united states district courtfiles.courthousenews.com/2014/03/17/geico.pdf2014/03/17 · 2 i....

UNITED STATES DISTRICT COURT for the

Middle District of Florida

GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO GENERAL INSURANCE COMPANY, GEICO CASUALTY COMPANY AND GEICO INDEMNITY COMPANY, Plaintiffs, vs. KJ CHIROPRACTIC CENTER, LLC, WELLNESS PAIN & REHAB, INC., SADAT SMITH, ARTHUR VITO, ESDRAS PIERRE LOUIS, JEAN CASSAMAJOR, ROBERT COHEN, ORLENE JOSEPH, EDNER DESIR, ELAINE FELIX, VLADIMIR “RICO” JEAN PIERRE, ROBERT THELUSMA, SHENIKA RICHARDSON, SHAYLA GAINES, CHANEL AKINS, QUEENA MCRAE, JEAN DORESTANT AND BELLE MANAGEMENT, LLC., Defendants.

CASE NO: 6:12-CV-1138-ORL-36-DAB

GEICO’S AMENDED C O MPL A IN T A ND D E M A ND F O R JUR Y T RI A L , F I L E D PURSUANT TO THE COURT’S MAY 31, 2013 ORDER (DOC. 179)

NOW COME the Plaintiffs, GOVERNMENT EMPLOYEES INSURANCE

COMPANY, GEICO GENERAL INSURANCE COMPANY, GEICO CASUALTY

COMPANY AND GEICO INDEMNITY COMPANY (hereinafter collectively referred to as

“GEICO”), and hereby sue the Defendants, KJ CHIROPRACTIC CENTER, LLC., WELLNESS

PAIN & REHAB, INC., SADAT SMITH, ARTHUR VITO, ESDRAS PIERRE LOUIS, JEAN

CASSAMAJOR, ROBERT COHEN, ORLENE JOSEPH, EDNER DESIR, ELAINE FELIX,

VLADIMIR “RICO” JEAN PIERRE, ROBERT THELUSMA, SHENIKA RICHARDSON,

SHAYLA GAINES, CHANEL AKINS, QUEENA MCRAE, JEAN DORESTANT AND

BELLE MANAGEMENT, LLC.: and hereby state:

Case 6:12cv01138CEHDAB Document 187 Filed 07/12/13 of 143 PageID 3640

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I . PR E L I M IN A R Y ST A T E M E N T

1. GEICO is in the business of writing insurance and paying legitimate claims in Florida

and throughout the United States.

2. This case arises out of an insurance fraud ring operating in Orlando, Florida.

3. These criminal enterprises involved chiropractic clinics, clinic operators, chiropractors,

patients and accident organizers known as Runners.

4. Beginning in 2009, and continuing into at least 2012, the Defendants actively engaged in

conspiracies to defraud GEICO by staging accidents, paying kickbacks to both Runners and

patients, and causing fraudulent records to be created and mailed to the Plaintiffs.

5. These false materials included bills and records for treatment unlawfully rendered by two

Florida businesses, KJ Chiropractic Center, LLC. and Wellness Pain & Rehab, Inc. (hereinafter,

collectively referred to as the “Clinics”).

6. The Personal Injury Protection (“PIP”) Claims, detailed throughout this Amended

Complaint, arise out of:

a. Staged crashes; b. Real accidents wherein the occupant(s) received treatment at KJ Chiropractic

and/or Wellness even though they were not truly injured; or, c. Real accidents wherein the occupant(s) incurred some injuries, but received “treatment” at KJ Chiropractic and/or Wellness that was pre-programmed, unnecessary, excessive and unlawful under Florida law.

7. As shown below, these conspiracies involved the regular ongoing participation of

numerous persons and entities, each with a different role to perform.

8. These insurance fraud conspiracies were initiated, financed, operated and maintained by

the Defendants. Specifically, the Defendants promoted their fraudulent enterprise by: (1)

offering money to anyone who referred accident victims to the Clinics, (2) offering cash directly


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to patients who agreed to accept unnecessary chiropractic treatment, and (3) dispensing treatment

in a manner designed to maximize their profits, rather than heal patients.

9. Using promises of significant financial gain, the Runner Defendants, (Esdras Pierre

Louis, Jean Cassamajor, Vladimir “Rico” Jean Pierre and others) recruited third parties to

participate in staged crashes.

10. Defendant, Jean Dorestant, held two different positions in the insurance fraud structure.

In addition to being a Runner, who crashed cars and referred PIP claimants to KJ Chiropractic

and Wellness, he also secretly owned and operated the KJ Chiropractic Clinic.

11. The Runners followed a regular identifiable pattern when creating false accident claims

between 2009 and 2012.

12. In advance of each staged crash, the Runners would instruct recruited individuals on how

to obtain appropriate automobile insurance from Florida carriers, including GEICO.

13. Once the automobile insurance was in place, the Runners would physically escort the

claimants to the location they had selected for the stage crash.

14. After ramming the vehicles, the Runners instructed the claimants to call the police in

order to document the event, thus making the staged crash appear to be a real accident.

15. The Runners further coached the staged crash participants to claim neck and/or back

injuries so they could present, and profit from, false PIP, bodily injury and, in some cases,

property damage claims.

16. The Runners then directed the PIP claimants to KJ Chiropractic and/or Wellness.

17. The Runners informed the claimants that if they agreed to accept at least 15 days of

unnecessary treatment, the Clinics would then pay them a secret cash kickback between $500.00


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and $1,000.00 dollars. The PIP claimants were also told they could make money by presenting

fake bodily injury claims.

18. The Clinics also paid money to the Runners for delivering compliant PIP claimants.

19. Public filings with the state of Florida document that Defendant, Sadat Smith, D.C., was

the president and sole owner of KJ Chiropractic. The same records listed Defendant, Arthur Vito,

D.C., as the president and sole owner of Wellness. These records were false.

20. Both Smith and Vito were sham clinic owners. They intentionally abrogated control of

KJ Chiropractic and Wellness to corrupt Clinic Operators who they knew had no medical

training or licenses.

21. Smith relinquished control of KJ Chiropractic to Defendants, Jean Dorestant and Orlene

Joseph.

22. Vito handed over the operation of Wellness to Defendants, Robert Thelusma, Elaine

Felix and Edner Desir.

23. Smith and Vito lent their names and chiropractic licenses to these Clinics so they would

appear to be legitimate chiropractic facilities, owned in compliance with Florida's Health Care

Clinic Act.

24. Smith and Vito then adopted an attitude of willful blindness with respect to the activities

of the Runners and Clinic Operators.

25. Smith, Vito and Defendant, Robert Cohen, D.C. (an employee of KJ Chiropractic) knew

that the Clinic employees were rendering unlawful, pre-programmed, cookie-cutter treatment to

the PIP claimants.

26. Smith and Vito profited from the pattern of unlawful activities and fraudulent conduct

perpetrated by the Clinics, Clinic Operators, and Runners.


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27. The Defendants undertook affirmative actions to conceal their fraudulent activities from

GEICO, third parties, law enforcement, and the public at large.

28. Through the conduct described above, the Defendants conspired to defraud GEICO by:

a. Secretly paying both Runners and patients; b. Misleading insurers, including GEICO, into believing that KJ Chiropractic and

Wellness were legitimate facilities owned and controlled by licensed chiropractors; and,

c. Billing for treatment that was predetermined, excessive, unlawful, and in many instances, rendered to patients who had not suffered legitimate injuries in real accidents.

29. The Defendants used the United States Mail in every claim to submit fraudulent medical

documentation to GEICO. They then, directly or indirectly, collected money from GEICO that

they had no right to receive.

30. GEICO’s Mail/Wire Fraud chart attached hereto as Exhibit 1, and fully incorporated

herein, displays over 200 instances of Mail and Wire Fraud in violation of 18 U.S.C. §§1341 and

1343. The chart also shows that the Defendants’ pattern of racketeering activity spanned from

2009 to at least 2012, and that each claim contained at least two mailings/wires. GEICO’s

Mail/Wire Fraud chart list the following information for each claim:

a. GEICO claim number; b. Date of loss; c. Initials the named insured/claimant; d. Date of mailing/wire; e. The sender; f. The recipient; g. The contents of the Mailing/Wire; and, h. Misrepresentations in each Mailing/Wire.

31. These Mailings/Wires listed in Exhibit 1 were caused by the actions and conduct of the

Clinics, Clinic Operators, and Runners.

32. Because of these fraudulent Mailings/Wires, GEICO has paid over $1,621,225.43 dollars

in connection with these automobile insurance claims.


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33. GEICO’s Damages Chart, attached hereto as Exhibit 2, and fully incorporated herein,

details the financial harm caused to GEICO by the Defendants’ conduct. GEICO’s Damages

Chart lists the following information for each claim:

a. GEICO claim number; b. Date of loss; c. Initials of the named insured; d. Amounts of chiropractic bills from the Clinics; e. Amounts of diagnostic bills; f. Amounts of property damage and other payments; g. Amounts of Expense Payments made in relation to claims; and, h. Total amount paid for each claim.

34. The intentional conduct of the Defendants, detailed in the balance of this Amended

Complaint, violates both Federal and Florida state law.

35. GEICO seeks to recover treble damages under the Racketeer Influenced and Corrupt

Organizations Act, 18 U.S.C. §1961, et seq. GEICO also asserts state law damage claims

including, Unfair and Deceptive Trade Practices, Fla. Stat. §501.204; Civil Conspiracy; Common

Law Fraud; Unjust Enrichment; and Declaratory Judgment.

I I . JURISDI C T I O N

36. This action seeks money damages in excess of $75,000.00 dollars, exclusive of interest,

costs and attorneys’ fees. This Court has jurisdiction over this matter pursuant to 28 U.S.C. §

1332, based upon the amount in controversy and diverse citizenship of the parties.

37. The jurisdiction of this Court also arises under the Racketeer Influenced and Corrupt

Organizations Act (“RICO”), 18 U.S.C. §§ 1961, et seq.; 28 U.S.C. § 1331; and the principles of

pendent jurisdiction.


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I I I . V E NU E

38. Venue lies in this Court under the provisions of 18 U.S.C. § 1965(a) and 28 U.S.C. §

1391(b), as the majority of the wrongful acts known to GEICO, as alleged herein, were carried

out within Orange County, Florida.

I V . PA R T I ES

A . G E I C O PL A IN T I F FS

39. Government Employees Insurance Company is a corporation duly organized under the

laws of Maryland, with a principal place of business at 5260 Western Ave., Chevy Chase,

Montgomery County, Maryland.

40. GEICO General Insurance Company is a corporation duly organized under the laws of

Maryland, with a principal place of business at 5260 Western Ave., Chevy Chase, Montgomery

County, Maryland.

41. GEICO Indemnity Company is a corporation duly organized under the laws of Maryland

with a principal place of business at 5260 Western Ave., Chevy Chase, Montgomery County,

Maryland.

42. GEICO Casualty Company is a corporation duly organized under the laws of Maryland,

with a principal place of business at 5260 Western Ave., Chevy Chase, Montgomery County,

Maryland.

43. The Plaintiffs have common corporate ownership as follows: Government Employees

Insurance Company owns GEICO General Insurance Company; GEICO Indemnity Company

owns GEICO Casualty Company; the parent entity to Government Employees Insurance

Company and GEICO Indemnity Company is GEICO Corporation. The four GEICO companies

named as Plaintiffs herein operate in a common claims function, and that common claims


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department handles claims for all four companies, including all of the claims at issue in this suit.

Although each Plaintiff would have a separate cause of action against each named Defendant,

due to the commonalities of the claims and the standard operating procedures of the Plaintiffs, as

well as the interest of judicial economy, the Plaintiffs have joined together to bring this action.

B . K J C H IR OPR A C T I C D E F E ND A N TS

44. KJ Chiropractic Center, LLC. was/is a Florida limited liability company with a principal

place of business at 5233 Old Winter Garden Road, Orlando, in Orange County, Florida.

45. Sadat Smith is a natural person residing at 3217 Fawnwood Drive, Ocoee, Orange

County, Florida.

46. Jean “Edence” Dorestant (“Dorestant”) is a natural person residing at 8038 Lake Park

Estate Blvd., Orlando, Orange County, Florida.

47. Belle Management, LLC (“Belle Management”) is a Florida limited liability company

with a principal place of business at 8038 Lake Park Estate Blvd., Orlando, Orange County,

Florida. Belle Management was owned and controlled by Jean Dorestant.

48. Robert Cohen, D.C. (“Cohen”) is a natural person, residing in Florida, with a place of

business at 1904 West Colonial Drive, Suite B, Orlando, Orange County, Florida.

49. Orlene Joseph (“Ms. Joseph”) is a natural person residing at 6151 Metrowest Blvd., Unit

10, Orlando, Orange County, Florida.

50. With the full knowledge, consent and permission of Sadat Smith, D.C., Jean Dorestant,

Orlene Joseph, Belle Management, Robert Cohen, D.C., Esdras Pierre Louis, Jean Cassamajor

and Vladimir “Rico” Jean Pierre controlled the internal operations of KJ Chiropractic, which

they used to create false insurance claims.


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51. Throughout this Amended Complaint, the Defendants, Sadat Smith, Orlene Joseph,

Robert Cohen, Jean Cassamajor, Vladimir “Rico” Jean Pierre, Esdras Pierre Louis, Jean

Dorestant and Belle Management, will collectively be referred to as the “KJ Chiropractic

Group.”

C . W E L L N ESS D E F E ND A N TS

52. Wellness Pain & Rehab, Inc. was/is a Florida corporation with a principal place of

business at 3231 Old Winter Garden Road, Orlando, Orange County, Florida. Wellness also

operated a second location at 7649 W. Colonial Drive, Orlando, Florida, Orange County, Florida.

53. Arthur Vito, D.C. (“Vito”) is a natural person residing at 117 E. 77th St., Apt. 5B-E, New

York, New York County, New York.

54. Robert Thelusma (“Thelusma”) is a natural person residing at 2809 Park Meadow Drive,

Apopka, Orange County, Florida.

55. From 2009-2010, Thelusma was the undisclosed proprietor of Wellness.

56. Elaine Felix (“Felix”) is a natural person residing at 1275 West Donegan Ave.,

Apartment H, Kissimmee, Orange County, Florida.

57. Edner Desir (“Desir”) is a natural person residing at 1070 Emerald Drive, Mount Dora,

Lake County, Florida.

58. In 2010, and continuing uninterrupted to 2012, Thelusma joined with Felix and Desir to

manage Wellness.

59. Throughout this Amended Complaint, the Defendants, Arthur Vito, Robert Thelusma,

Elaine Felix, Edner Desir, Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis, and Vladimir

“Rico” Jean Pierre, will collectively be referred to as the “Wellness Group.”


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D . RUNN E R D E F E ND A N TS

60. Esdras Pierre Louis is a natural person currently residing at 535 Appleyard Drive,

Tallahassee, Leon County, Florida.

61. Vladimir Jean Pierre (“Rico”) is a natural person residing at 2805 Grassmere Lane,

Orlando, Orange County, Florida.

62. Jean Cassamajor (“Cassamajor”) is a natural person residing at 1445 NE 145th Street,

Miami, Miami-Dade County, Florida.

63. Jean Dorestant, named as a KJ Chiropractic Defendant for his role in controlling the

fraudulent operation of the Clinic, was also a Runner, who staged accidents and solicited PIP

patients/claimants for unnecessary treatment at both KJ Chiropractic and Wellness.

E . PIP C L A I M A N T /PA T I E N T D E F E ND A N TS

64. Shenika Richardson (“Richardson”) is a natural person residing at 4401 South Semoran

Boulevard, Apartment 3, Orlando, Orange County, Florida.

65. Shayla Gaines (“Gaines”) is a natural person residing at 4773 North Pine Hills Road,

Orlando, Orange County, Florida.

66. Chanel Akins (“Akins”) is a natural person residing at 3333 North Wilts Circle, Orlando,

Orange County, Florida.

67. Queena McRae (“McRae”) is a natural person residing at 1408 North Fiske Boulevard,

Cocoa, in Brevard County, Florida.

68. At all relevant times, and in connection with the conduct alleged herein, KJ Chiropractic,

Wellness, Sadat Smith, D.C., Arthur Vito, D.C., Jean Dorestant, Belle Management, LLC.,

Robert Cohen, D.C., Orlene Joseph, Robert Thelusma, Elaine Felix, Edner Desir, Jean


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Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and GEICO were involved in

trade and commerce in the state of Florida.

69. All of the Defendants’ wrongful conduct, alleged in this Amended Complaint, was

intentional.

V . ST RU C T UR E A ND F R A UDU L E N T OPE R A T I O NS O F T H E C L INI C D E F E ND A N TS

A . F O R M A T I O N O F K J C H IR OPR A C T I C C E N T E R , L L C .

70. KJ Chiropractic Center, LLC., filed Articles of Organization with the Florida Secretary of

State, Division of Corporations, on November 24, 2009. This document lists the limited liability

company as effective on November 23, 2009.

71. According to the Articles of Organization, Sadat Smith was the registered agent and the

only manager/managing member of KJ Chiropractic.

72. On December 1, 2009, KJ Chiropractic entered into a Marketing, Management and

Operations Services Agreement with Belle Management, attached hereto as Exhibit 3.

73. Sadat Smith signed this agreement on behalf of KJ Chiropractic, while Jean Dorestant

signed on behalf of Belle Management.

74. On December 1, 2009, however, Belle Management was not yet a corporation.

75. According to the Articles of Organization, Jean Dorestant was/is at all times the

registered agent and the managing member of Belle Management, LLC. The effective date of

Belle Management’s filing was January 11, 2010.

76. Jean Dorestant created Belle Management and entered into this agreement with KJ

Chiropractic and Sadat Smith in an attempt to further conceal their secret agreement; wherein

Smith relinquished, to Dorestant, true ownership and control of KJ Chiropractic. Subsequently,


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in January of 2010, around the same time Belle Management became a company, KJ

Chiropractic began operating and submitting bills to GEICO.

77. KJ Chiropractic filed Limited Liability Company Reinstatement documents with the

Florida Secretary of State, Division of Corporations, on November 25, 2010, May 1, 2011 and

May 1, 2012. Despite being truly owned and controlled by Dorestant, Sadat Smith purportedly

signed each Reinstatement document as KJ Chiropractic’s “Managing Member, Manager, or

Authorized Representative.”

78. KJ Chiropractic stopped “treating” patients on or about May 11, 2012, when the office

was damaged in a fire. Smith, however, continues to treat patients in the State of Florida.

79. On October 9, 2012, KJ Chiropractic changed its mailing address with the Florida

Secretary of State, Division of Corporations, to “P.O. Box 327, Ocoee, FL 34761.”

80. On December 20, 2012, Sadat Smith testified under oath that he "controlled everything

clinically", "hired all the staff”, and made all "major" decisions at KJ Chiropractic. See Sadat

Smith Deposition Transcript attached hereto as Exhibit 4, p. 49:1 - 49:8.

81. Smith testified, “Anything that they did major had to come through me and get

authorization by me.” See Exhibit 4, p. 49:9 - 49:10. Smith further testified that he delegated

certain business-related tasks to a person named, Jean Dorestant, and a company called, Belle

Management, LLC. See Exhibit 4, p. 38:22 - 38:25; p. 44:2 - 44:4; p. 63:4 – 63:8.

