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Four Arrested in Personal Injury Protection Fraud Scheme

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Four individuals have been arrested as a result of recent revelations of their intimate involvement in various personal injury protection (PIP) fraud schemes. Alexis Gonzalez, Erick Perez, Nayef Casas Diaz, and Vicente Ortiz Alpizar, allegedly billed various insurance companies more than $145,000 in fraudulent claims, according to the Florida Department of Financial Services’ Division of Insurance Fraud (DIF).

To gain access to the scheme, undercover agents approached Gonzalez, who was the owner of Health Max Medical Center (HMMC) in Hialeah. He and Perez, his employee, offered an undercover agent $1,000 to fake an accident and sign for medical treatment that was never given, according to the DIF. Had the scheme succeeded, Gonzalez and Perez would have taken in roughly $10,000.

Moreover, Diaz, the owner of M&N Rehabilitation Center in Miami, is accused of putting together a staged accident, whereby the participants would receive “medical care” at his clinic for which he would then bill insurance companies over $63,000. Those who partook of the fake automobile accident were to receive $1,000 each for their false injuries, according to DIF.

Similarly, Alpizar was arrested for taking part in a staged accident. He then went to two clinics in Miami, A&J Rehabilitation Center and D&J Rehabilitation Center, where he received “treatment” for his non-existent injuries that purportedly came from a car accident.

Florida Law (817.234) states that anyone who presents “any written or oral statement as part of, or in support of, a claim for payment or other benefit pursuant to an insurance policy…knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim” is guilty of PIP fraud. In short, per this law alone, the complicity in the PIP fraud schemes carries as much criminal liability as those medical professionals typically involved in these schemes. In this case, violations of Florida’s fraud laws faces $5,000 fines given to first-time offenders. Insurers who have been defrauded have a right to be compensated for all monetary losses, as well as attorney fees and “reasonable” investigation fees related to the case at hand.

All four men are being charged with Insurance Fraud and Grand Theft, while Gonzalez, Perez, and Diaz have also been accused of an organized scheme to defraud. These four arrests are merely the latest in an ongoing DAF investigation; so far, fifteen such arrests have been made.

It is estimated that nearly half of all insurance fraud cases in Florida involve personal injury protection (PIP) schemes such as these. Florida courts have awarded more than $150 million in damages in these cases. Gonzalez, Peres, Diaz, and Alpizar will be tried in Miami-Dade County. If they are convicted for their crimes, they could serve 15-30 years in jail.