant Mike Shea, made 39 arrests.  Leading his squad was Detective Carlos Rodriguez, who had 16 arrests.  Workers compensation fraud is another pervasive insurance crime that costs businesses millions of dollars each year.

 

Brigada de Fraude en General

La brigada de Fraude en General, dirigida por el Teniente Bill Santner, made 49 arrests.  Leading his squad were Detectives Joe Shepherd and Carlos Losada, who had 11 arrests each.  The general fraud squad handles all other types of insurance fraud, including homeowners, vehicle theft, medical fraud, licensees, and hurricane claims.

 

Casos Destacados

“Operation TGIF” - started in kicked off in February 2007 with a phone call to the Fraud Hotline after a radio appearance by Fraud detectives.  The phone call initiated an investigation that uncovered a staged accident ring that had been operating for several years.  Using informants to infiltrate the ring, fraud detectives identified ten staged accidents and more than $328,000 in fraudulent PIP claims.  Nearly 40 participants were arrested, four search warrants were executed and more than $200,000 was seized from target bank accounts.  Most of the participants have entered pleas, but several are still pending plea or trial.

“Kitchen Fires” - This investigation involves public adjusters who have admitted to setting up numerous kitchen fires with homeowner’s knowledge and involvement, in order to profit from the insurance money.  In October 2007, we arrested two subjects who were charged with working with the public adjusters to set the fires in question.  The resulting claim was in excess of $120,000.  One of the arsonists was convicted by jury trial and the other is a fugitive from justice.

“Worst Case of Misrepresentation and Fraud” -  The subject filed a medical malpractice lawsuit in Miami-Dade County against two hospitals and a group of doctors, alleging that as a result of their deviation from the standard of care, she went from an individual with back pain and weakness in the lower extremities and an inability to support herself on her legs on occasion, to being paralyzed.  The subject gave a deposition, arriving in a wheelchair, and stated that she was left paralyzed and could not walk.  Subsequent video surveillance was conducted where the subject was observed to walk without the use of a wheelchair, using only a cane.  A subsequent deposition was taken and the subject again stated that she is unable to stand up from a sitting position or remain standing without assistance and is unable to clean house.  She also says that she is unable to go into the bathroom because her wheelchair won’t fit through the door and has to use a bedside commode.  She also states that she cannot get out of a car without assistance.  The malpractice insurance carrier offered to settle the case out of court and give the subject $250,000.00 for her injury, which was rejected.  The Circuit Court Judge dismissed the case with prejudice. The Judge stated in open court that this was the worst case of misrepresentation and fraud that she had seen in 22 years.  The subject was arrested and charged with Insurance Fraud and Grand Theft.

 

En Memoria de:

 

El Teniente John Haczynski murió el 15 de enero de 2006, cuando su motocicleta fue embestida por una camioneta en North Miami. John había trabajado para la División de Fraude de Seguros durante cuatro años y recién había sido promovido a Teniente en diciembre de 2005.  John se había retirado del Departamento de Policía de Nueva York después de 20 años. Como detective de la unidad de crimen organizado del NYPD, investigaba casos de corrupción en compañías privadas, formaba parte de un grupo de trabajo que investigaba mafias rusas7 y, como parte de un grupo de trabajo del FBI-NYPD, ayudó a arrestar a miembros de la familia mafiosa Genovese en 2001. En su tiempo libre, John era un botero ferviente y le encantaban las motocicletas. John era uno de los empleados más productivos de DIF y lo extrañaremos muchísimo. John tenía 49.

 

 

 

 

Detective Mike Schulgen died on June 28, 2002, shortly after being diagnosed with Leukemia.  Mike had trabajado para la División de Fraude de Seguros por más de cuatro años.  Mike era un ex oficial de la Marina, fue técnico en huellas dactilares para el FBI y Detective de Robos de la Policía de Metro-Dade antes de comenzar a investigar fraudes de seguro en 1998.  También había trabajado para la División de Licencias de la Florida por 9 años.  Mike tenía 55 años.