82. Between 2009 and 2012, KJ Chiropractic employed three chiropractors, Robert Cohen,

D.C., Glenn Behrman, D.C. and Miyoashi Gay, D.C.

83. Robert Cohen, D.C., worked as a chiropractor at KJ Chiropractic from approximately

January 2010 through September 2010.


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84. Glenn Behrman, D.C., worked as a chiropractor at KJ Chiropractic from approximately

October 2010 through December 2010.

85. Miyoashi Gay, D.C., worked as a chiropractor at KJ Chiropractic from November 2010

through May 2012.

86. Natacha LeGrand, L.M.T., worked as a massage therapist and manager at KJ

Chiropractic from approximately May 2010 through July 2011.

87. Dianna Rose, L.M.T., worked as a massage therapist at KJ Chiropractic from

approximately November 2010 through January 2012.

88. Orlene Joseph and Jean Dorestant worked as office managers at KJ Chiropractic from

2009 through 2012.

89. Jean Cassamajor, Vladimir “Rico” Jean Pierre, and Esdras Pierre Louis worked for KJ

Chiropractic as Runners who recruited PIP claimants to participate in staged crashes. Jean

Dorestant staged many of these crashes personally and referred PIP Claimants to the Clinic he

secretly owned (KJ Chiropractic) as well as other clinics, including Wellness.

B . W R O N G F U L C O NDU C T O F T H E K J C H IR OPR A C T I C G R O UP

90. Together, Jean Dorestant and Sadat Smith: (1) created KJ Chiropractic, (2) set the prices

charged by KJ Chiropractic, (3) established the procedures used by KJ Chiropractic to document

treatment and create invoices for services, (4) caused KJ Chiropractic’s unlawful treatment

records and invoices for services to be mailed to GEICO via the U.S. Mail, (5) caused money to

be paid to the Runner Defendants and, (6) jointly profited from KJ Chiropractic’s unlawful

business operations.

91. Sadat Smith caused money to be paid to Jean Dorestant, Esdras Pierre Louis, Jean

Cassamajor and Vladimir “Rico” Jean Pierre in connection with false PIP claims.


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92. Sadat Smith granted Jean Dorestant, Esdras Pierre Louis, Jean Cassamajor and Vladimir

“Rico” Jean Pierre regular access to KJ Chiropractic and permitted them to bring staged crash

participants into KJ Chiropractic on a regular basis.

93. Sadat Smith gave a key to KJ Chiropractic’s office to Jean Dorestant.

94. Esdras Pierre Louis, Jean Cassamajor and Vladimir “Rico” Jean Pierre regularly

delivered patients to KJ Chiropractic in exchange for cash payments.

95. Jean Dorestant and Sadat Smith hired Orlene Joseph and Natacha LeGrand to work as

employees in the KJ Chiropractic facility.

96. Jean Dorestant hired chiropractor, Robert Cohen, to work at KJ Chiropractic.

97. Later, Orlene Joseph, hired chiropractor, Glenn Behrman, to work at KJ Chiropractic.

98. Chiropractor, Miyoashi Gay, was hired by Sadat Smith.

99. Cohen and Behrman only worked two days per week at KJ Chiropractic.

100. Gay only worked two or three days per week at KJ Chiropractic.

101. Natacha LeGrand and Orlene Joseph acted as liaisons between the Runners and KJ

Chiropractic.

102. LeGrand would instruct patients to provide KJ Chiropractic with multiple signatures

during a single visit so that KJ Chiropractic could create false treatment records, even if the

patient failed to return for future scheduled treatments.

103. This process provided KJ Chiropractic with an inventory of signatures that they could

place on different medical records called “SOAP notes” to make it appear that the patient had

visited KJ Chiropractic for treatment many times when, in fact, this had not actually occurred.

104. Some KJ Chiropractic patients would appear at the Clinic, sign in, and then leave without

actually receiving any treatment.


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105. As discussed in the Queena McRae and Chanel Akins confessions (discussed below), it

was common knowledge within KJ Chiropractic that the Runners were bringing in “patients”

from staged crashes, and that the Clinic was producing false bills and records.

106. When chiropractor, Robert Cohen, worked for KJ Chiropractic he knew the Clinic was

providing unlawful treatment, because the business did not employ Licensed Massage Therapists

at that time. The fraudulent nature of the KJ Chiropractic claims is further supported by the

Statement of Robert Cohen, D.C.

107. More specifically, while an employee of KJ Chiropractic, Robert Cohen informed Jean

Dorestant, the person he understood to be the manager of KJ Chiropractic, that the Clinic needed

to employ Licensed Massage Therapists to administer physiotherapy modalities such as hot

packs and electric stimulation.

108. Dorestant acknowledged that he knew that KJ Chiropractic did not employ a Licensed

Massage Therapist, and further, that he had decided not to hire a Licensed Massage Therapist.

109. After this conversation, Robert Cohen continued to work at KJ Chiropractic with full

knowledge that the Clinic was continuing to provide unlawful treatment.

110. Robert Cohen adopted this attitude of willful blindness because he needed the money he

was being paid by KJ Chiropractic.

111. Jean Dorestant had multiple roles in this insurance fraud scheme.

112. Dorestant organized staged accidents and then arranged to have the PIP claimants treat at

KJ Chiropractic and/or Wellness.

113. Dorestant acted as a de facto co-manager at KJ Chiropractic, along with Orlene Joseph.


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114. Dorestant also took on the role of “GEICO Insured.” In this false claim, GEICO Claim

No. 0393540740101019, claimant, JPL sought treatment at KJ Chiropractic after an alleged

accident involving a vehicle insured in Dorestant’s name.

115. Dorestant’s control over KJ Chiropractic’s internal operations is exemplified by the fact

that he, not Sadat Smith, hired Robert Cohen.

116. Indeed, Dorestant’s pervasive control over KJ Chiropractic eventually lead Robert Cohen

to conclude that Jean Dorestant was the owner of KJ Chiropractic, even though Cohen knew that

Sadat Smith was the listed owner of KJ Chiropractic “on paper.”

117. Members of the KJ Chiropractic Group caused Robert Cohen’s name to be placed on KJ

Chiropractic’s CMS 1500 forms for all treatment and therapy occurring five days a week.

118. These bills represented that Cohen was either providing all of this treatment himself or

supervising properly Licensed Massaged Therapists. These misrepresentations were intended to

mislead, and did mislead, GEICO into believing KJ Chiropractic was rendering lawful treatment.

119. In reality, Cohen was not supervising necessary care, rendered by KJ Chiropractic’s

Licensed Massage Therapists, for the simple reason that, at that time, KJ Chiropractic did not

employ Licensed Massage Therapists.

120. Sadat Smith’s involvement in the creation of false bills is further demonstrated by two

incidents that occurred in late November/early December, 2011.

121. By that time, Dr. Cohen had left KJ Chiropractic. He was replaced by a chiropractor

named Glenn Behrman, D.C.

122. Dr. Behrman was hired by Orlene Joseph to work at KJ Chiropractic two days a week.

Most of the time, he worked Tuesday and Thursday. On occasion, he worked Monday and

Wednesday. However, like Cohen, he never worked five days a week, nor did he have any


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involvement in the selection of CPT (Current Procedural Terminology) Codes that were placed

on KJ Chiropractic’s bills, which were prepared on CMS 1500 forms.

123. Dr. Behrman’s sole function at the Clinic was to provide adjustments to patients. Dr.

Behrman had no role in the administration or supervision of physiotherapy modalities that were

reportedly given to all KJ Chiropractic patients.

124. During his employment, the patient volume at KJ Chiropractic grew dramatically. On

some occasions, Dr. Behrman was adjusting approximately fifty patients a day.

125. In and around November 2010, Dr. Behrman came across a bill that had been prepared in

connection with one of his patients. At that time, he observed that his name was being typed in

the lower left hand corner of this CMS 1500 form. He further noted that this form memorialized

treatment (in the form of physiotherapy modalities, such as heat and EMS) that had reportedly

been administered on days when he was not present at the Clinic. This caused Dr. Behrman

great concern since he was not supervising any of the physiotherapy treatments that were

routinely being administered at KJ Chiropractic.

126. Dr. Behrman immediately brought his discovery to the attention of the woman he had

come to know as the office manager, Orlene Joseph. When he stated that he objected to this

practice, Orlene Joseph said that he would have to speak with Sadat Smith.

127. Shortly thereafter, Dr. Behrman spoke with Sadat Smith. During this conversation, he

told Sadat Smith he objected to having his name placed on bills for physiotherapy treatments that

he neither observed nor supervised.

128. Smith responded with words to the effect that he wanted to continue this practice. Smith

also asked Dr. Behrman if he could create a signature stamp for use in future bills. Dr. Behrman

refused.


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129. Orlene Joseph stated words to the effect that it would be a lot of trouble to go back and

change the bills that already listed Dr. Behrman’s name.

130. Dr. Behrman left his meeting with Orlene Joseph and Sadat Smith understanding that the

practice of placing his name on all of KJ Chiropractic’s bills would stop.

131. Shortly thereafter, Dr. Behrman was dismayed to discover additional bills (specifically,

CMS 1500 forms) where his name appeared in the same fashion. This caused him to seek a

second meeting with Sadat Smith to complain about the practice. Shortly thereafter, Dr.

Behrman’s employment with KJ Chiropractic was terminated.

132. Each member of the KJ Chiropractic Group knew that the Clinic was:

a. Billing for services not properly rendered; b. Illegally soliciting patients and paid kickbacks to Runners who were staging

crashes; c. Creating bills that misrepresented that physiotherapy modalities had been

performed by Licensed Massage Therapists who were actually being supervised by Licensed Florida Chiropractors;

d. Allowing unlicensed individuals to administer treatments to its patients; e. Routinely ordering unnecessary diagnostic imaging studies, without clinical

indications, that were not considered by KJ Chiropractic employees when they administered the Clinic’s predetermined therapy protocols; and/or,

f. Following a predetermined cookie cutter treatment plan wherein its employees provided chiropractic care that was excessive and designed to enrich the KJ Chiropractic Group, rather than heal legitimate injuries.

133. Each member of the KJ Chiropractic Group had actual knowledge that KJ Chiropractic

was causing false bills to be mailed and/or that false bills would be mailed to GEICO in the

ordinary course of their scheme.

134. Even if each member of the KJ Chiropractic Group did not know for certain that a

particular crash was staged they reasonably knew that their conduct was causing staged crashes,

fake injuries and/or unnecessary treatment for financial gain.


19

135. Each member of the KJ Chiropractic Group intentionally adopted an attitude of willful

blindness with regards to the financial harm its conduct was causing GEICO, other automobile

insurers in Florida and the public at large.

C . DR. DON R. WAKEFIELD’S EXPERT MEDICAL OPINION IN SUPPORT OF GEICO’S ALLEGATIONS AGAINST KJ C H IR OPR A C T I C 136. After paying the KJ Chiropractic bills referenced in Exhibits 1 and 2 of this Amended

Complaint, but before commencing this lawsuit, GEICO caused the bills and records from the

Clinics to be reviewed and analyzed by Dr. Don R. Wakefield, DC, JD, PA. See Curriculum

Vitae of Dr. Don R. Wakefield, DC, JD, PA attached as Exhibit 5.

137. Dr. Wakefield’s expert analysis of all of the bills and records mailed to GEICO, along

with statements from patients, Runners and clinic employees, demonstrates that KJ Chiropractic

and the KJ Chiropractic Group engaged in fraud by:

a. employing protocol or pre-programmed treatment plans for typical patients; b. following a protocol wherein individualized care was not provided to its patients; c. using deceptive billing practices throughout its records; d. employing unqualified personnel to perform therapeutic procedures and

modalities; e. routinely billing for services that were not provided; f. using a deceptive business structure designed to produce revenue, as opposed to

providing legitimate healthcare; and, g. using office procedures and clinical plans designed to deceive third party payors,

including GEICO, into compensating Wellness for unnecessary services and treatment not rendered. See Exhibit 6. (Fraudulent Medical Record Analysis Chart by Dr. Don R. Wakefield, DC, JD, PA).

138. Dr. Wakefield’s analysis demonstrates that KJ Chiropractic implemented a cookie-cutter

treatment plan that would include in almost every instance, regardless of the patients’ condition

or the severity of the accident in question, unsupported or miscoded C.P.T. codes.


20

139. Dr. Wakefield determined that this type of protocol or programmed treatment plan did

not demonstrate individualized care, but instead, represented an unlawful predetermined and

systematic use of therapies, modalities and associated billing codes.

140. Dr. Wakefield opined that the claims submitted by KJ Chiropractic involved unlawful,

excessive, and/or deceptive medical records/bills. This pattern of fraudulent billing occurred in

every GEICO claim involving KJ Chiropractic.

D . F O R M A T I O N O F W E L L N ESS PA IN A ND R E H A BI L I T A T I O N , IN C .

141. From July 10, 2009 through February 14, 2012, Defendant, Wellness, was a Florida

corporation with a place of business located at 3231 Old Winter Garden Road, Orlando, Florida;

2.1 miles from the office of KJ Chiropractic. Wellness also operated a second location at 7649

W. Colonial Drive, Orlando, Florida, Orange County, Florida.

142. Wellness, began operating in August 2009.

143. Wellness filed Articles of Organization with the Florida Secretary of State, Division of

Corporations, on July 10, 2009. This document lists the corporation as effective on July 5, 2009.

144. According to the Articles of Organization, Arthur Vito was the registered agent,

incorporator, President and the only officer or director of the corporation.

145. Robert Thelusma was also involved in the creation of Wellness, as he was the

undisclosed proprietor from 2009-2010.

146. During the time in question, Robert Thelusma entered into a lease agreement for the

property at 3231 Old Winter Garden Road, Orlando, Florida from April, 2009 through April,

2010. See Exhibit 7.

147. Thelusma later partnered with Elaine Felix and Edner Desir.


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148. Elaine Felix and Edner Desir entered into a lease for the same premises at 3231 Old

Winter Garden Road, Orlando, Florida, from March 2010 through April 2011. See Exhibit 8.

149. Subsequently, Vito electronically signed Wellness for Profit Corporation Reinstatement,

which was filed with the Florida Secretary of State, Division of Corporations, on January 3,

2011.

150. Finally, as the President of Wellness, Arthur Vito signed Articles of Dissolution on

December 31, 2011 and filed them with the Florida Secretary of State, Division of Corporations,

on February 14, 2012. Vito signed these documents approximately four months after he left the

State of Florida and moved to New York.

151. Vito, Thelusma, Felix and Desir worked together to establish and operate Wellness.

152. Between 2009 and 2012, Wellness employed two chiropractors, Arthur Vito, D.C., and

John McCarthy, D.C.

153. Arthur Vito, D.C., worked as a chiropractor at Wellness from approximately July 2009

through November 2011.

154. John McCarthy, D.C., worked as a chiropractor at Wellness from approximately

November 2011 through January 2012.

155. For a period of time between 2009 and 2012, Charles Vanderbrink, L.M.T., worked as a

massage therapist at Wellness.

156. Clivens Baltazar, L.M.T., worked as a massage therapist at Wellness from approximately

January, 2011 through November 30, 2011.


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E . W R O N G F U L C O NDU C T O F T H E W E L L N ESS G R O UP

157. Defendants, Arthur Vito, Robert Thelusma, Elaine Felix, Edner Desir, Jean Cassamajor,

Esdras Pierre Louis, Jean Dorestant and Vladimir “Rico” Jean Pierre worked together to defraud

GEICO by causing the creation of false and unlawful medical records and bills.

158. Arthur Vito was involved in the creation of Wellness.

159. Arthur Vito profited from Wellness’ business operations.

160. Arthur Vito paid the people who worked at Wellness.

161. Arthur Vito set the prices charged by Wellness for services rendered to its patients.

162. Arthur Vito established the procedures used by Wellness to document treatment and

created invoices for services.

163. Arthur Vito caused money to be paid to Jean Dorestant, Jean Cassamajor, Esdras Pierre

Louis and Vladimir “Rico” Jean Pierre.

164. Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre

delivered patients to Wellness in exchange for cash payments.

165. Arthur Vito caused Wellness’ false treatment records and invoices for services to be sent

to GEICO via the U.S. Mails.

166. Robert Thelusma hired, trained and supervised the employees who worked at Wellness.

167. Robert Thelusma paid the people who worked at Wellness.

168. Robert Thelusma set the prices charged by Wellness for services rendered to patients.

169. Robert Thelusma established the procedures used by Wellness to document treatment and

created invoices for services.

170. Robert Thelusma profited from Wellness’ business operations.


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171. Robert Thelusma knew that Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and

Vladimir “Rico” Jean Pierre were staging crashes in order to refer patients to Wellness.

172. Robert Thelusma authorized Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and

Vladimir “Rico” Jean Pierre to bring patients into Wellness on a regular basis.

173. Robert Thelusma caused money to be paid to Runners: Jean Cassamajor, Jean Dorestant,

Esdras Pierre Louis and Vladimir “Rico” Jean Pierre.

174. Elaine Felix hired, trained and supervised the employees who worked at Wellness.

175. Elaine Felix paid the people who worked at Wellness.

176. Elaine Felix profited from Wellness’ business operations.

177. Elaine Felix knew that Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and


178. Elaine Felix authorized to Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and


179. Elaine Felix caused money to be paid to Runners: Jean Cassamajor, Jean Dorestant,


180. Edner Desir knew that Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and


181. Edner Desir authorized Jean Cassamajor, Jean Dorestant, Esdras Pierre Louis and


182. Edner Desir caused money to be paid to Runners: Jean Cassamajor, Jean Dorestant,


183. Edner Desir profited from Wellness’ business operations.


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184. Robert Thelusma, Elaine Felix and Edner Desir, all caused employees at Wellness, who

were responsible for preparing invoices, to bill for treatments that patients had not received.

185. Robert Thelusma, Elaine Felix and Edner Desir, caused Wellness’ fraudulent treatment

records and invoices for services to be sent to GEICO via the U.S. Mails/Wires.

186. Robert Thelusma’s leadership role in Wellness’ internal operations is exemplified by the

fact that he, not Arthur Vito, hired John McCarthy, DC, Clivens Baltazar, L.M.T. and Charles

Vanderbrink, L.M.T.

187. Indeed, Robert Thelusma’s pervasive control over the Wellness Group eventually caused

employees to believe that he was the owner of Wellness, even though Arthur Vito was the owner

listed on the corporate documents filed with the Florida Secretary of State.

188. Just as Jean Dorestant was the secret owner of KJ Chiropractic, Robert Thelusma was the

secret owner of Wellness. Together with Elaine Felix and Edner Desir, he conspired to control,

and did control, Wellness’ fraudulent operations.

189. Thelusma’s controlling ownership is detailed in the Statement of former Wellness

employee, Licensed Massage Therapist, Charles Vanderbrink which reads, in pertinent part, as

follows:

Q. … how did you come to work there? A. I was referred to by Joslyn Burns that his nephew, Robert Thelusma needed help at his clinic. They needed a massage therapist at their clinic on Old Winter Garden. Q. He needed help –- A. Yes. Q. -- at Wellness Pain & Rehab on Old Winter Garden? A. Yes, sir. Q. Okay, and were you told that Robert Thelusma was the owner? A. Yes, I was…. Q. Okay, all right, and did Robert tell you he was the owner? A. Yes. Q. Of Wellness Pain & Rehab?


