Division of Insurance Division of Insurance Fraud ReferralsFraud Referrals

Presented to thePresented to theAutomobile Insurance Fraud Strike ForceAutomobile Insurance Fraud Strike Force

January 24, 2013January 24, 2013

Captain Steven SmithCaptain Steven SmithDivision of Insurance FraudDivision of Insurance Fraud

DIF PIP ResourcesDIF PIP Resources

In response to the expanding PIP fraud problem, DIF In response to the expanding PIP fraud problem, DIF created dedicated squads around the statecreated dedicated squads around the state

Currently, we have 9 squads and 48 detectives that Currently, we have 9 squads and 48 detectives that are dedicated to PIP fraud investigationsare dedicated to PIP fraud investigations

Miami, Broward, WPB, Orlando, Tampa have Miami, Broward, WPB, Orlando, Tampa have dedicated squads and Ft Myers and Jacksonville have dedicated squads and Ft Myers and Jacksonville have dedicated detectivesdedicated detectives

In each of those jurisdictions except Ft Myers, we In each of those jurisdictions except Ft Myers, we also have dedicated prosecutorsalso have dedicated prosecutors

Working with Other AgenciesWorking with Other Agencies

DIF works with various other law enforcement and DIF works with various other law enforcement and regulatory agencies throughout the state, including regulatory agencies throughout the state, including local police departments, federal agencies like the local police departments, federal agencies like the FBI and IRS, and state agencies like DOH and AHCAFBI and IRS, and state agencies like DOH and AHCA

We work closely with the National Insurance Crime We work closely with the National Insurance Crime Bureau (NICB), which operates two major task forces Bureau (NICB), which operates two major task forces in Florida (Plantation and Tampa). NICB is in Florida (Plantation and Tampa). NICB is instrumental in providing support and resources to instrumental in providing support and resources to law enforcement, including vehicles, equipment, u/c law enforcement, including vehicles, equipment, u/c pretext policies, and is a liaison between law pretext policies, and is a liaison between law enforcement and the insurance companiesenforcement and the insurance companies

Referrals to DIFReferrals to DIF

All licensees must report suspected acts of insurance All licensees must report suspected acts of insurance fraud directly to the fraud divisionfraud directly to the fraud division

If they deny a claim for fraud, there must be a If they deny a claim for fraud, there must be a matching referral to DIFmatching referral to DIF

Referrals are automatically entered into DIF’s case Referrals are automatically entered into DIF’s case tracking system and forwarded to the appropriate tracking system and forwarded to the appropriate Captain or Lieutenant for review and assignmentCaptain or Lieutenant for review and assignment

More than 90% of our PIP fraud referrals come from More than 90% of our PIP fraud referrals come from insurance companiesinsurance companies

Volume of ReferralsVolume of Referrals

We want to work the cases that have most impact on We want to work the cases that have most impact on PIP fraud and we need to have aPIP fraud and we need to have a probability of probability of successful prosecutionsuccessful prosecution

In 2011-12, DIF received more than 7,700 PIP In 2011-12, DIF received more than 7,700 PIP referrals, which accounts for 51% of the total referrals, which accounts for 51% of the total referrals, an increase of nearly 16% from the referrals, an increase of nearly 16% from the previous yearprevious year

Statewide, we made 496 PIP-related arrests, an Statewide, we made 496 PIP-related arrests, an increase of 40% from the previous yearincrease of 40% from the previous year

The PIP problem is greater than any numbers can The PIP problem is greater than any numbers can showshow

Staged Accident Rings and Clinic InvestigationsStaged Accident Rings and Clinic Investigations

Fraud CasesFraud Cases

Staged Accidents and Accident ClinicsStaged Accidents and Accident Clinics Unlicensed Clinics / Straw OwnershipUnlicensed Clinics / Straw Ownership Crash Reports / Solicitation / Patient BrokeringCrash Reports / Solicitation / Patient Brokering Fraud by Patient and Jump-InsFraud by Patient and Jump-Ins

Work these investigations up the food chain to get Work these investigations up the food chain to get to the persons who are controlling the schemes and to the persons who are controlling the schemes and profiting from the fraudprofiting from the fraud

Some cases can be done relatively quickly, others Some cases can be done relatively quickly, others can take months or even years, depending on the can take months or even years, depending on the scope of the schemescope of the scheme

Operation Dark HorizonOperation Dark Horizon

Recent Impact ChangesRecent Impact Changes Hillsborough County PIP Ordinance – impacted and Hillsborough County PIP Ordinance – impacted and

educated community, and people got involvededucated community, and people got involved

Prosecutors working with Department of Health to Prosecutors working with Department of Health to take the licenses of medical personnel convicted of take the licenses of medical personnel convicted of fraudfraud

DIF’s expansion of dedicated PIP squads throughout DIF’s expansion of dedicated PIP squads throughout statestate

Huge successes in West Palm Beach through recent Huge successes in West Palm Beach through recent actions including Operation Sledgehammer and actions including Operation Sledgehammer and other casesother cases

Major cases underway in Jacksonville against Major cases underway in Jacksonville against organized ringsorganized rings

Major arrests in Tampa and Ft MyersMajor arrests in Tampa and Ft Myers

Training with law enforcement agencies (increased Training with law enforcement agencies (increased awareness and active reporting)awareness and active reporting)

Potential Changes from HB Potential Changes from HB 119119

Shift from straw ownership of clinics by massage Shift from straw ownership of clinics by massage therapists to chiropractors and doctorstherapists to chiropractors and doctors

Bypass billing PIP and shift to BI (bodily injury) and Bypass billing PIP and shift to BI (bodily injury) and med paymed pay

Shift of licensing by massage therapists to Shift of licensing by massage therapists to chiropractic assistantschiropractic assistants

State missed an opportunity – should have required State missed an opportunity – should have required that clinics obtain an AHCA license to bill for PIP, that clinics obtain an AHCA license to bill for PIP, without any exemptionswithout any exemptions

Education and Public Education and Public AwarenessAwareness In an effort to better inform the public about PIP fraud, In an effort to better inform the public about PIP fraud,

DIF and the Florida Outdoor Advertising Association DIF and the Florida Outdoor Advertising Association (FOAA) joined together in a statewide campaign using (FOAA) joined together in a statewide campaign using billboards and bus postersbillboards and bus posters

DIF has provided training to various law enforcement DIF has provided training to various law enforcement agencies including the Florida Highway Patrol, who also agencies including the Florida Highway Patrol, who also recently launched a website on staged crash awarenessrecently launched a website on staged crash awareness

DFS has a reward hotline (800-378-0445) for the public DFS has a reward hotline (800-378-0445) for the public to report fraud and has distributed more than $300,000 to report fraud and has distributed more than $300,000 to citizensto citizens

We publish a monthly newsletter called The PIP Source We publish a monthly newsletter called The PIP Source which reports on successful investigations, publishes which reports on successful investigations, publishes the names of persons arrested, and provides other the names of persons arrested, and provides other useful information on PIP related issuesuseful information on PIP related issues