25

A. Yes. Q. At this point had you met Dr. Vito yet? A. Yes, I have. He started working with us at Joslyn’s clinic on the corner of Old Winter Garden and Powers. Q. Okay, so you already knew Dr. Vito? A. Yes. Q. Did Dr. Vito ever tell you -– contradict Robert and say I’m the owner of Wellness Pain? A. No, he didn’t. Q. So the entire time that you worked for Wellness Pain did you believe to be Robert Thelusma to be the owner? A. Yes. I took orders from him and our checks were signed by Robert.

See Exhibit 9, pp. 12-14. 190. Vanderbrink also stated Wellness was billing for cookie cutter care and treatments that

were not being rendered to PIP Claimants:

Q. The treatments that these people were claiming to get they wouldn’t get most of the time; is that right? A. Yes, sir. Q. So whoever was getting the bills or whatever was getting bills for something that the patients were not getting? A. Yes, sir. Q. Okay, and that’s most of the time? A. Mm-mm. Q. Is that right? A. Yes, sir. Q. Okay, and then the actual treatments that were claimed, not that they were getting, was that all the same treatment? In other words, the same thing for everybody? A. Yes. Q. Was there any variance? A. No, no variance of our billing. Q. So in other words it was cookie-cutter treatment? A. Yes. Q. Same all the way? A. Mm-mmm. Q. Okay. Alleged treatment; right? A. Yeah. Q. Cookie-cutter billing is what you’re saying? A. Yes.


26

See Exhibit 9, pp. 24-25 191. Vanderbrink further explained the relationship between clinic employees, Thelusma,

Felix and Desir:

Q. Who was Edner Desir? A. Edner Desir was -– I was told he was a manager. He also drove a lot of our patients… Q. And then the owner, Elaine, tells you the manager is Edner Desir? A. Yes, like they worked together. I wasn’t quite a hundred percent sure on either of their roles. Q. Okay, but she was certainly in the capacity owner much more –- A. Yes. Q. -- than Vito? A. She signed our checks and made sure we were stocked up on the Clinic, like made orders for equipment and the like. Q. She paid the day to day bills? A. Yes. Q. Made the day to day decisions? A. Yes. Q. What about Desir? A. Desir, he didn’t seem to actually make any decisions. More or less he was also following orders from Elaine. Q. And Elaine was following orders from Thelusma? A. Yes.

See Exhibit 9, p. 26 192. Vanderbrink eventually realized that Wellness was routinely adding treatments to bills

that the patients had not received:

Q. How did you know that that was going on? A. After a while I just realized that all of the things we were billing for none

of our patients are receiving. Q. How did you find that out? A. Just by observation. Q . You looked at the bills? A . Yeah. Q . So you saw much greater billing going out than what were actually

services rendered? A . Yes. Q . And you said it’s an 80 percent greater?


27

A. Mm-mm. I remember at one time I actually would write down what they actually received, which would be either a massage or some traction. I would just write that down and it would be handed back to me about after a week, more of a disciplinary manner of like I need to bill for more of these things.

Q. Who did you hand it to? A. I would hand it to –- or it was handed to me by Robert Thelusma.

See Exhibit 9, pp. 27-28. (emphasis added.) 193. Vanderbrink explained that Wellness’ Chiropractors (Vito and McCarthy) played no

meaningful role in patient care:

Q. So when patients came in and you were there, you would be the sole

person to deal with those patients? A. Yes. Q. So you would know what percentage are getting treated and not? A. Yeah. Q. You’re in a clear position to know that? A. Mm-mm. Q . And you knew that about 80 percent of the people were not getting

thei r full treatments? A . Yes. Q . And they were just getting maybe one treatment and leaving? A . Yes, si r . Q . With some getting none? A . Mm-mm. Q . Is that right? A . Yes, si r . Q . O kay. And E laine knew this; r ight? A . Yes. Q . And Robert knew this? A . Yes. Q . And Dr . V ito knew this because he told you to do it? A . Yes. Q. Is that right? Okay, is that right? A. Yes, sir. Q. Who made out the paychecks? A. Elaine. We couldn’t cash them unless she signed them.

See Exhibit 9, pp. 31- 32 (emphasis added).


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194. A majority of Wellness patients would appear at the Clinic, sign in and then leave

without actually receiving any treatment.

195. Vanderbrink stated that most “patients” were not hurt and did not receive individualized

treatment:

Q. Did you feel like you were helping anybody over at Wellness Pain & Rehab?

A. Not necessarily, no, maybe only a handful of people. Q. Out of? A. Out of maybe –- let’s say three out of 30 people I was actually helping. Q. Okay, and the rest you don’t think were hurt? A. The rest I don’t -– yeah, I don’t think that they were hurt.

***

Q. And those days that you would sign those treatment forms were only those days you were there?

A. Yes, sir. Q. And in those days would be –- that would be Monday, Wednesday and

Friday; right? A. Yes. Q. And the doctor wouldn’t witness anything that you did? A. No. Q. Did he ever go over and ask you what you did? Did he repeatedly say did

you do this and hand you the soap notes? A. No. Q. Did he ever supervise any of the things that you did? A. No. Q. Did anyone supervise what you did? A. No, not at all. Q. Who decided –- so it was decided in advance of what you were going to

do with each patient? A. Yes. Q. And each patient the treatment was all the same? A. Yes. Q. Okay. A. No individualized treatment.

See Exhibit 9, pp. 35, 40-41.


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196. The Wellness bills mailed to GEICO represented that Wellness’ chiropractors were either

providing all of this treatment themselves or supervising properly Licensed Massage Therapists.

These representations were false.

197. When Arthur Vito stopped treating patients at Wellness, he was replaced by a

chiropractor named John McCarthy. Thereafter, members of the Wellness Group caused a stamp

of John McCarthy’s signature to be placed on Wellness’ CMS 1500 forms for treatment therapy

occurring five days per week, without his authorization. Dr. McCarthy never authorized anyone

at Wellness to create this signature stamp.

198. Neither Arthur Vito nor John McCarthy were supervising necessary care rendered by

Wellness’ Licensed Massage Therapists, as treatment was being rendered on days when neither

were present at Wellness.

199. These representations were intended to mislead, and did mislead, GEICO into believing

Wellness was rendering lawful treatment.

200. Vanderbrink ultimately confirmed that Vito left Wellness in September of 2011:

A. It was Elaine, Edner and Judna who worked there. Q. Both of them told you this at the same time? A. Yes, mm-mm. Q. It wasn’t Vito? A. No. Vito was long gone by then. Q. When did Vito leave? A. Vito left around sometime after September. Q. September 2011? A. 2011 he went – he told me he was moving back to New York.

See Exhibit 9, p. 49. 201. Each member of the Wellness Group knew that Wellness was:

a. billing for services not properly rendered; b. illegally soliciting patients and paying kickbacks to Runners who were staging crashes;


30

c. creating bills that misrepresented that physiotherapy modalities had been performed by Licensed Massage Therapists who were actually being supervised by Licensed Florida Chiropractors; d. allowing unlicensed individuals to administer treatment to its patients; e. routinely ordering unnecessary radiographs without clinical indications, that were not considered by Wellness employees while they administered the Clinic’s predetermined therapy protocols; and, f. following a pre-determined cookie cutter treatment plan wherein its employees provided chiropractic care that was excessive and designed to enrich the Wellness Group; rather than heal legitimate injuries.

202. Each member of the Wellness Group had actual knowledge that Wellness was causing

false bills to be mailed and/or that false bills would be mailed to GEICO in the ordinary course

of their scheme.

203. Even if each member of the Wellness Group did not know for certain that a particular

crash was staged, they reasonably knew that their conduct was causing staged crashes, fake

injuries, and/or unnecessary treatment for financial gain.

204. Each member of the Wellness Group intentionally adopted an attitude of willful blindness

with regards to the financial harm its conduct was causing GEICO, other automobile insurers in

Florida and the public at large.

F . DR . D O N R . W A K E F IELD’S EXPERT MEDICAL OPINIO N IN SUPPORT OF GEICO’S ALLEGATIONS AGAINST W E L L N ESS A ND T H E W E L L N ESS G R O UP

205. After paying the Wellness bills referenced in Exhibits 1 and 2 of this Amended

Complaint, but before commencing this lawsuit, GEICO caused the bills and records from the

Clinics to be reviewed and analyzed by Dr. Don R. Wakefield, DC, JD, PA. See Curriculum

Vitae of Dr. Don R. Wakefield, DC, JD, PA attached as Exhibit 5.


31

206. Dr. Wakefield’s expert analysis of all of the bills and records mailed to GEICO, along

with statements from patients, runners and clinic employees, demonstrates that Wellness and the

Wellness Group engaged in fraud by:

a. employing protocol or pre-programmed treatment plans for typical patients; b. following a protocol wherein individualized care was not provided to its patients; c. using deceptive billing practices throughout its records; d. employing unqualified personnel to perform therapeutic procedures and

modalities; e. routinely billing for services that were not provided; f. using a deceptive business structure designed to produce revenue, as opposed to

providing legitimate healthcare; and, g. using office procedures and clinical plans designed to deceive third party payors,

including GEICO, into compensating Wellness for unnecessary services and treatment not rendered. See Exhibit 6, (Fraudulent Medical Record Analysis Chart by Dr. Don R. Wakefield, DC, JD, PA).

207. Dr. Wakefield’s analysis demonstrates that Wellness implemented a cookie-cutter

treatment plan that would include in almost every instance, regardless of the patients’ condition

or the severity of the accident in question, unsupported or miscoded C.P.T. codes.

208. Dr. Wakefield determined that this type of protocol or programmed treatment plan did

not demonstrate legitimate individualized care, but instead, represented an unlawful

predetermined and systematic use of therapies/modalities and associated billing codes.

209. Ultimately, Dr. Wakefield opined that the claims submitted by Wellness involved

unlawful, excessive, and/or deceptive medical records/bills. This pattern of fraudulent billing

occurred in every GEICO claim involving Wellness.


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V I . THE DEFENDANTS DEFRAUDED GEICO BY CORRUPTING FLORIDA’S R E G U L A T O R Y SC H E M E R E L A T IN G T O PE RSO N A L INJUR Y PR O T E C T I O N B E N E F I TS A ND T H E OPE R A T I O N O F C H IR OPR A C T I C T R E A T M E N T F A C I L I T I ES

A . T H E B I L LS A ND R E C O RDS C R E A T E D A ND M A I L E D T O G E I C O B Y T H E D E F E ND A N TS W E R E UN L A W F U L , M ISL E A DIN G A ND C O N T A IN E D M A T E RI A L M ISR EPR ESE N T A T I O NS O F F A C T IN V I O L A T I O N O F F L O RID A L A W

210. Pursuant to the Florida Motor Vehicle No-Fault Law, §§627.730 – 627.7405, et seq.,

every owner or registrant of a motor vehicle, required to be registered and licensed in Florida, is

required to carry a minimum of $10,000.00 dollars in Personal Injury Protection insurance,

(hereinafter, “PIP”) which pays reasonable and necessary medical expenses, incurred for

legitimate accident-related injuries regardless of fault.

211. Pursuant to Fla. Stat. §627.736(1)(a), GEICO’s medical benefits coverage shall provide

reimbursement only for such services and care that are lawfully provided. (emphasis added).

212. Pursuant to Fla. Stat. §627.732(11), lawfully is defined as in substantial compliance with

all relevant applicable criminal, civil, and administrative requirements of state and federal law

relating to medical services or treatment. (emphasis added).

213. Pursuant to Fla. Stat. §627.736(4)(e), GEICO is only required to pay PIP benefits for

accidental bodily injury (emphasis added).

214. Pursuant to Fla. Stat. §627.736(2)(b), GEICO may exclude PIP benefits to any injured

person, if such person’s conduct contributed to his or her injury under any of the following

circumstances:

a. causing injury to himself or herself intentionally; or, b. being injured while committing a felony.


33

215. Pursuant to Fla. Stat. §817.234(1)(b), the reverse side of the standard CMS 1500 claim

form, submitted to GEICO by the Clinics in connection with the insurance claims identified in

Exhibits 1 and 2 of this Amended Complaint, contained the following warning:

Any person who knowingly files a statement of claim containing any misrepresentation of any false, incomplete or misleading information may be guilty of a criminal act punishable under law and may be subject to civil penalties.

216. To fulfill its obligation to promptly process claims under Florida’s No-Fault Law,

GEICO justifiably relied upon the accuracy of the Clinics’ CMS 1500 claim forms and

documentation submitted in support of PIP claims.

217. As a result, GEICO paid the Defendants and third parties, based on the representations

and information that Defendants sent, or caused to be sent, through the US Mails and interstate

wires.

218. The Defendant Clinics, clinic operators, Runners and Chiropractors intentionally filed

statements of claims – including CMS 1500 Forms – that contained misrepresentations,

incomplete information and misleading facts. In so doing, these Defendants violated Florida’s

PIP laws, and fraudulently billed No-Fault insurance carriers, including GEICO.

B . B Y USIN G ST R A W O W N E RS A ND BI L L IN G F O R F A LSE C H IR OPR A C T I C C A R E , T H E D E F E ND A N TS V I O L A T E D FLORIDA’S C H IR OPR A C T I C C L INI C L I C E NSIN G SYST E M

219. Pursuant to Fla. Stat. §400.990(2), health care Clinics are regulated to prevent significant

cost and harm to consumers. The purpose of this statute is to provide for the licensure,

establishment, and enforcement of basic standards for health care Clinics and to provide

administrative oversight by the Agency for Health Care Administration.


34

220. According to Fla. Stat. §400.9905(4) the term “Clinic” means an entity at which health

care services are provided to individuals and which tenders charges for reimbursement for such

services, including a mobile clinic and a portable equipment provider.

221. However, pursuant to Fla. Stat. §400.9905(4)(g), these licensure requirements for

“Clinics” do not apply to clinical facilities wholly owned and operated by individuals licensed

under Chapter 460, governing Chiropractic Medicine.

222. Pursuant to Fla. Stat. §460.4167(1), a person, other than a licensed chiropractic physician

or corporation that is wholly owned by one or more licensed chiropractic physicians, may not

employ a chiropractic physician licensed under this chapter or enter into a contract or

arrangement with a chiropractic physician pursuant to which such unlicensed person or such

entity exercises control over:

a. The selection of a course of treatment for a patient, the procedures or materials to be used as part of such course of treatment, and the manner in which such course of treatment is carried out by the licensee;

b. The patient records of a chiropractor; or, c. Decisions relating to office personnel and hours of practice.

223. Furthermore, pursuant to Fla. Stat. §460.4167(2), no person other than a licensed

chiropractic physician shall direct, control, or interfere with a chiropractic physician’s clinical

judgment regarding the medical necessity of chiropractic treatment.

224. The enumerated purpose of this statute is to prevent individuals, other than the licensed

chiropractic physician, from influencing or otherwise interfering with the exercise of a

chiropractic physician’s independent professional judgment.

225. The Clinics, Clinic Operators, and Chiropractor Defendants engaged in wrongful conduct

by conspiring to violate, and in fact violating, the above captioned Florida Chiropractic

Licensing System as follows:


35

a. By falsely representing to the public, the State of Florida, GEICO and other automobile insurers that Sadat Smith was the true owner and operator of KJ Chiropractic, and that Arthur Vito was the true owner of Wellness, in order to avoid Florida’s licensure requirements for “Clinics” owned and operated by unlicensed individuals;

b. By exercising improper control over:

i. The selection of the course of treatment; ii. The procedures or materials to be used as part of such

course of treatment; iii. The manner in which such course of treatment is carried

out by licensed clinic employees; iv. Patient records of a chiropractor; and, v. Decisions relating to office personnel and hours of practice.

c. By creating and maintaining an ongoing scheme wherein

unlicensed individuals regularly interfered with a chiropractic physician’s clinical judgment regarding the medical necessity of chiropractic treatment.

226. KJ Chiropractic, Smith, Wellness, Vito, Dorestant, Joseph, Thelusma, Felix and Desir,

violated Chapters 400, 408 and 460 because KJ Chiropractic and Wellness were secretly owned

by unlicensed clinic operators who created unlawful fraudulent bills and records.

227. Although KJ Chiropractic claims to be wholly owned by Smith, it is actually owned by

Dorestant.

228. Smith was not the “owner” as contemplated in the licensure exemption provided in Fla.

Stat. §400.9905 (4)(g) and his listed ownership was solely for the purpose of avoiding the

licensing requirements of Fla. Stat. §§400.990 - 400.995 and Fla. Stat. §§408.801 - 408.832.

229. Similarly, Vito was not the “owner” of Wellness as contemplated by the statute. The

true proprietors of Wellness, Thelusma and Felix, maintained Vito’s name of the Clinic’s public

documents to avoid the above-captioned licensing requirements.


36

230. Smith and Vito did not supervise the business activities at KJ Chiropractic or Wellness as

required by Fla. Stat. §400.9905 (4)(g), nor make appropriate efforts to ensure that the Clinics

complied with Florida statutes, as required by Fla. Stat. §400.9905 (4)(g).

231. Belle Management, a company owned by Dorestant, actually supervised the daily

operations of KJ Chiropractic, even though the Clinic was purportedly owned by Smith. Belle

Management, through Dorestant and Joseph, coordinated virtually every aspect of KJ

Chiropractic’s corrupt operations.

232. Dorestant, Joseph, Thelusma and Felix operated and controlled KJ Chiropractic and

Wellness even though they are not licensed health care practitioners. Their conduct violates the

exemption requirements set forth in Fla. Stat. § 400.9905 (4)(g).

233. Even though Dorestant, Joseph, Felix and Thelusma were the de-facto owners of the

Clinics, they never obtained clinic licenses as required by Florida law.

234. Fla. Stat. §400.9935 makes all charges or claims by an unlicensed clinic unlawful and

noncompensable.

235. Defendants, KJ Chiropractic and Wellness, sought reimbursement for what they

represented to be lawful and necessary chiropractic services related to accidents involving

GEICO PIP claimants. See Exhibits 1 and 2.

236. KJ Chiropractic and Wellness took assignments for benefits from GEICO’s PIP

Claimants so they could directly bill GEICO for services.

237. Bills for reimbursement were mailed to GEICO on CMS 1500 forms. These forms

represent that lawful services were rendered to the GEICO PIP claimants listed in Exhibits 1 and

2.


37

238. The CMS 1500 forms were repeatedly mailed to GEICO for its consideration and

payment with corresponding medical records certified by KJ Chiropractic and Wellness to be

true and correct.

239. Relying upon the accuracy of the CMS 1500 invoices and accompanying medical records

submitted by KJ Chiropractic and Wellness, GEICO paid these clinics the amounts listed in

Exhibit 2 attached to this Amended Complaint.

240. As described herein, the services rendered by KJ Chiropractic and Wellness were

unlawful and in violation of Fla. Stat. §627.736 (1)(a).

C . SMITH, VITO, AND COHEN’S FRAUDULENT CONDUCT VIOLATED FLORIDA’S LAWS FOR HEALTH CARE PROFESSIONALS 241. Fla. Stat. §§ 456.072 & 460.413 outline specific prohibitions which apply to the practice

of health care professionals.

242. Smith, Vito, and Cohen repeatedly engaged in wrongful conduct by violating sections

(b), (c), (d) and (f) of §456.072(1).

243. Smith, Vito and Cohen repeatedly engaged in wrongful conduct by violating sections (a),

(b), (c), (d), (g), and (h) of §460.413.

244. In addition to the foregoing, KJ Chiropractic, the KJ Chiropractic Group, Wellness and

the Wellness Group facilitated the referral of patients in violation of Fla. Stat. §817.234 and

§817.505. Such violations include, but are not limited to, the following:

a. Soliciting and causing business to be solicited from a person involved in a motor vehicle accident for the purpose of making or settling a motor vehicle tort claim or claim for PIP benefits;

b. Offering and paying commissions, bonuses, rebates, kickbacks, and bribes, directly and indirectly, in cash and in kind, and split-fee arrangements to induce the referral of patients or patronage to a health care provider or health care facility;

c. Soliciting and receiving, commissions, bonuses, rebates, kickbacks, and bribes, directly and indirectly, in cash and in kind, and split-fee arrangements in return


38

for the acceptance or acknowledgement of treatment from a health care provider or health care facility; and,

d. Aiding and abetting this process.

245. The bills submitted to GEICO by the KJ Chiropractic Group and Wellness Group were

not lawfully provided pursuant to Fla. Stat. §§§400.9935(3), 627.736(1), 627.736(2), 817.234

and 817.505, and are therefore not compensable.

V I I . T H E ST A T E O F F L O RID A H AS C O M M E N C E D C RI M IN A L A C T I O NS A G A INST ESDR AS PI E RR E L O UIS, SH E NI K A RI C H A RDSO N , H ASH L E Y MOCOMBE, YVIO L’ESPERANCE, H E NR Y PR E V A L A ND L ESL I E L O W E A RISIN G O U T O F T H E IR INSUR A N C E F R A UD A C T I V I T I ES

246. After the Defendants submitted bills to GEICO for payment of claims associated with

staged accidents, the State of Florida commenced criminal actions against certain individuals

who participated in these staged accidents in violation of Florida law.

247. Defendant, Esdras Pierre Louis, was identified by Queena McRae and Chanel Akins, as

the individual who planned, arranged and staged motor vehicle accidents for the purposes of

defrauding insurance companies.

248. On or about December 2, 2011, Esdras Pierre Louis was arrested and charged with

Staging Motor Vehicle Crashes in violation of Fla. Stat. §817.234(9), Engaging in a Scheme to

Defraud in violation of Fla. Stat. §817.034(4)(a)(3) & Filing False and Fraudulent Insurance

Claims in violation of Fla. Stat. §817.234(11)(a). (case number 2011-CF-06155).

249. On April 5, 2013, Pierre Louis proffered Deposition testimony in this criminal matter that

corroborated GEICO’s allegations regarding this staged accident scheme.

250. Specifically, as stated above, Pierre Louis’ testimony confirmed that:

a. The May 1, 2011 alleged accident (GEICO Claim No. 0415141630101010) from GEICO’s Complaint was a staged event, and the medical bills submitted to


39

GEICO by KJ Chiropractic and Wellness Pain & Rehab, Inc. (“Wellness”) were false. (Exhibit 10, pp. 9-11; 57-59);

b. Pierre Louis and Defendant, Jean Cassamajor (“Cassamajor”) worked together in an ongoing scheme to stage accidents with Dorestant. (Exhibit 10, pp. 11-16; 46-53);

c. Dorestant was the secret owner of KJ Chiropractic. (Exhibit 10, pp. 16-18, 24); d. Pierre Louis would refer fraudulent patients to KJ Chiropractic, while Cassamajor

would refer fraudulent patients to Wellness Pain & Rehab, Inc. (Exhibit 10, pp. 4, 51-54);

e. Dorestant paid Pierre Louis (approx. $1,000.00) to stage crashes and refer patients for “treatment” at KJ Chiropractic. (Exhibit 10, pp. 4, 6, 11-12);

f. “Patients” would only be paid by the Clinics if they presented at the Clinic 15 times. (Exhibit 10, pp. 11, 68);

g. Pierre Louis had unrestricted access within KJ Chiropractic. (Exhibit 10, p. 55); h. Pierre Louis was in the KJ Chiropractic facility over 100 times. (Exhibit 10, pp.

61); i. Dorestant instructed Pierre Louis to establish automobile insurance policies with

GEICO because their quotes for policies were the lowest. (Exhibit 10, pp. 47-48); and,

j. Dorestant informed Pierre Louis that he continues to own other chiropractic clinics, including Orange County Rehab on West Colonial Avenue in Orlando, Florida. (Exhibit 10, pp. 22-25).

251. On or about December 16, 2011, Defendant, Richardson, who also participated in the

identified staged accident from May 1, 2011, GEICO claim no. 0418141630101010, was arrested

and charged with Staging Motor Vehicle Crashes in violation of Fla. Stat. §817.234(9) &

Engaging in a Scheme to Defraud in violation of Fla. Stat. §817.034(4)(a)(3).

252. Following the staged crash, Richardson submitted a claim to GEICO, knowing it to be

false and presented for treatment at KJ Chiropractic in order to get paid for her involvement in

the scheme.

253. Richardson has pleaded guilty to Petit Theft in violation of Fla. Stat. §812.014(2)(e). in

connection with the staged accident.

254. In early 2012, Henry Preval, Hashley Mocombe and Yvio L’esperance were also arrested

and charged with Staging Motor Vehicle Crashes in violation of Fla. Stat. §817.234(9), Engaging

in a Scheme to Defraud in violation of Fla. Stat. §817.034(4)(a)(3) & Filing False and Fraudulent


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Insurance Claims in violation of Fla. Stat. §817.234(11)(a) in connection with their involvement

in the staging of the same May 1, 2011 accident. Following the staged crash, these claimants

presented at Wellness for “treatment.”

255. On or about May 31, 2013, Leslie Lowe was also arrested and charged with Staging

Motor Vehicle Crashes in violation of Fla. Stat. §817.234(9), Engaging in a Scheme to Defraud

in violation of Fla. Stat. §817.034(4)(a)(3) in connection with her involvement in the staging of

the confessed staged accident involving Queena McRae from May 4, 2011.

V I I I . O V E R V I E W O F PIP A U T O M O BI L E INSUR A N C E C L A I MS I L L UST R A T IN G H O W K J C H IR OPR A C T I C , T H E K J C H IR OPR A C T I C G R O UP, W E L L N ESS A ND T H E W E L L N ESS G R O UP E N G A G E D IN A PA T T E RN O F C O NDU C T T O D E F R A UD G E I C O IN V I O L A T I O N O F F E D E R A L A ND F L O RID A ST A T E RI C O ST A T U T ES

256. The confessions provided by five PIP claimants (i.e., Defendants, Shenika Richardson,

Shayla Gaines, Queena McRae, Chanel Akins, and Shantrese Williams; former KJ Chiropractic

employee Robert Cohen, former Wellness employees, John McCarthy, and Charles Vanderbrink

(Exhibit 9); and, Runner, Esdras Pierre Louis (Exhibits 10 and 13) exposed the existence of a

sophisticated - - and previously undetected - - staged accident ring. Their testimony indicated

that Runners, Esdras Pierre Louis, Jean Cassamajor, Vladimir “Rico” Jean Pierre, Jean Dorestant

and others were conspiring to fake crashes and create false medical bills so they, the PIP

claimants, the Clinics, and others, could obtain money from GEICO, and other insurers, that they

had no right to receive.

257. The above referenced statements and confessions exposed a long standing insurance

fraud enterprise that employed a consistent modus operandi to defraud automobile insurers,

including GEICO. They revealed that the crash organizers were using a “fake accident recipe”

that followed an identifiable pattern; a pattern and common plan that had been almost impossible


41

to detect before the acquisition of these confessions. Indeed, this testimony indicates that

accidents were being staged before 2009. Moreover, since the closure of KJ Chiropractic and

Wellness, Defendants, Jean Dorestant and Vladimir “Rico” Jean Pierre, have continued staging

accidents in the Orlando area.

258. This pattern was not previously detected by GEICO for several reasons. Florida PIP law

imposes significant financial penalties upon automobile insurers who fail to promptly pay PIP

medical bills. The Defendants knew that the threat of these penalties would pressure GEICO to

pay PIP claims quickly. These PIP laws - - in conjunction with an extremely high volume of PIP

claims - - allowed the Defendants to defraud large amounts of money from GEICO in a relatively

short period of time using the U.S. Mails/Wires.

259. In addition to the evidence captioned above, the operation, interconnectedness,

continuity, and pattern of fraudulent conduct, engaged in by KJ Chiropractic, the KJ Chiropractic

Group, Wellness and the Wellness Group, can be illustrated by analyzing the claims themselves.

As demonstrated below, these claims share a common Staged Crash Profile.

A . SU M M A R Y O F G E I C O PIP C L A I MS W H E R E IN A C C ID E N T V I C T I MS H A V E A D M I T T E D T H A T T H E IR C R ASH ES W E R E ST A G E D A ND T H A T T H E C H IR OPR A C T I C C A R E R EPO R T E D L Y R E ND E R E D B Y K J C H IR OPR A C T I C A ND W E L L N ESS W AS F R A UDULENT (HEREINAFTER, “THE CONFESSION FILES”) May 1, 2011 (Admitted Staged Accident) Named Insured: Shenika L . Richardson G E I C O C laim No.: 0415141630101010 Involved C linics: K J Chiropractic and W ellness 260. On May 2, 2011, GEICO received an automobile insurance claim seeking PIP Benefits

from Richardson. At first blush, this claim appeared to arise out of a routine two vehicle crash.

261. An investigation undertaken by GEICO subsequently revealed that this “accident” was, in

fact, one in a series of staged events.


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262. GEICO insurance policy application records document that Richardson applied for a

GEICO policy on or about April 11, 2011. This policy was applied for by telephone. The policy

was issued for a 1996 Mercedes on April 12, 2011. The policy number was 4227-55-84-44.

263. On May 2, 2011, GEICO received a telephone call from Richardson wherein she claimed

that her GEICO insured 1996 Mercedes Benz had been involved in a crash on May 1, 2011 with

a 1998 Jaguar insured by Farmers/21st Century and reportedly owned by a person named Hashley

Mocombe. According to Ms. Richardson, her Mercedes was being operated by Shayla Gaines

while Richardson rode as a passenger.

264. The reported time of the accident was 9:26 P.M.

265. According to the Florida Traffic Crash Report [hereinafter, “FTCR”], the accident

reportedly occurred on 5 Powers Drive, fifty feet from an intersection with Old Winter Garden

Road.

266. The author of the FTCR, Trooper J.A. Evans, issued a citation to Shayla Gaines for

failing to yield at a crosswalk (Citation No.: 1512 SVC). Trooper Evans went on to state in his

FTCR as follows:

Note: Both drivers appeared to be dishonest in their statements and I suspected that the traffic crash was staged. I noticed that Peter Towing (440 Metcalf Ave., Orlando FL 32811 (407) 758-8250) was already at the scene when I arrived. I observed that Peter Towing towed both vehicles, which is very uncommon. I also thought it was suspicious when the driver of VO1 asked the driver of VO2 “Are you going to pay my ticket?”

267. The tow truck company referred to by Trooper Evans is Peter Towing at 440 Metcalf

Avenue, Orlando, Florida. This is the same address used by another tow truck company called

“Power Towing.” As discussed below, Peter Towing and Power Towing are involved in many

of the GEICO claims identified in this Amended Complaint.


43

268. Between May 2, 2011 and July 22, 2011, GEICO received a series of documents via U.S.

Mail related to the adjustment of this claim including, but not limited to, property damage

records and documents from KJ Chiropractic and Wellness. The records represented the PIP

Claimants had been injured in this “accident” and were receiving treatments at the Clinics.

269. On May 5, 2011, a person identifying himself as Hashley Mocombe called GEICO and

demanded that it pay to repair his Jaguar.

270. During its investigation of the claim, GEICO learned that Hashley Mocombe was the

roommate of a person named Clivens Baltazar. Clivens Baltazar is a licensed massage therapist

who worked at Wellness during the time in question. Hashley Mocombe reported to

Farmers/21st Century Insurance Company that he and his two passengers (Henry Preval and Yvio

L’esperance) treated for back related injuries at Wellness. The Farmers/21st Century Insurance

Company’s Claim Number is 1018556519. The occupants of the GEICO insured Mercedes

reportedly treated at KJ Chiropractic for back injuries.

271. Prior to May 1, 2011, Sadat Smith informed GEICO that he would not allow its

representatives to inspect the KJ Chiropractic clinic or review medical documentation within the

facility. Smith would only make medical records available at the office of his legal counsel. For

this reason, GEICO SIU investigator, Randall Gibson, traveled to the office of KJ Chiropractic’s

legal counsel on August 1, 2011 to inspect KJ Chiropractic’s treatment records for Shayla Gaines

and Shenika Richardson.

272. The KJ Chiropractic consultation report presented to Gibson by KJ Chiropractic’s legal

representatives on August 1, 2011 records that Shenika Richardson was examined by KJ

Chiropractic chiropractor, Miyoashi Gay, on May 3, 2011.


44

273. The consultation report and SOAP notes for Shayla Gaines records that Dr. Gay

reportedly examined and treated Gaines on May 10, 2011 and May 13, 2011.

274. The KJ Chiropractic bills sent to GEICO for Shayla Gaines and Shenika Richardson all

have “Miyoashi A. Gay, D.C.’s” name typed in the lower left hand corner. These bills show

numerous dates of treatment. See CMS 1500 forms pertaining to Shayla Gaines and Shenika

Richardson attached hereto as Exhibit 11.

275. As discussed below, Shayla Gaines stated to Randall Gibson (in a recorded statement

taken on July 22, 2011) that this accident was staged, that she was not injured, and that she never

was examined by any female chiropractor at KJ Chiropractic. Ms. Gaines’ statement reads, in

pertinent part, as follows:

R G: All Right. Did you ever talk to the Chiropractor? The female chiropractor there? SG L : No. Every time I went, she was never there.

276. In connection with the Shenika Richardson and Shayla Gaines claims, KJ Chiropractic

billed GEICO for treatment that was not rendered and/or that did not represent reasonable or

necessary chiropractic care.

277. The accident organizer identified by Shenika Richardson and Shayla Gaines as “Elijah,”

is, in fact, Defendant, Esdras Pierre Louis.

1. C O N F ESSI O N T EST I M O N Y O F SH E NI K A RI C H A RDSO N T A K E N O N JU L Y 22, 2011. 278. On July 22, 2011, Shenika Richardson appeared for an examination under oath regarding

an alleged accident that occurred on May 1, 2011 (GEICO Claim No. 0418141630101010).

279. Ms. Richardson admitted that the accident of May 1, 2011 was “fake.”

280. Ms. Richardson admitted that she became involved in this scheme through her friend

“Elijah.”


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281. Ms. Richardson admitted that “Elijah” purchased a white Mercedes and asked her to put

the vehicle in her name.

282. Ms. Richardson admitted that “Elijah” asked her to have the vehicle insured. He also

instructed Ms. Richardson regarding how to purchase insurance with full coverage and rental car

reimbursement.

283. Ms. Richardson admitted that “Elijah” gave her approximately $200.00 dollars to pay for

insurance. Ms. Richardson then established a GEICO policy as “Elijah” instructed.

284. Ms. Richardson admitted that on the date of loss she had reservations about participating

in the staged accident and ultimately the risk of getting in trouble. However, “Elijah” assured her

that she would not get in trouble and that, “they always do it.”

285. Ms. Richardson admitted that she was offered $500.00 dollars by “Elijah” to participate

in a staged motor vehicle accident.

286. Ms. Richardson admitted that on the date of loss, she and Ms. Gaines met “Elijah” and

the other accident organizers at approximately 8 P.M. at a chiropractic clinic on Old Winter

Garden Road, which she identified as KJ Chiropractic. Ms. Richardson stated that the accident

organizers entered the Clinic using a key.

287. Ms. Richardson stated that the men staging the collision waited “for the coast to be

clear,” so there would be no witnesses.

288. Ms. Richardson stated that the white Mercedes involved was made to look as though it

was pulling out of the parking lot, while a man in a Jaguar drove into the Mercedes.

289. Ms. Richardson admitted that she witnessed the collision take place while she stood with

the other staged accident participants in a parking lot nearby.

290. Ms. Richardson admitted that she and Shayla Gaines did not enter the vehicle


46

until after the staged collision.

291. Ms. Richardson stated that four men jumped in the Jaguar and falsely claimed to be in the

collision.

292. Ms. Richardson stated that the accident organizers left as soon as the collision took place.

293. Ms. Richardson admitted that nothing she told the Florida Patrolmen was true, because it

was all staged.

294. Ms. Richardson admitted that she met Ms. Gaines and “Elijah” the next day outside of KJ

Chiropractic in order to report the accident to GEICO.

295. Ms. Richardson admitted that “Elijah” coached her regarding what she should say when

reporting the accident.

296. Ms. Richardson admitted that she fraudulently informed GEICO that she had pain in her

back as a result of this “accident.”

297. Ms. Richardson admitted that immediately after reporting the accident to GEICO, she

entered KJ Chiropractic and filled out paperwork.

298. Ms. Richardson stated that “Elijah” and the employees of KJ Chiropractic instructed her

to go to the Clinic three times per week.

299. Ms. Richardson admitted that GEICO paid approximately $3,500.00 dollars to repair the

white Mercedes in her name. Pursuant to their agreement, she gave this money directly to

“Elijah”.

300. Ms. Richardson admitted that whenever she received something from GEICO she called

“Elijah.”


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2. C O N F ESSI O N O F SH A Y L A G A IN ES T A K E N O N M A Y 1, 2011

301. On or about July 28, 2011, Shayla Gaines provided a recorded statement to GEICO’s SIU

investigator, Randall Gibson, regarding an alleged accident that occurred on May 1, 2011

(GEICO Claim No. 0418141630101010).

302. Ms. Gaines admitted that the alleged accident on May 1, 2011 was “faked.”

303. Ms. Gaines admitted that “Elijah” was going to pay undisclosed shares to Ms. Gaines and

Ms. Richardson for their participation in the staged accident.

304. Ms. Gaines admitted that on the date of the alleged accident, Ms. Richardson picked her

up at home and drove her to Old Winter Garden Road to meet with “Elijah” and the other staged

accident participants.

305. Ms. Gaines stated that she first found out about the staging of the accident at

approximately 6 or 7 P.M. on May 1, 2011, when she arrived at the “chiropractor’s office” on

Old Winter Garden Road.

306. Ms. Gaines stated that the men who arrived spoke amongst themselves. Then a short,

bald man instructed her to follow them to the accident scene.

307. Ms. Gaines stated that the Jaguar and Mercedes she had previously seen at the

chiropractic office were the vehicles used in the staged accident.

308. Ms. Gaines stated that the short, bald man intentionally drove the Jaguar into the

Mercedes, which was unoccupied.

309. Ms. Gaines stated that she believed the Mercedes used in staging this accident to be

inoperable and that it was pulled to the accident site on a rope by the Jaguar.

310. Ms. Gaines admitted that after the collision occurred, she and Shenika Richardson

entered the Mercedes while the other accident participants entered the Jaguar.


48

311. Ms. Gaines stated that she was instructed to claim an injury to her back as a result of the

accident.

312. Ms. Gaines admitted that she met with “Elijah” outside of KJ Chiropractic in order to

report the accident to GEICO.

313. Ms. Gaines admitted that her first report to GEICO consisted of the false story line that

she had been provided by the accident stagers, and that there was no truth to anything she

reported.

314. Ms. Gaines stated that she had been instructed by the short, bald man to go to KJ

Chiropractic approximately 20 times.

315. Ms. Gaines admitted that after the accident, she began to present for treatment at KJ

Chiropractic despite not having been in the vehicle at the time of impact.

316. Ms. Gaines admitted that the female chiropractor was never there when she was at KJ

Chiropractic. This is significant because of the May 10, 2011 Assessment and the May 13, 2011

SOAP Notes which represent that Dr. Gay treated Ms. Gaines on those dates and are attached

hereto as Exhibit 12.

317. KJ Chiropractic also presented numerous CMS 1500 forms to GEICO bearing Miyoashi

Gay’s name representing that treatment and therapies had been administered. Ms. Gaines

admitted that her visits consisted solely of filling out papers and signing-in to the Clinic.

318. Ms. Gaines admitted that she did not have the bald man’s contact information. However,

Ms. Gaines stated that when she called and asked for “the driver,” the employees at the Clinic

knew who she was referencing.


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319. On April 5, 2013, Runner Defendant Esdras Pierre Louis admitted under oath that this

staged “accident” was a staged event designed to defraud GEICO into paying false medical bills

created by the KJ Chiropractic and Wellness Groups.

Date of Loss: May 4, 2011 Named Insured (Initials): L eslie Lowe (A r rested) G E I C O C laim No.: 0404807430101014 A ND Named Insured (Initials): Queena McRae (Admitted Staged Accident) G E I C O C laim No.: 0419394450101029 Involved C linics: K J Chiropractic and W ellness 320. On May 5, 2011, GEICO received notice via telephone of a two car collision involving

GEICO named insured, Queena McRae (Claim No. 0404807430101014).

321. Ms. McRae reported that while driving her 1997 Mercury Grand Marquis she rear ended

a 2006 Pontiac Grand Prix. A traffic accident report (FHPD110FF036744) indicates that Ms.

McRae reported that a collision occurred at 9:13 P.M. on Old Winter Garden Road near the

intersection with Carolina Avenue. The FHPD lists no witnesses or passengers in either vehicle.

Fla. Stat. §316.068 states, in part, that the names and addresses of all passengers in the vehicles

involved in a crash must be listed on the crash report and that the absence of this information

constitutes a rebuttable presumption that no such passengers were involved in the reported crash.

322. Ms. McRae reported that she and her passenger, Leslie Lowe, suffered back related

injuries and were transported to the hospital by ambulance. Both Lowe and McRae treated at KJ

Chiropractic. Lowe sought PIP benefits under a separate GEICO policy (Claim No.

0404807430101014). Lowe was added to her daughter’s GEICO policy on May 2, 2011, just

two days before the May 4, 2011 crash.


50

323. The occupants of the 2006 Pontiac Grand Prix, AJ and MM, reportedly treated at

Wellness.

324. GEICO policy records document that McRae’s policy was obtained only six days before

the May 4, 2011 reported crash.

325. Between May 5, 2011 and September 22, 2011, GEICO received dozens of documents

via U.S. Mail related to the adjustment of this claim, including but not limited to, documents

relating to the resolution of the vehicle property damage claims, and medical bills and records

from KJ Chiropractic and Wellness. Included in these documents were reports from Wellness

indicating that AJ and MM were treated by Arthur Vito on numerous occasions between May 10,

2011 and June 14, 2011.

326. The medical records created by Wellness for AJ and MM are false in that they represent

billings for treatments that were not actually rendered to the patients for legitimate injuries.

327. Queena McRae identified Jean Cassamajor and Esdras Pierre Louis as two of the accident

organizers in the May 4, 2011 fake accident.

3. C O N F ESSI O N O F Q U E E N A M C R A E T A K E N O N SEPT E M B E R 15, 2011

328. On September 15, 2011, Queena McRae provided a two part recorded statement to

GEICO’s SIU investigator, Randall Gibson, regarding an alleged accident that occurred on May

4, 2011. (GEICO Claim No.: 0419394450101029).

329. Ms. McRae admitted that she became a policyholder with GEICO approximately one

month prior to the date of the accident.

330. Ms. McRae admitted that the accident was a staged event, performed solely for the

purpose of obtaining money.


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331. Ms. McRae stated that a man whom she knew as, “E” coordinated the staging of these

accidents.

332. Ms. McRae identified a picture of the Defendant, Esdras Pierre Louis, as the individual

that she knew by the name, “E”.

333. Ms. McRae admitted that, she also met “Rico,” Esdras Pierre Louis’ co-conspirator, at a

gas station on Old Winter Garden Road.

334. Ms. McRae admitted that as she spent time with "Rico" and Esdras Pierre Louis, they

began to discuss how they made money and asked if she would be interested in participating in

staging an accident.

335. Ms. McRae stated that they described staging accidents as their “own little business.”

336. Ms. McRae stated that Esdras Pierre Louis’ brother, “Tony,” was also involved in the

planning and staging of accidents.

337. Ms. McRae admitted that Esdras Pierre Louis informed her that she would be paid

$500.00 dollars for going to the chiropractor and that she would be given a “bonus” of $500.00

dollars after presenting for treatment.

338. Ms. McRae stated that she did not have to do anything and that Esdras Pierre Louis and

“Rico” assured her that they would take care of everything.

339. Ms. McRae stated that “Rico” told her that she would recover money from the damage to

her car in addition to the $500.00 dollar payment for going to the chiropractic clinic.

340. Ms. McRae testified that on the date of the accident, she received a telephone call from

Esdras Pierre Louis, who informed her that she would need to meet them at the accident site later

that evening.


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341. Ms. McRae admitted that she met all of the staged accident participants at a Walgreens’

parking lot on Old Winter Garden Road at approximately 7 or 8 P.M.

342. Ms. McRae stated that the short man pulled off of a side street, approached a vehicle in

front of him, and waited to see brake lights before intentionally striking the other vehicle from

behind.

343. Ms. McRae stated that after the staged collision, the short man who was driving exited

the vehicle and fled the scene.

344. Ms. McRae admitted that she was contacted by accident organizers the day after the

collision. She stated that "Rico" was upset that she went to the hospital and did not simply seek

chiropractic treatment.

345. Ms. McRae testified that Esdras Pierre Louis called her the day after she went to the

hospital. He told Ms. McRae that “we know how to handle these people,” with regard to

reporting the accident to GEICO.

346. Ms. McRae admitted that she reported the staged accident to GEICO the next day and

that she was not truthful in her report.

347. Ms. McRae admitted that she was picked up by the accident organizers a few days later

and brought to KJ Chiropractic with instructions to treat there in order to get paid.

348. Ms. McRae stated that the accident organizers constantly emphasized that she continue to

treat at KJ Chiropractic.

349. Ms. McRae stated that often times when she presented at KJ Chiropractic, she

encountered the bald man who had staged the accident.

350. Ms. McRae stated that she believed this man to be the owner of KJ Chiropractic because

there appeared to be “no limit” to his access within the Clinic.


53

351. Ms. McRae stated that the accident organizers were familiar with the Clinic. She stated

that “they’re all family there.”

352. Ms. McRae stated that she continued to see “Tony” and "Rico" at KJ Chiropractic when

she would receive treatment.

353. Ms. McRae stated that she believed the receptionist, “Tasha,” knew that her accident was

staged as she would call Ms. McRae and say things to the effect of, “you’re going to come

today” and “you have to keep coming.”

354. Medical records mailed to GEICO by KJ Chiropractic in connection with this claim

reveal that a Licensed Massage Therapist named Natacha LeGrand was reportedly involved in

treating Queena McRae.

355. Ms. McRae stated that the employees at KJ Chiropractic did not want her to go to her

own doctor.

356. Ms. McRae stated that ultimately she had to change her telephone number so "Rico" and

Esdras Pierre Louis would stop bothering her about the staging of accidents.

357. About a week after the accident, GEICO paid Ms. McRae approximately $1,800.00

dollars for the damage to her car as a result of the staged collision.

358. On April 5, 2013, Runner Defendant, Esdras Pierre Louis, admitted that he and

representatives of KJ Chiropractic, (Dorestant) and Wellness, (Cassamajor), and other Runners

(Rico) regularly staged accident involving GEICO. These May, 2011 accidents claims represent

two such claims and illustrate the Defendants’ pattern of staged accidents described throughout

the balance of this Amended Complaint.


54

Date of Loss: May 17, 2011 (Admitted Staged Accident) Named Insured (Initials): Queena McRae G E I C O C laim No.: 0419394450101037 Involved C linics: K J Chiropractic 359. Thirteen days after the May 4, 2011 reported accident, a second claim was presented

under Queena McRae’s GEICO policy.

360. In this claim, a woman named Chanel Akins was supposedly driving Queena McRae’s

2000 Ford Focus.

361. The circumstances of the reported accident were identical to the May 1, 2011 and May 4,

2011 accidents described above that were ultimately determined to be entirely fraudulent.

362. As discussed below, Akins eventually admitted to GEICO that the May 17, 2011 accident

was a staged crash.

4. C O N F ESSI O N O F C H A N E L A K INS T A K E N O N JA NU A R Y 25, 2012 363. On January 25, 2012, Chanel Akins appeared for an examination under oath regarding an

alleged accident that occurred on May 17, 2011 (GEICO Claim No.: 0419394450101037).

364. Ms. Akins admitted that she received a telephone call from her friend, Candice Toomer,

who informed her that a man named, “Eddie” was recruiting people to stage accidents. Ms.

Akins admitted that she spoke to “Eddie” who told her that she could earn up to $1,000.00

dollars by serving as the driver of a staged accident vehicle.

365. Ms. Akins identified an individual in a photograph and stated that it was the man she

knew as “Eddie.” The individual in the photograph was Esdras Pierre Louis.

366. Ms. Akins stated that Esdras Pierre Louis informed her that she would receive $500.00

dollars up front and another $500.00 dollars after the staged accident.

367. Ms. Akins admitted that on the date of the accident, she was picked up at her residence

and transported by Esdras Pierre Louis to the site of the staged accident.


55

368. Ms. Akins admitted that while she and Esdras Pierre Louis waited for a telephone call to

determine where the accident would take place, they heard the sound of a collision nearby.

369. Ms. Akins admitted that she and Esdras Pierre Louis then drove to the scene of the

accident where the vehicles were arranged to make it appear as if a real accident had taken place.

370. Ms. Akins admitted that she was instructed by Esdras Pierre Louis to fabricate a story in

which, she knew Queena McRae, that Ms. McRae had let her use her vehicle, and that something

caught her attention while driving which caused her to rear-end the vehicle in front of her.

371. Ms. Akins admitted that Esdras Pierre Louis told her to act nervous and apologetic when

the police arrived at the scene of the accident.

372. Ms. Akins admitted that Esdras Pierre Louis instructed her to go to the chiropractor and

that the insurance company would eventually call to obtain her statement.

373. Ms. Akins admitted that Esdras Pierre Louis selected the chiropractic clinic where she

would present for treatment.

374. Ms. Akins admitted that Esdras Pierre Louis told her that once she went to the

chiropractor, they were going to give her the rest of her money.

375. Ms. Akins admitted that a representative from the chiropractic clinic called her two days

after the accident and informed her that someone would be coming to pick her up and transport

her to the facility on Old Winter Garden Road.

376. Ms. Akins admitted that the chiropractic facility that she was transported to was located

on Old Winter Garden Road next to the Starlight Lounge and a bakery. This is the location of KJ

Chiropractic.

377. Ms. Akins stated that when she first arrived at KJ Chiropractic it was, “completely

empty. No noise, no nothing. No movement.”


56

378. Ms. Akins admitted that she filled out paperwork, but was not examined by anyone.

379. Ms. Akins admitted that the women behind the desk at KJ Chiropractic told her that

Esdras Pierre Louis would be coming in and giving her money.

380. Ms. Akins stated KJ Chiropractic was “creepy,” which was the catalyst for attempting to

“treat” elsewhere.

381. Ms. Akins stated that the only reason she presented for chiropractic treatment was that

she was told to do so by the accident organizers.

382. Ms. Akins stated that people would enter the Clinic, go to the office, and were paid with

“little envelopes.”

B . C O N F ESSI O NS O F B Y RUNN E R D E F E ND A N T , ESDR AS PI E RR E L O UIS

383. In depositions conducted April 5, 2013 and June 28, 2013, Runner Defendant, Esdras

Pierre Louis, admitted that he and representatives of KJ Chiropractic (Dorestant) and Wellness

(Cassamajor), and other Runners (Rico), regularly staged crashes involving GEICO insured

vehicles.

384. Esdras Pierre Louis explained that after meeting Jean Dorestant, he was offered a role in

Dorestant’s business of staging accidents:

Q: Okay. Did you later learn that this gentleman, Ed's full name was Jean Dorestant? A: Yes, sir. Q: And you and he became friends? A: Yes, sir. Q: And he asked you if you wanted to get involved in his business? A: Yes, sir.

Exhibit 13, p. 10, ¶¶ 11-18. 385. Pierre Louis admitted that the accidents were, not only staged, but a ploy to make money:

Q: So this business involved you recruiting -- A: Yeah.


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Q: -- individuals, people to participate in automobile accidents, correct? A: Yeah. Q: Now, sir, you are saying an automobile accident. By that word, do you mean that these were truly accidents, or were these events that were staged or arranged? A: Yeah, it was staged and arranged. *** A: Everybody was in it for the money.

Exhibit 13, p. 11, ¶¶ 15-25; p. 12, ¶ 3.

386. Pierre Louis testified that PIP Claimants were paid to accept unnecessary treatment:

Q: Now, how would you make money being involved in these staged crashes? A: Well, by finding the people, you know, making sure they go to the chiropractor, you know, tell them they would get a thousand dollars, go 15 visits, whatever…I think like 15 visits or something so they can make a case.

Exhibit 13, p. 12, ¶¶14-18, 22-23.

387. Pierre Louis admitted Dorestant trained him how to victimize GEICO:

Q: And said that Mr. Dorestant showed you how to call the insurance companies. Was GEICO one of those insurance companies? A: Yeah. Q: And are you saying that you would get insurance on vehicles specifically so those vehicles could be used in staged crashes? A: Yeah. Q: And in false insurance claims? A: Yeah.

Exhibit 13, p. 13, ¶¶3-12.

388. Pierre Louis testified that Dorestant created KJ Chiropractic:

Q: And at some point, did [Dorestant], in fact, open up his own clinic? A: Yes, sir. Q: And what was that clinic called? A: KJ Chiropractic.

Exhibit 13, p. 13, ¶¶3-12, 16-20.


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389. Pierre Louis testified that he witnessed Dorestant stage accidents first hand:

Q: Did Mr. Dorestant tell you how he was staging accidents? *** A: He didn't have to tell me. I seen him do it.

Exhibit 13, p. 17, ¶¶16-20, 22-23.

390. Pierre Louis further described the procedure used by the staged accident organizers:

Q: So what you observed were normally three cars in a row, correct? A: Yeah. Q: And the front car was normally driven by? A: Whoever was going to call 911 and tell them I had been in an accident. Q: Would these have been -- the people in the front car, would they be people who had been recruited to be in a staged accident? A: Yeah. Q: And they were recruited with promises of money? A: Yeah, that was Jean's people. Q: Jean Cassamajor would normally recruit the people for the front car, is that what you observed? A Yeah.

Exhibit 13, p. 19, ¶¶6-21. 391. Pierre Louis admitted that Jean Cassamajor repeated crashed cars:

Q: And it would be when he would flash the lights, that was to alert the people in the front car to slow down so that he could intentionally run into them, correct? A Yeah. Q: And then the third car in the back, who would be driving the third car? A Jean. ** Q: …And who would -- who, if anyone, would be in the car with Jean? A The people that would be in the middle car.

Exhibit 13, p. 20, ¶¶6-13, 16-19.

*** Q: And where -- based on what you observed, where were these accidents being staged?

A A lot on Apopka-Vineland.


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*** Q: How far is that location from the Clinic, KJ? A Probably 15 minutes away.

Exhibit 13, p. 21, ¶¶6-8, 12-14.

392. Pierre Louis conceded that this pattern of fraud continued for “years,” admitting:

Q: How often did you do this, sir? A I don't keep count, man, just, basically, I did it, I did it for a little minute, years. Q: You did it, did I hear you say you did it for years? A Yeah.

Exhibit 13, p. 22, ¶¶1-7. 393. The staged accident organizers packed the cars with PIP Claimants:

Q: How many people would you put in each car during one of these staged accidents? A Many as possible, you know, I believe as many as possible. Q: And there were two cars usually in these accidents? A Yes, two cars all the time. Q: And what kind of an area would you look for to stage the accident? A Not a busy area, kind of dark. Q: Is that so there would be no witnesses to the staged crash? A Yes, sir. *** Q: Did you instruct the accident participants to call the police so the police

report could verify that the accident happened? A Yeah…

Exhibit 13, p. 26, ¶¶21-25; p. 27, ¶¶1-8, 2425; p. 28, ¶¶1-3.

394. Pierre Louis further explained that the staged accident organizers used the same towing

company for most of their staged accidents:

Q: And then you said there was a towing company that would usually be involved in towing at least one of the vehicles? A Yeah. Q: And was that Power Towing? A Yeah.


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Exhibit 13, p. 29, ¶¶4-9.

395. Pierre Louis admitted that the KJ Chiropractic Defendants and the Wellness Chiropractic

Defendants were co-conspirators in this pattern of fraud. In pertinent part, he testified:

Q: When I said involved, KJ, I meant after the staged accidents, were the accident victims sent to KJ Chiropractic? A Yeah. Q: And you mentioned in your answer the people in the other car were sent to Wellness, correct? A Yeah. Q: And it was -- from what you said, it was your job to recruit accident victims to go to KJ? A Yeah. Q: And it was Jean Cassamajor's job to recruit accident victims who went to Wellness? A Yeah.

Exhibit 13, p. 31, ¶¶12-25. ***

Q: And they were told that up front? A Yeah. Q: That it would be necessary for them to go to KJ and to Wellness 15 times

before they would get their thousand dollars? A Yeah. Q: And how was that thousand dollars paid? *** A Cash. *** Q: And who actually paid the patients? *** A Ed would give me the money; I would give it to them. Q: What would you get out of recruiting these people, sir? I understand that

the patients were getting a thousand dollars from KJ and from Wellness, but what were you getting? A I would get a thousand dollars for bringing them in, whatever.

Exhibit 13, p. 33, ¶¶1-7, 9, 12, 14-21.

*** Q: Jean Dorestant told you that he owned KJ, correct? *** A: Yeah.


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Q: And that payment was only made after the patient treated 15 times at KJ? A : Yes. Q: Were the patients told when they should go to KJ? A : Yeah. Q: What were they instructed to do? *** A : Come every day.

Exhibit 13, pg. 34, ¶¶7-8, 10-17, 19.

396. Pierre Louis admitted that KJ Chiropractic and Wellness patients were not injured:

Q: Now, these individuals that were going to the chiropractor to KJ and to Wellness, were they actually injured? *** A: No.

Exhibit 13, p. 34, ¶25.

397. He even admitted to crashing into occupied vehicles:

Q: Over time you changed how you staged the accidents; is that what you are saying, so that you actually put the people in the car? A: Yeah.

Exhibit 13, p. 35, ¶¶ 1-2, 5, 18-21.

Q: So in order to collect more money from the insurance company, Jean Dorestant changed this -- the method of staging accidents and started putting the people in the car during the crash? A: Yes, sir. *** Q: And the reason he did this was why? A: So that – *** A: - - so the people could really be hurt basically, you know.

Exhibit 13, p. 38, ¶¶16-25, p. 39, ¶¶1-2. ***

Q: … [Dorestant] definitely told you he owned KJ, correct? *** A: Yeah.


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Exhibit 13, p. 40, ¶¶24-25; p. 41, ¶¶1-3.

398. Pierre Louis explained that both he and Dorestant referred patients to Wellness:

Q: Did Jean Dorestant ever refer patients to Wellness? *** A: Yeah, sometimes, basically, if he couldn't put them people at his chiropractor probably a relative or something already going to his chiropractor, he would give to Jean…

Exhibit 13, p. 41, ¶¶22-25; p. 42, ¶¶1-11.

*** Q: Jean Cassamajor would pay you money? A: Yeah.

Exhibit 13, p. 46, ¶¶14-15.

Q: But you understood that the money you were getting from Jean Cassamajor had come from the Wellness Clinic? A: Yeah. *** Q: In exchange for the referral of the patient, correct? A: Yeah. Q: Because that's how the scheme worked? *** A: Yeah. Q: It was understood when you referred a patient, you would, in return for that referral, whether it was KJ or Wellness, you would get a thousand dollar cash payment? A: Yeah.

Exhibit 13, pp. 47, 48, ¶¶11-14, 16-19, 21-25; ¶1.

399. Pierre Louis also testified that Defendant, Rico, conspired with the other Defendants,

explaining:

Q: Do you know an individual named Vladimir Jean Pierre? A: Yeah. Q: Nicknamed Rico? A: Yeah. *** Q: Was he involved in this scheme?


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A: Yeah. Q: Was he recruiting people and being paid for bringing patients to KJ? A: Yeah.

Exhibit 13, p. 49, ¶¶3-7, 10-14. 400. Pierre Louis also testified to the personal relationship between Defendants, Joseph and Dorestant:

Q: Do you know a person named Orlene Joseph? A: Yeah, that's Ed's big mama. *** Q: Did you ever see her working in KJ Chiropractic? A: Yeah. Q: So Jean Dorestant and Orlene Joseph were close? A: Yeah, that's his big mama.

Exhibit 13, p. 50 ¶¶7-9, 17-19; p. 51, ¶¶7-8.

401. Pierre Louis testified that Jean Dorestant is still engaging in insurance fraud, this time at a

different chiropractic clinic. He explained:

Q: KJ, to your knowledge, is no longer operating, right? A: Yeah. *** Q: To your knowledge, is Jean Dorestant -- what is Jean Dorestant doing now for work? A: Same thing. Q: Has he opened another chiropractic clinic? *** A: Yeah. *** Q: Is that Orange County Chiropractic? A: Yeah. *** Q: In Orlando? *** A: Yeah. Q: And when you say he is still doing the same thing, to your knowledge is he still involved in staging accidents and filing false insurance claims? *** A: Yeah.

Exhibit 13, pg. 53, ¶¶7-9, 17-19; p. 54, ¶¶4, 6, 8-10, 12, 14-18, 21.


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402. Once more, Pierre Louis corroborated the fact that the conspiracy to defraud GEICO and

other insurers is ongoing. He admitted, in pertinent part:

Q: So he told you that because of the investigation into KJ, he [Dorestant] was going to shut KJ down and open up under a new name? *** A: Yeah. Q: You said earlier that you would – when you recruited patients for staged

accidents, you would help them get insurance with specific insurance companies; is that right?

A: Yeah. Q: And was GEICO one of those insurance companies? A: Yeah… Q: How long -- how long after you would insure a car with an insurance

company like GEICO would you wait until you staged the accident? Would you do it right away? Would you wait a specific amount of time?

A: Like a week, week or two. Exhibit 13, pg. 55, ¶¶13-16, 17, 20-25; p. 56, ¶¶ 1-2, 13-18. 403. Pierre Louis explained that an attorney offered him cash for the referral of PIP Claimants:

Q: So you were in KJ Chiropractic, you meet this attorney, and she tells you that she will pay you an amount of money if you refer patients to her? *** A: Yeah. Q: How much money did she offer to pay you for the referral of patients? *** A: $250, $250, something like that. Q: So from that, you understood that KJ Chiropractic or more specifically Jean Dorestant was being paid by this attorney to refer patients? *** A: Yeah.

Exhibit 13, p. 58, ¶¶20-23, 25; p. 59, ¶¶1-2, 4, 13-16, 21. 404. Jean Dorestant was the decision-maker at KJ Chiropractic, admitting:

Q: When you were in KJ, who seemed – based on what you observed, who seemed to be in charge? *** A: Ed. Q: And that would be Jean Dorestant?


65

A: Yeah. Exhibit 13, p. 61, ¶¶7-8, 10-13. 405. Pierre Louis testified that he believed Orlene Joseph was aware of the fraud occurring in

and around KJ Chiropractic:

Q: Orlene Joseph, you said you had a conversation with her from time to time when you were in KJ? A: Yeah. Q: Based on her close friendship with Jean Dorestant, do you believe she knew what was going on? *** A: I believe so. Q: And by saying that she knew that there were staged accidents going on and that patients were being paid money? *** A: Yeah. Q: And that the people who were getting treatment at KJ were there because they needed to come 15 times in order to get their thousand dollars? *** A: Yeah.

Exhibit 13, p. 65, ¶¶20-23; p. 66, ¶¶13-15, 18-21, 24-25; p. 67, ¶¶1-3, 5. 406. Pierre Louis explained the enterprises pattern of the staged crashes:

Q: So the pattern that you were following in the staged accidents would be as follows: You would recruit people who would agree to get involved in a fake accident based on the promise of them getting a thousand dollars from the chiropractor? A: Yes. Q: And most of your claims were with KJ Chiropractic, correct? A: Yeah. Q: The accidents would usually involve two cars, were they mostly rear-end crashes? *** A: Most of the time, yeah. Q: Or did you vary it around? A: Yeah, most of the time from the back. Q: Most of these were done at night, correct? A: Yeah. Q: So that there would be less chance of a witnesses, right? A: Yeah.


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Exhibit 13, p. 70, ¶¶9-19, 21-25; p. 71, ¶¶1-3. 407. Pierre Louis testified to the large scale of this fraudulent operation, admitting:

Q: Do you think it's possible, sir, that you staged as many as 40 accidents? Do you think that's possible? *** A: It's possible.

Exhibit 13, p. 72, ¶¶19-21, 23. 408. Pierre Louis testified to the culture of insurance fraud in Orlando, explaining:

Q: Is this kind of ongoing scheme of staging accidents and filing false insurance claims based on your experience, is this a widespread phenomenon in Orlando? *** A: Yeah. Q: Was it going on before KJ was created? *** A: Yeah

Exhibit 13, p.74, ¶¶7-19.

409. Pierre Louis further testified as to how Dorestant continues to engage in insurance fraud

via a different chiropractic clinic:

Q: Well, you did know about Orange County [chiropractic], Mr. Dorestant's company he is operating now, right? A: Yeah. Q: He is still staging accidents and paying runners? *** A: That's what he told me. Q: And you also mentioned the gentleman Vladimir, his nickname his Rico, and he is still staging accidents with another clinic with Will Vitale? A: Yeah. Q: And in all the accidents that you were involved in, sir, the staged accidents, the people that were referred to KJ were either not hurt; or if they were hurt, it was as a result of an intentional -- an intentional crash, rather than an accident; is that right? *** A: Yes, sir.


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Q: You used the same method; you used the same plan each time? A: Yeah. Q: You were doing the same thing over and over again, correct? A: Yeah.

Exhibit 13, p. 75, ¶¶2-15, 21-25; p. 76, ¶¶1-3, 10-12, 16-18.

410. Pierre Louis further conceded that he knew that the Clinics were submitting false bills to

insurers, admitting:

Q: You knew when you were staging these accidents, that the bills that were being created by KJ and Wellness were being sent to GEICO for payment? *** A: Yeah. Q: Along with many other insurance companies, correct? *** A: Yeah.

Exhibit 13, p. 78, ¶¶17-25; p. 79, ¶¶1-2. 411. Pierre Louis admitted being involved in fraud at Wellness as well as KJ Chiropractic:

Q: Mr. Pierre-Louis, have you ever been to a facility known as Wellness, Pain & Rehab? A: Yeah, couple times. Q: When was the first time that you went there? A: In -- they gave me money for patients that went to his chiropractor.

Exhibit 13, p. 144, ¶¶19-25. C . E X E MPL A R C L A I MS I L L UST R A T IN G A PA T T E RN O F F A K E A C C ID E N TS A ND T H E ST A G E D C R ASH PR O F I L E

412. Along with Pierre Louis’ deposition, the Richardson, Gaines, McRae and Akins

confessions relating to the May 1, 2011, May 4, 2011 and May 17, 2011 staged accidents

demonstrate that the Defendants were engaged in an organized staged crash ring.


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413. These confessions - - along with the statements described above - - revealed that the

accident organizers routinely engaged in these activities as part of an ongoing enterprise whose

sole purpose was to defraud automobile insurers, including GEICO. The fraudulent nature of the

losses detailed below is evident because they closely follow the identifiable Staged Crash Profile

that match the circumstances in the May 1, 4 and 17 false claims (hereinafter, the “Confession

Claims”).

414. More specifically, the Confession Claims share many, if not all, of the following common

characteristics:

a. Accidents occur in the evening usually around 9:00 P.M.; b. No witnesses; c. Newly purchased GEICO policy; d. Accident location near the involved clinic; e. Multiple individuals claiming similar soft tissue injuries; f. Reported involvement of the same towing companies; g. PIP Claimants treat at KJ Chiropractic, Wellness or both; h. Most PIP Claimants receiving in excess of 15 visits; and/or, i. In a majority of the claims, the PIP Claimants exhibit no objective signs of injury

and receive treatment only from KJ Chiropractic or Wellness.

415. The Confession Files coupled with the Pierre Louis Depositions, illustrate the nefarious

illegal means used by the Defendants to execute their massive scheme to defraud. The initial

decision of the Clinics and the Clinic Operators to solicit, sanction and conspire with Runners

caused the Runners to stage even more accidents.

416. Every aspect of the Defendants’ fraudulent scheme was motivated by money and greed,

without regard to the harm which they knew would be inflicted upon GEICO, and the public at

large. The Clinics held themselves out as legitimate health care providers when, in fact, they

were not. Their fraudulent criminal enterprise, described herein, drained limited health care

resources that are already under strain to meet legitimate health care needs.


69

417. The Pierre Louis Depositions and Confession File statements demonstrate that the

Clinics, and the Clinic Operators, had forged relationships with Runners who were regularly and

brazenly, staging accidents on the streets of Orlando, usually within a few miles from KJ

Chiropractic and Wellness. See Exhibit 14 (GEICO’s Chart illustrating Patterns that Exist within

the Exemplar Claims and Google Maps illustrating the proximity of the staged accidents to the

Clinics) that the majority of the GEICO claims involved “accidents” that supposedly occurred

within a few miles of KJ Chiropractic and Wellness).

418. The Pierre Louis Deposition and Confession Files reveal that the Defendants had created

an organization to exploit the Florida PIP system. The remarkable similarities present in the KJ

Chiropractic and Wellness claims, outlined below, show that the Clinics’ stable of experienced

Runners have repeatedly used an identifiable formula to orchestrate staged accidents. By

participating in these enterprises, the Clinics, and their operators, were guaranteed a steady

stream of compliant claimants for whom the Clinics could fraudulently bill insurance companies,

including GEICO, for a plethora of services that were never rendered or were otherwise

unlawful.

419. The Clinics’ arrangements with the Runners were predicated on the Runners being able

to thoroughly memorialize each of the “accidents” that were being delivered to the Clinics.

420. The following exemplar claims from both KJ Chiropractic and Wellness demonstrate that

the Runners devised their crashes to create confirmatory documentation such as police crash

reports, citations for moving violations and tow truck receipts.

421. Such documentation plays a critical role in the PIP claims process. For example, such

documentation made it appear to GEICO that an accident was legitimate and that the PIP


70

claimants’ injuries were significant and worthy of substantial medical attention, in the form of

both chiropractic care and diagnostic imaging studies.

422. Within this Amended Complaint, the names of the “accident” PIP claimants have been

replaced with initials to protect the privacy of the “patients.” Since these PIP claimants

reportedly treated at KJ Chiropractic and Wellness, the full names of the patients are already in

the Defendants’ possession. Notwithstanding, GEICO will provide the names of all the patients

to the Defendants during discovery.

423. All of these accidents conform to the pattern of admitted staged crashes arranged by

Esdras Pierre Louis, Jean Dorestant, Jean Cassamajor, and Vladimir “Rico” Jean Pierre in

furtherance of the Defendants’ common goal to obtain payment from GEICO by submitting

fraudulent medical documentation/bills and claim materials through the U.S. Mail/Wire.

424. The following claims are a representative sampling of the ninety-three (93) claims

submitted to GEICO by KJ Chiropractic and Wellness. See Exhibits 1 and 2.

Date of Loss: 7/31/09 Insured Name (Initials): M B G E I C O C laim No.: 0354172760101039 C linic: W ellness 425. On July 31, 2009, GEICO’s named insured, MB, was reportedly involved in an alleged

motor vehicle accident while operating the insured vehicle, a 1996 Nissan.

426. Claimant, PJ, was a passenger in the insured vehicle at the time of the alleged accident.

427. The Police Report associated with this loss indicates that the alleged accident occurred

approximately 17 miles from Wellness, at 9:16 P.M., when visibility and witnesses would have

been limited.

428. When police officers arrived at the scene, the 1996 Nissan had already been moved.


71

429. Following the alleged accident, claimants, JJ and MB, supposedly presented for

“treatment” at Wellness.

430. Wellness submitted bills to GEICO for treatment allegedly rendered to these claimants

from August 5, 2009 through December 22, 2009.

431. Moreover, as is customary for almost every patient at Wellness, Dr. Arthur Vito referred

both claimants to Advanced 3-D Diagnostics for diagnostic imaging studies.

432. Prior to and irrespective of any diagnostic findings in this claim, any therapies

administered by Wellness were in line with a pre-programmed treatment plan.

433. During its investigation of this claim, GEICO scheduled Independent Medical

Examinations of claimants, JJ and MB. Both claimants failed to appear for their scheduled

appointments.

Date of Loss: 8/21/09 Insured Name (Initials): SJ G E I C O C laim No.: 0375521270101019 C linic: W ellness 434. Twenty days later, on August 21, 2009, GEICO’s named insured, SJ, was involved in an

alleged motor vehicle accident.


approximately six miles from Wellness, at 9:30 P.M., when visibility and witnesses would have

been limited.

436. According to the Police Report, the insured was traveling in a vehicle operated by a

female driver. However, when the insured called to report the loss to GEICO, he was only able

to identify the driver by her first name.

437. In the Police Report, the Trooper elaborated on the suspicious nature of the alleged

accident, stating, “It should be noted that [the driver of the adverse vehicle] advised they


72

believed that a passenger in [the insured’s vehicle] was driving at the time of the accident. [The

driver of the adverse vehicle also] advised she thought [the alleged driver of the insured’s

vehicle] arrived in a separate van.”

438. According to the Police Report, when police officers arrived at the scene, the vehicles

had already been moved.

439. Following the alleged accident, the insured, SJ, supposedly presented for “treatment” at

Wellness.

440. Wellness submitted bills to GEICO for treatment allegedly rendered to the insured, SJ,

from August 24, 2009 through September 23, 2009.


the insured, SJ, to Advanced 3-D Diagnostics for diagnostic imaging studies.



443. As part of its investigation into the claim, GEICO noticed the insured, SJ, for an

Examination Under Oath. The insured failed to appear.

Date of Loss: 9/10/09 Insured Name (Initials): R W G E I C O C laim No.: 0377352720101013 C linic: W ellness 444. Twenty days later, on September 10, 2009, GEICO’s named insured, RW, was involved

in an alleged motor vehicle accident while operating the insured vehicle, a 1998 Oldsmobile.

445. Claimants, ML and JP, were allegedly passengers in the insured vehicle at the time of

loss.

446. However, the Police Report associated with this loss does not indicate that any

passengers were in either vehicle.


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447. In accordance with Fla. Stat. §316.068(g), there is a presumption that neither ML nor JP

were in the insured vehicle at the time of the alleged loss.

448. The Police Report also indicates that the alleged accident occurred at a location that is

approximately five miles from Wellness, at 10:13 P.M., when visibility and witnesses would

have been limited.



450. Following the alleged accident, claimants, ML and JP, reportedly presented for



from September 15, 2009 through December 3, 2009; with both claimants starting and finishing

their “treatment” on the same date.


both claimants to Advanced 3-D Diagnostics for diagnostic imaging studies.



Date of Loss: 5/2/10 Insured Name (Initials): SM G E I C O C laim No.: 0389924140101017 C linic: W ellness 454. On May 2, 2010, GEICO’s named insured, SM, was involved in an alleged motor vehicle

accident in a 2002 Dodge sedan. Claimant, WI, was allegedly a passenger in the vehicle.

455. The adverse vehicle, a 1995 Ford SUV, was occupied by claimants, LM and JM, who

sought treatment at International Chiropractic, Orlando, FL.


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approximately six miles from Wellness, at 10:10 P.M., when visibility and witnesses would have

been limited.

457. The Police Report noted that there were no reported injuries as a result of the loss.

458. On June 28, 2010, almost two months after the date of loss, claimants WI and SM

allegedly began treating at Wellness. Wellness submitted bills to GEICO for treatment

supposedly rendered through August 3, 2010.

459. Moreover, Dr. Vito referred claimants, WI and SM, to Advanced 3-D Diagnostics for

diagnostic imaging studies.



461. During the course of investigating this claim, GEICO discovered extensive claim

histories for both claimants, WI and SM.

462. GEICO noticed claimant, WI, for two Examinations Under Oath. He failed to appear on

both occasions.

Date of Loss: 5/13/10 Insured Name (Initials): N M G E I C O C laim No.: 0395201990101013 C linic: K J Chiropractic 463. This collision loss conforms to the Confession File staged crash profile.

464. The GEICO policy was issued on the same date as the crash, May 13, 2010.

465. The crash reportedly occurred at 9:24 P.M., 3.4 miles from KJ Chiropractic. There were

no witnesses.


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466. The vehicle occupants claimed soft tissue back injuries and received extensive treatment

at KJ Chiropractic, including referrals for diagnostic imaging studies.

467. Peter Towing appeared to tow the vehicles.

468. An examination of the damage existing on the involved vehicles (a Camry and a Land

Rover) conducted by an accident reconstructionist concluded that these cars were not involved in

a reciprocal collision as described by the vehicle occupants.

Date of Loss: 6/20/10 Insured Name (Initials): E E G E I C O C laim No.: 0221240890101061 C linic: W ellness 469. Approximately five weeks later, on June 20, 2010, GEICO insured, EE was involved in

an alleged motor vehicle accident.

470. Claimants, ER, IR and JR, were allegedly passengers in the insured’s vehicle on the date

of loss.

471. According to the accident report filed on June 27, 2010, this loss occurred approximately

two miles from Wellness, at 10:00 P.M., when visibility and witnesses would be limited.

472. Following the alleged accident, claimants, IR, ER and JR, supposedly presented for



from June 21, 2010 to August 9, 2010.

474. Moreover, Dr. Vito referred these claimants to Advanced 3-D Diagnostics for diagnostic

imaging studies.




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Date of Loss: 8/10/10 Insured Name (Initials): RJP G E I C O C laim No.: 0355588040101011 C linic: K J Chiropractic 476. This collision loss conforms to the Confession File staged crash profile.

477. The crash reportedly occurred at 11:00 P.M., 11.5 miles from KJ Chiropractic. There

were no witnesses.

478. The occupants claimed soft tissue back injuries and received extensive treatment at KJ

Chiropractic, including referrals for diagnostic imaging studies.

479. The police report notes that both vehicles were removed from the roadway prior to arrival

at the accident scene.

Date of Loss 8/24/10 Insured Name (Initials): R C & F F G E I C O C laim No.: 0296839410101012 C linic: K J Chiropractic 480. Fourteen days later another collision loss that conforms to the Confession File staged

crash profile was reported to GEICO.


no witnesses.



Date of Loss: 9/5/2010 Insured Name (Initials): NB T G E I C O C laim No.: 0165759820101030 C linic: K J Chiropractic 483. Eleven days later, another collision loss that conforms to the Confession File staged crash

profile was reported to GEICO.


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484. The crash was reportedly occurred at 2:51 P.M., 4.4 miles from KJ Chiropractic. There

were no witnesses.



486. Both vehicles were towed by the same tow company.

Date of Loss: 10/6/10 Insured Name (Initials): I L C G E I C O C laim No.: 0404093240101011 C linic: K J Chiropractic 487. Thirty days later, another collision loss that conforms to the Confession File staged crash


488. The GEICO policy was issued on September 25, 2010, eleven days before the crash on

October 6, 2010.


no witnesses.



491. This was a rear end accident where both vehicles were removed from the scene of the

accident prior to the arrival of the police department. Power Towing was involved in removing

vehicles from the scene.

492. During the investigation of this claim on December 6, 2010, GEICO SIU Supervisor,

Robert Goldman, visited KJ Chiropractic and spoke with chiropractor Miyoashi Gay.

493. During this interview, Dr. Gay told Goldman that the Clinic was owned by Sadat Smith.

494. In this claim, the named insured (ILC) had reportedly loaned her car to her niece, LW.


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Date of Loss: 11/20/10 Insured Name (Initials): N G G E I C O C laim No.: 0363235720101024 C linic: K J Chiropractic 495. In November, another collision loss that conforms to the Confession File staged crash

profile was received by GEICO.


no witnesses.


Chiropractic, including referrals for diagnostics imaging studies.

Date of Loss: 1/3/11 Insured Name (Initials): WS G E I C O C laim No.: 0403578540101019 C linic: W ellness 498. On January 3, 2011, GEICO insured, WS was involved in an alleged motor vehicle

accident.

499. According to the Police Report, the accident occurred approximately 14 miles from

Wellness, at 9:00 P.M., when visibility and witnesses would be limited.

500. The Police Report noted that a phantom vehicle allegedly collided with the insured

vehicle then fled the scene. Additionally, when police officers arrived, the insured vehicle had

been moved.

501. Approximately one month after the accident, the claimants, JM and WS presented for

treatment at Wellness.

502. Wellness submitted bills to GEICO for treatment allegedly rendered to those claimants

from February 7, 2011 to May 4, 2011.


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503. Notably, the bills submitted to GEICO by Wellness were signed using a stamp of Dr.

Vito’s signature.

504. Moreover, Dr. Vito referred both claimants to Advanced 3-D Diagnostics for diagnostic

imaging studies.



Date of Loss: 1/7/2011 Insured Name (Initials): R .S. G E I C O C laim No.: 0288478080101042 C linic: K J Chiropractic and W ellness 506. This collision loss conforms to the Confession File staged crash profile.


no witnesses.



509. The police report notes that both vehicles were removed from the roadway prior to their

arrival at the accident scene. Power’s Towing towed the vehicles involved in the reported crash.

510. This accident involved a two car collision where AD’s 2002 Chevrolet Monte Carlo

reportedly collided with a Toyota Matrix occupied by RS and AU. Both received treatment at

KJ Chiropractic.

511. The occupants in AD’s Monte Carlo, TW, TC, and SD presented for treatment at

Wellness.

512. During the presentment of this claim, SD represented to GEICO that, before the crash,

she had sold the car she owned to a towing company.


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513. The same passenger represented to GEICO that she was the driver of AD’s vehicle when

the crash occurred.

514. These representations were contrary to the named insured’s version of events that had

been reported to GEICO.

515. During the investigation of this loss, GEICO SIU investigator, Randall Gibson, visited

the KJ Chiropractic facility on February 1, 2011.

516. During that visit, he met with Natacha LeGrand who stated that she was a manager of KJ

Chiropractic.

517. During the investigation of the claim, AU, indicated that she and her sister, RS, were

picked up at the hospital by RS’s boyfriend, “Edence.” As mentioned above, “Edence” is Jean

Dorestant’s middle name.

518. During the investigation of the claim, GEICO retained an accident reconstructionist to

examine the circumstances surrounding the accident. This expert reported to GEICO that the

damage to the Monte Carlo was inconsistent with a rear end collision with RS’s Toyota Matrix

as reported to the police.

Date of Loss: 1/8/11 Insured Name (Initials): PF G E I C O C laim No.: 0330289040101040 C linic: W ellness 519. The next day, on January 8, 2011, GEICO’s named insured, PF, was involved in an

alleged motor vehicle accident.


approximately six miles from Wellness, at 9:54 P.M., when visibility and witnesses would be

limited.


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521. In the Police Report, the Trooper indicates, “The Orlando Fire Department responded to

the scene and confirmed that there were no injuries at the scene.”

522. Four people were traveling in the insured vehicle, and two people were traveling in the

adverse vehicle.

523. All six of the alleged occupants in these vehicles sought treatment for their “injuries.”

524. Following the alleged accident, claimants, SS, AF and PF, supposedly presented for



from January 10, 2011 through February 24, 2011; with all three claimants starting and finishing

their “treatment” around the same date.

526. Any therapies administered by Wellness were in line with a pre-programmed treatment

plan.

527. During the course of its investigation, GEICO learned that claimants, PF and AF, have a

claim history involving soft tissue injuries.

528. Pursuant to its investigation, GEICO conducted Examinations Under Oath of claimants,

PF and AF. Their testimony yielded the following inconsistencies:

a. Claimants, PF and AF, provided different responses as to the location of other passengers in the vehicle at the time of the loss;

b. Claimant, PF, was unable to name the doctor or any employee at Wellness despite almost two months of alleged medical treatment; and,

c. Claimant, AF, refused to indicate how the accident occurred when asked to illustrate the point of impact using two index cards.


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Date of Loss: 1/22/11 Insured Name (Initials): A M G E I C O C laim No.: 0411485140101011 C linic: K J Chiropractic 529. Two weeks later, another collision loss that conforms to the Confession File staged crash


530. The GEICO policy was issued on January 20, 2011, only two days prior to the crash on

January 22, 2011. This same policy was cancelled approximately one month after the crash.


no witnesses.



533. The police report indicates that both vehicles were moved from the roadway prior to their

arrival. Power Towing appeared at the scene to tow one of the vehicles.

534. The insured vehicle was a 2006 Chevrolet Cobalt which had recently been purchased

from a company called Jason Auto Sales, LLC. Public records available from the Florida

Department of State, Division of Corporations, reveal that the registered agent and manager of

Jason Auto Sales, LLC is Orlene Joseph. As noted above, Orlene Joseph was a manager of KJ

Chiropractic.

535. In this accident, the GEICO insured 2006 Cobalt reportedly rear ended a 2006 Sentra.

536. The occupants of the vehicles provided conflicting reports to Travelers regarding whether

or not airbags deployed as a result of this collision.

537. An accident reconstruction report commissioned by Travelers concluded that the airbags

did not deploy as the result of a collision, but instead were removed manually.


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538. The Florida Traffic Crash Report indicates that Power Towing was already on the scene

to tow the vehicles when the officer arrived.

539. AM and MM were reportedly occupying the Cobalt. They treated at KJ Chiropractic.

WC, EJA and MU occupied the Travelers insured 2006 Sentra. All three sought treatment at

Wellness.

540. GEICO twice requested that its named insured, AM, testify in an examination under oath.

She never appeared.

Date of Loss: 1/30/2011 Insured Name (Initials): CS G E I C O C laim No.: 0309762140101018 C linic: K J Chiropractic 541. Eight days later, another collision loss that conforms to the Confession File staged crash


542. This GEICO policy was issued only four days before the January 30, 2011 crash date.


no witnesses.



545. The Police Report notes that both vehicles were removed from the roadway prior to their

arrival.

Date of Loss: 2/10/11 Insured Name (Initials): EJB G E I C O C laim No.: 0405891190101017 C linic: K J Chiropractic 546. Eleven days later, another collision loss that conforms to the Confession File staged crash

profile was received by GEICO.


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no witnesses.



Date of Loss: 2/10/11 Insured Name (Initials): M C G E I C O C laim No.: 0412511630101010 C linic: K J Chiropractic 549. Also on February 10, 2011, a second loss that conforms to the Confession File staged


550. The GEICO policy was issued February 2, 2011, eight days prior to the crash on

February 10, 2011.


no witnesses.



553. In this loss, GEICO named insured MC, reportedly had an accident in his 2005 Acura TL.

554. The passenger in MC’s GEICO insured 2005 Acura was SC.

555. The Acura allegedly was involved in a crash with a Nissan.

556. The participants in the accident had prior automobile accident claims.

557. During the presentment of this claim, MC represented that he obtained his vehicle from

Jason Auto Sales, LLC, shortly before the loss.

558. The Registered Agent and manager of Jason Auto Sales, LLC, is Defendant, Orlene

Joseph.


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559. According to the deposition testimony of Esdras Pierre Louis, Jean Dorestant was the

silent owner of a car lot in Orlando. The car lot was Jason Auto Sales, LLC. Dorestant and

Orlene Joseph used Jason Auto Sales to supply vehicles for staged crashes. (Exhibit 10, pp. 19-

20). In some claims, Orlene Joseph signed the titles for vehicles purchased from Jason Auto

Sales.

Date of Loss: 3/2/2011 Named Insured (Initials): Y N C laim No.: 01915160240101011 Named Insured (Initials): Y C C laim No.: 0308182760101050 Named Insured (Initials): H A C laim No.: 0273957830101011 C linics: K J Chiropractic and W ellness 560. Three weeks later, another collision that conforms to the Confession File staged crash

profile was reported to GEICO. This collision involved multiple claims made on multiple

GEICO policies.

561. The policy was issued to the at fault insured vehicle fourteen days prior to the crash on

March 2, 2011.


no witnesses.

563. The occupants of both vehicles reported soft tissue back injuries. Claimants YC and RC

received extensive treatment at KJ Chiropractic, including referrals for diagnostic imaging

studies. Claimant DP received excessive treatment at Wellness, including referrals for diagnostic

imaging studies.

564. In this claim, the named insured, YN, represented that her friend “Eddie” had recently

helped her purchase the insured Acura. She could not provide GEICO with Eddie’s last name,


86

address or phone number. She represented that Eddie had contributed $2,000.00 dollars toward

the $4,000.00 dollars price of the Acura.

565. YN was not driving the Acura on March 2, 2011, when it reportedly collided with the

2006 Toyota Sequoia. The driver of the Acura is listed at TW. DP and KR were her passengers.

566. TW reportedly rear ended the Sequoia because it had slowed down in traffic, and a

vehicle on the inside lane kept her from changing lanes.

567. All five occupants in both cars had been involved in prior automobile injury claims.

568. TW represented to GEICO that when Power Towing arrived, prior to the police, they

urged the driver of the Sequoia (YC) to let them tow her car, so that she could go to the hospital.

During an examination under oath of YC, she indicated that a tow truck had appeared at the

crash site, but she did not call for it because she did not need to be towed. She indicated that her

car was still drivable.

Date of Loss: 3/2/11 Insured Name (Initials): M L G E I C O C laim No.: 0410598410101015 C linic: W ellness 569. On March 2, 2011, GEICO’s named insured, ML, was involved in an alleged motor

vehicle accident while operating the insured vehicle, a 2001 Isuzu Trooper.

570. Claimants, RL, AL1 and AL2, were allegedly passengers in the insured vehicle at the

time of the alleged accident.

571. The GEICO policy associated with this loss was approximately two months old at the

time of the alleged accident with an effective date of January 6, 2011.

572. The Police Report associated with this loss indicates that the alleged accident occurred at

8:27 P.M., when visibility and witnesses would have been limited.


87

573. The alleged accident occurred on Old Winter Garden Road, Orlando, Florida. As

mentioned, supra, both KJ Chiropractic and Wellness are located on Old Winter Garden,

Orlando, FL.

574. According to the Police Report, when police officers arrived at the scene, both vehicles


575. Following the alleged accident, claimants ML, RL, AL1, and AL2 supposedly presented

for “treatment” at Wellness. AL1 and AL2 were minors.


from March 1, 2011 through June 11, 2011.

577. The bills and treatment notes submitted to GEICO by Wellness demonstrate the

following suspect characteristics:

a. The alleged accident occurred on March 2, 2011, and Wellness submitted bills to GEICO for eight modalities rendered to claimant, ML on March 1, 2011, prior to the alleged accident (attached hereto as Exhibit 13); and,

b. The bills submitted to GEICO by Wellness were signed using a stamp of Dr. Vito’s signature.


all of the claimants to Advanced 3-D Diagnostics for diagnostic imaging studies.

579. Prior to and irrespective of any diagnostic findings in this claim, the therapies


580. During its investigation, GEICO conducted an Examination Under Oath of claimant, ML.

The claimant’s testimony exhibited the following suspect characteristics:

a. The claimant was unable to identify any characteristics pertinent to the adverse vehicle, including, but not limited to, the color or type of vehicle;

b. The claimant was unable to identify the number of individuals in the adverse vehicle at the time of loss;

c. The claimant was unable to identify any physical characteristics of the individuals in the adverse vehicle, including whether they were male or female; and,


88

d. The claimant was also unable to identify the name of the tow company or any physical characteristics associated with the tow truck or tow truck driver.

Date of Loss: 3/20/2011 Named Insured (Initials): Y N G E I C O C laim No.: 0195160240101029 C linic: K J Chiropractic & Wellness 581. Eighteen days later, on March 20, 2011, another loss that conforms to the Confession File

staged crash profile was reported to GEICO.

582. This loss was reported under the same GEICO policy that had been issued to YN for the

Acura had reportedly been totaled on March 2, 2011 (the Acura that had been located, purchased

and partially paid for by “Eddie”). After March 2, 2011, YN rented a Chevrolet Impala as

substitute transportation.

583. YN was not driving the Impala in the March 20, 2011 incident. Instead, a person named

SW was the operator. She, and her two passengers (JR and SS) all claimed injuries.

584. The Impala reportedly ran a stop sign and collided with a 1998 Cadillac Limousine. The

occupants in the Cadillac (FJ, EJ and ML) claimed injuries and treated at Wellness.

585. Examinations Under Oath of YN, JR and SS were requested. All failed to appear.

586. In an unsworn interview, YN claimed that her boyfriend, “Eddie,” had taken the Impala

with her permission, but he had failed to return it as promised.

587. Shantrese Williams (the driver of the Impala) represented to GEICO that she had decided

not to seek treatment for the March 20, 2011 crash. She claimed that a man she knew as “Elijah”

had picked her and her friends up at work in the rental car shortly before the crash.

588. In a statement to GEICO, Shantrese Williams claimed that she had not actually been the

driver of the Impala. She claimed that a friend of “Elijah” was actually driving after they all met

behind a shopping plaza.


89

589. This man drove the Impala through a stop sign and hit the adverse vehicle just after he

hung up from a call.

590. The driver then jumped out of the Impala and ran away. Shantrese Williams had noticed

this Cadillac Limo in the area before the crash.

591. During this statement, Shantrese Williams was shown a picture of Defendant, Esdras

Pierre Louis. Shantrese Williams immediately identified him as the person she knew as “Elijah.”

592. Shantrese Williams informed GEICO that she and her supposed passengers (FJ and EJ)

were offered money to say that they were injured. This offer was conditioned upon their

agreeing to treat with a chiropractor.

593. Shantrese Williams originally agreed to participate in Esdras Pierre Louis’ scheme. In

fact, Esdras Pierre Louis took Shantrese Williams to chiropractors to negotiate a deal.

594. Esdras Pierre Louis took Shantrese Williams to KJ Chiropractic and other clinics. She

claimed Esdras Pierre Louis would pick her up at work and take her to the Clinics.

595. Esdras Pierre Louis would then speak privately with the people working the facilities.

596. JR and SS agreed to treat at KJ Chiropractic. When Shantrese Williams was taken to the

Clinic, she was asked to read a paper discussing insurance fraud being a felony.

597. Shantrese Williams accompanied her friends, JR and SS, when they were driven to KJ

Chiropractic. While she waited in the Clinic’s waiting room, a gentleman who was in the facility

tried to talk her into accepting treatment.

598. At one point, Shantrese Williams was told that she could make $10,000.00 dollars in a

claim if she kept going to the Clinic. JR also repeatedly asked her to accept treatment.


90

Date of Loss: 3/30/2011 Insured Name (Initials): JPL G E I C O C laim No.: 0416368760101013 C linic: K J Chiropractic 599. Ten days after the March 20, 2011 fake claim involving YN’s rented Chevrolet Impala,

another claim that conforms to the Confession File staged crash profile was received by GEICO.

600. The GEICO policy was issued to Esdras Pierre Louis’ brother, JPL, eleven days before

this March 30, 2011 loss.

601. The accident reportedly occurred at 10:29 P.M., 3.5 miles from KJ Chiropractic. There

were no witnesses.

602. The adverse policy was obtained over the telephone on March 23, 2011. The adverse

vehicle was purchased on March 26, 2011 and was a rebuilt salvage. The insured vehicle was

purchased on March 11, 2011.

603. The occupants in the GEICO insured vehicle all claimed soft tissue back injuries and

received referrals for diagnostic imaging studies.

604. The Florida Traffic Crash Report, completed by Trooper D.M. Jonas at the scene states as

follows:

When the investigator arrived on scene, I observed both vehicles in contact with each other at final rest. The heavy damage looked more consistent with that of a crash with one stopped or moving slowly than 2 vehicles travelling at or above 40 mph speed limit. The debris field for the crash was contained into a small area (20-30 feet from final rest) with no noticeable skid marks on the wet roadway. The 2 rear passengers were transported to the hospital from the scene by Orange County EMS and later met by Trooper Oliver at the hospital. Both passengers stated that they were picked up by the driver of V01 around the corner because they were walking in the rain and did not even know the first names of the driver or the front passenger. The driver of V01 agreed to make his own arrangements to have V01 towed. I asked several times if he had a tow truck on the way to which he


91

replied yes. When my rotation tow truck arrived on scene I asked again about his tow truck and he replied that he needed to call “Eddie” about getting the vehicle towed and wanted to use my cell phone to do so. I asked if his passenger had a cell phone he could use. He said “No.” I did not let him use my phone. I informed him I was going to have to tow his vehicle to get it out of the roadway and he agreed. I handed them there (sic) paperwork and let them walk away from the scene. Approximately 5 minutes later Powers Towing arrived on scene (driving past the driver of V01) and the driver of V01 and the Passenger of V01 walked back to the scene wanting Powers towing to tow the vehicle. Both vehicles appeared to have no personal property in the vehicles. Both were paper free and without cd’s or general items seen in most personal vehicles.

605. PIP claimants in this loss failed to appear for requested Examinations Under Oath.

However, during subsequent depositions, the claimants provided contradictory statements

regarding the loss.

Date of Loss: 5/1/11 Insured Name (Initials): SR G E I C O C laim No.: 0418141630101010 C linic: K J Chiropractic and W ellness 606. As discussed above in this Amended Complaint, Defendants, (and KJ Chiropractic

“patients”) Shenika Richardson and Shayla Gaines, confessed to GEICO that this was a staged

accident. Hashley Mocombe, Henry Preval and Yvio L’esperance presented for “treatment” at

Wellness, despite the fact that this crash was staged.

Date of Loss: 5/4/11 Insured Name (Initials): SD M G E I C O C laim No.: 0404807430101014 Insured Name (Initials): Q M G E I C O C laim No.: 0419394450101029 C linic: K J Chiropractic and W ellness 607. As discussed above in this Amended Complaint, Defendant, Queena McRae has

confessed to GEICO that this was a staged accident.


92

Date of Loss: 5/17/11 Insured Name (Initials): C A G E I C O C laim No.: 0419394450101037 C linic: K J Chiropractic 608. As discussed above in this Amended Complaint, Defendant, Chanel Akins, has confessed

to GEICO that this was a staged accident.

Date of Loss: 5/20/11 Insured Name (Initials): K D G E I C O C laim No.: 0420871250101017 C linic: W ellness 609. On May 20, 2011, GEICO’s named insured, KD, was involved in an alleged motor

vehicle accident while operating the insured vehicle, a 1998 Ford Windstar.

610. Three other individuals were allegedly traveling in the insured vehicle at the time of the

alleged accident.

611. Two individuals were allegedly traveling in the adverse vehicle at the time of the alleged

accident. It should be noted that the adverse vehicle, a 2010 Cadillac CTS, was a rental car.

612. The Police Report associated with the loss indicates that the alleged accident occurred

approximately 19 miles from Wellness, at 10:24 P.M., when visibility and witnesses would have

been limited.



614. Claimant, CA, who was six years of age when the accident occurred, allegedly treated at

Wellness from July 21, 2011 through August 24, 2011, for which Wellness submitted bills to

GEICO.

615. Notably, the parents of claimant CA, claimants KD and MA, both sought chiropractic

treatment at a different clinic.


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616. During the course of its investigation, GEICO learned that claimant, MA, has a

significant claim history, including twelve prior losses.

617. GEICO also determined that the insured vehicle involved in this loss was purchased on

March 11, 2011, approximately two months prior to the alleged accident.

618. Moreover, the insured’s policy with GEICO was effective as of May 19, 2011, one day

before the alleged accident. During the investigation of a prior loss, claimant, MA, made an

admission to the adverse carrier that he had been paid to participate in a prior loss.

Date of Loss: 6/3/11 Insured Name (Initials): T W G E I C O C laim No.: 0393860770101030 C linic: K J Chiropractic 619. Two weeks later, another collision loss that conforms to the Confession File staged crash



no witnesses.



622. The police report indicates that vehicles were moved from the roadway prior to their

arrival. Ketterle Towing towed one of the vehicles.

Date of Loss: 6/13/11 Insured Name (Initials): C NB G E I C O C laim No.: 042057944101017 C linic: W ellness 623. Ten days later, on June 14, 2011, GEICO’s named insured, CNB, was involved in an

alleged motor vehicle accident, while operating the insured vehicle, a 2001 BMW X5.


94

624. CNB’s automobile insurance policy with GEICO was effective as of May 14, 2011, and,

was approximately one month old at the time of the alleged accident.

625. Claimants, AM and EM, were allegedly passengers in the insured vehicle at the time of

loss.

626. However, the Police Report associated with this loss indicates that insured, CNB, was the

only person in the insured vehicle at the time of the alleged accident.

627. In accordance with Fla. Stat. §316.068(g), there is a presumption that neither AM nor EM

were in the insured vehicle at the time of the alleged loss.

628. The Police Report indicates that the alleged accident occurred approximately six miles

from Wellness, at 9:03 P.M., when visibility and witnesses would have been limited.

629. Moreover, the Police Report reads, “V01 was southbound on Apopka-Vineland Road in

the outside through lane at an excessive rate of speed. V02 was southbound on Apopka-

Vineland Rd. at an unusually slow rate of speed in the same lane. V01 failed to brake (no skid

marks) and struck the rear of V02 with its front. Both vehicles relocated to Palm Cove Drive.

Note: This crash has the appearance of a staged collision that may result in fraudulent [sic]

insurance claims.” (emphasis added).

630. Following the alleged accident, claimants, AM and EM, reportedly presented for


631. Wellness submitted bills to GEICO for treatment allegedly rendered to all of these

claimants from June 15, 2011 through September 12, 2011. Notably, all three claimants began

treating on the same date.

632. Moreover, as is customary for almost every patient at Wellness, Dr. Vito referred all

three claimants to Advanced 3-D Diagnostics for diagnostic imaging studies.


95



634. The claimants, AM and EM, were added to this claim to defraud GEICO.

635. A crash reconstruction report completed by National Forensic Consultants, Inc. resulted

in the following conclusions:

a. “The damage to the front of the Lexus [could] not have been the result of an impact with the BMW.”

b. “The damage to the rear of the BMW [could] not have been the result of an impact with the Lexus.”

636. During the course of its investigation of this claim, GEICO noticed claimants, CNB, EM

and AM, for Examinations Under Oath. All three claimants failed to appear.

637. Finally, the BMW operated by the insured on this claim is the same vehicle operated by

an adverse driver in a October 18, 2011 loss, GEICO Claim No. 0425365580101016. Infra.

Date of Loss: 7/7/11 Insured Name (Initials): K M G G E I C O C laim No.: 0344666690101038 C linic: K J Chiropractic 638. Approximately three weeks later, another collision loss that conforms to the Confession

File staged crash profile was reported to GEICO.


no witnesses.

640. The occupants claimed soft tissue injuries and received extensive treatment at KJ


641. The Florida State Trooper who responded to the scene of the accident noted that both

vehicles were removed from the roadway prior to his arrival.


96

642. The adverse vehicle, a 1997 Jeep Cherokee, was insured by Farmers Insurance Group in

the name of the Defendant, Jean Cassamajor.

643. As part of its investigation, Farmer’s retained an accident reconstructionist to examine

the involved vehicles, a Jeep Grand Cherokee and a Chevrolet Impala.

644. This accident reconstructionist concluded that these cars were not involved in a reciprocal

collision as described by the vehicle occupants.

Date of Loss: 8/17/11 Insured Name (Initials): PH G E I C O C laim No.: 0112491250101025 C linic: K J Chiropractic 645. On August 17, 2011, another collision loss that conforms to the Confession File staged


646. The GEICO policy issued on June 5, 2011, approximately two months prior to the

reported crash on August 17, 2011.


no witnesses.



649. The Police Report indicated that both vehicles were removed from the roadway before

they arrived.

Date of Loss: 8/17/11 Insured Name (Initials): M N G E I C O C laim No.: 0183812280101160 C linic: W ellness 650. The same day, GEICO insured, MN, was involved in an alleged motor vehicle accident

with three other alleged passengers.


97

651. According to the Police Report associated with this loss, the alleged accident occurred

approximately six miles from Wellness.

652. The Police Report listed claimants MN, WC and YS as being in the vehicle at the time of

the crash. Claimant, RB was not listed as a passenger.

653. In accordance with Fla. Stat. §316.068(g), there is a presumption that RB was not in the

insured vehicle at the time of the alleged loss.

654. Following the alleged accident, claimant, RB, reportedly presented for “treatment” at

Wellness.

655. Wellness submitted bills to GEICO for treatment allegedly rendered to all of these

claimants from January 5, 2011 to March 23, 2011.

656. Moreover, Dr. Vito referred all four claimants to Advanced 3-D Diagnostics for

diagnostic imaging studies.



658. The claimants reported to GEICO that claimant, RB was in the vehicle in order to inflate

their total medical bills at Wellness.

659. As part of its continued investigation, GEICO learned that on August 17, 2011, the

insured, MN, submitted another claim to GEICO regarding an alleged accident, for which

multiple claimants sought treatment at Wellness.

Date of Loss: 8/31/11 Insured Name (Initials): NP G E I C O C laim No.: 0363235720101073 C linic: K J Chiropractic 660. Two weeks later, another loss that conforms to the Confession File staged crash profile

was received by GEICO.


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no witnesses.

662. GEICO’s named insured in this accident, NP, treated at KJ Chiropractic where he

claimed soft tissue back injuries. While a KJ Chiropractic patient, he was referred for diagnostic

imaging studies.

663. NP was the claimant in the November 20, 2012 GEICO loss listed above in this Amended

Complaint. See GEICO Claim No. 0363235720101024.

664. Johnson’s Towing was involved in both this August 31, 2011 loss and NP’s November

20, 2010 claim.

665. Notably, KJ Chiropractic mailed blank CMS 1500 bills to GEICO in connection with the

August 31, 2011 loss. Even though the form is purportedly signed by both the “patient” and

chiropractor, Miyoashi Gay, the bill records no treatment whatsoever. See Pre-signed and blank

CMS 1500 Forms attached as Exhibit 15.

Date of Loss: 9/15/11 Insured Name (Initials): R A G E I C O C laim No.: 0428882540101016 C linic: K J Chiropractic and W ellness 666. Approximately two weeks later, another loss that conforms to the Confession File staged

crash profile was received by GEICO.

667. The GEICO policy in this accident was issued on September 7, 2011, only eight days

prior to the September 15, 2011 accident.

668. The crash reportedly occurred at 2:00 P.M., 7.8 miles from KJ Chiropractic and 6.1 miles

from Wellness. There were no witnesses.




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670. Many of the involved individuals had prior claims. The GEICO insured, RA, was the

owner of the GEICO insured 1996 Buick LaSabre.

671. He and his two passengers, AD and MG, stopped treating at KJ Chiropractic on the same

day.

672. All three failed to appear for Examinations Under Oath.

673. Notably, AD is not listed in the Florida Traffic Crash Report.

674. Pursuant to Fla. Stat. §316.0682, an individual not listed in a Crash Report is presumed to

not have been in the vehicle.

675. The insured vehicle was reportedly purchased at a Power Towing Auction.

676. The 1996 Buick LaSabre reportedly rear ended a 2004 Chevrolet owned by AD. The

driver of the 2004 Chevrolet was reportedly AD.

677. The passengers in the 2004 Chevrolet were reportedly PN, DN, and JB. The claimants in

the 2004 Chevrolet reported for treatment at Wellness.

Date of Loss: 10/8/11 Insured Name (Initials): WP G E I C O C laim No.: 0200988100101033 C linic: W ellness 678. On October 8, 2011, GEICO’s named insured, WP, was involved in an alleged motor

vehicle accident while operating the insured vehicle, a 2002 Dodge Durango.

679. Claimant, PJ, was allegedly a passenger in the insured vehicle at the time of loss.

680. Three individuals, including SPL, the brother of Esdras Pierre Louis, were allegedly in

the adverse vehicle at the time of the alleged accident.

681. According to the Police Report associated with this loss, the alleged accident occurred on

Old Winter Garden Road, Orlando, Florida.


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682. The Police Report also indicates that the alleged accident occurred at 10:20 P.M., when

visibility and witnesses would be limited.

683. According to this report, when police arrived at the scene, the vehicles had already been

moved to a nearby gas station.

684. Notably, the Police Report did not record any injuries at the time of loss.


from October 10, 2011 through November 30, 2011.

686. The bills and treatment notes submitted to GEICO by Wellness demonstrate the

following suspect characteristics:

a. A majority of the treatment notes were unsigned by any medical professional; b. The bills submitted to GEICO by Wellness were signed using a stamp of Dr.

Vito’s signature after he allegedly left for New York; and, c. The signature block on the CMS 1500 forms for treatment allegedly rendered by

massage therapist, Clivens Baltazar, contains the typed label, “Clivens Baltazar, DC,” above which appears a signature stamp, “Clivens Baltazar, LMT.”

687. Moreover, as is customary for almost every patient at Wellness, Vito referred the

claimants to Advanced 3-D Diagnostics for diagnostic imaging studies.



689. During its investigation of suspicious claims associated with both Wellness and KJ

Chiropractic, GEICO learned that SPL, involved in the above referenced claim, is the brother of

JPL, EPL and “Eddie” Pierre Louis.

690. As mentioned, supra, Chanel Akins identified the individual who arranged the staged

accident in which she was involved as “Eddie.” The individual identified from the photograph

was Esdras Pierre Louis.


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691. Additionally, both Queena McRae and Chanel Akins stated that Esdras Pierre Louis’

brothers were involved in staging accidents. Esdras Pierre Louis has also admitted his

involvement in numerous staged accidents and false claims.

692. It should be noted that in addition to identifying the above mentioned brothers JPL

claimed that he had four brothers.

693. JPL was involved in a suspicious motor vehicle accident associated with this action,

GEICO Claim No.: 0416368760101013, for which he allegedly sought treatment at KJ

Chiropractic.

694. EPL was involved in a suspicious motor vehicle accident, GEICO Claim No.:

0404093240101011, for which he allegedly treated at KJ Chiropractic.

695. All of these accidents were staged and arranged by Esdras Pierre Louis, his brothers, and

others presently known and unknown to GEICO.

Date of Loss: 10/18/11 Insured Name (Initials): JR G E I C O C laim No.: 0425365580101016 C linic: W ellness 696. Ten days later, on October 18, 2011, GEICO’s named insured, JR, was involved in an

alleged motor vehicle accident while operating the insured vehicle, a 2003 Mercedes S430.

697. The GEICO automobile insurance policy associated with this claim was effective as of

July 21, 2011, approximately three months old on the date of loss.

698. The adverse vehicle, a BMW X5 is the same vehicle operated by a GEICO insured in the

June 14, 2011 loss, GEICO Claim No. 0420579441017. Supra.


approximately five miles from Wellness, at 9:03 P.M., when visibility and witnesses would have

been limited.


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700. When police officers arrived at the scene, the insured vehicle had been moved.

701. Moreover, the Police Report noted that the “injury severity,” as a result of the accident

was, “None,” for all parties involved.

702. The adverse operator, MF, presented for “treatment” at KJ Chiropractic.

703. Wellness submitted bills to GEICO for treatment allegedly rendered to the insured, JR,

from October 21, 2011 through November 8, 2011.

704. The insured, JR, informed E-surance, the carrier for the adverse operator, that he only

treated approximately six times at Wellness. However, Wellness submitted bills to GEICO for

twelve dates of treatment.

705. The insured, JR, subsequently treated at Nguyen Wellness Center, LLC, from November

16, 2011 through December 29, 2011.

706. An unsigned handwritten treatment note from Nguyen Wellness Center, LLC, dated

November 16, 2011 states, “Saw a D.C. for PIP; pt said D.C. moved so pt had to discontinue tx.”

707. GEICO noticed the insured, JR, for an Examination Under Oath. JR failed to appear.

708. E-surance, noticed its insured, adverse operator, MF, for an Examination Under Oath.

MF failed to appear.

Date of Loss: 12/2/11 Insured Name (Initials): E C G E I C O C laim No.: 0286172730101146 C linic: K J Chiropractic 709. On or about December 2, 2011, another claim that conforms to the Confession File staged

crash profile was received by GEICO.

710. The accident reportedly occurred at 10:30 P.M., 4.3 miles from KJ Chiropractic. There

were no witnesses.


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711. In this accident, the claimants, MV and MD, alleged soft tissue injuries from a low

impact crash wherein the other vehicle was backing up into the vehicle occupied by MV and

MD.

712. Both occupants reportedly treated at KJ Chiropractic.

713. Both MV and MD had reported injures in prior accidents.

714. In one of these prior claims, both MV and MD claimed neck and back injuries. This

accident reportedly occurred on August 11, 2010 (GEICO Claim No.: 02861727301010).

715. Two of the accidents involving MV and MD occurred at the same intersection.

716. In the August 11, 2010 loss, MV and MD, treated at a clinic (not KJ Chiropractic or

Wellness) where the owners were subsequently arrested on insurance fraud related charges.

I X . A C TS O F M A I L A ND W IR E F R A UD

A . SPE C I F I C A L L E G A T I O NS O F M A I L /W IR E F R A UD A ND R A C K E T E E RIN G A C T I V I T Y B Y D E F E ND A N TS

717. As discussed above, the KJ Chiropractic Group; (Sadat Smith, Jean Dorestant, Belle

Management, LLC, Orlene Joseph, Robert Cohen, Jean Cassamajor, Esdras Pierre Louis and

Vladimir “Rico” Jean Pierre), agreed to enact a scheme to defraud GEICO by soliciting

chiropractic patients and staging accidents.

718. Moreover, by and through the same Runners, the Wellness Group; (Arthur Vito, Robert

Thelusma, Elaine Felix, Edner Desir, Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis and

Vladimir “Rico” Jean Pierre), agreed to enact a scheme to defraud GEICO by soliciting

chiropractic patients and staging accidents.

719. This solicitation was accomplished through the use of Runners. Specifically, Jean

Dorestant, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Jean Cassamajor; in addition to

a series of individual agreements by and between:


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a. Sadat Smith, Jean Dorestant, and Orlene Joseph regarding ownership/control of KJ Chiropractic;

b. Sadat Smith, Jean Dorestant, Orlene Joseph and Robert Cohen regarding KJ Chiropractic’s payment of Runners/patients and fraudulent unlawful billing practices at KJ Chiropractic;

c. Sadat Smith, Jean Dorestant, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Jean Cassamajor regarding the KJ Chiropractic’s payment of Runners/patients;

d. Arthur Vito, Elaine Felix, Robert Thelusma, and Edner Desir regarding Wellness’ payment of Runners/patients, ownership/control of Wellness facility and fraudulent unlawful billing practices at Wellness;

e. Arthur Vito, Robert Thelusma, Elaine Felix, Edner Desir, Jean Dorestant, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Jean Cassamajor regarding the Wellness Group’s payment of Runners;

f. Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre regarding the staging of accidents and payment of accident participants who would present for “treatment” at KJ Chiropractic and/or Wellness including, but not limited to:

i. Shenika Richardson; ii. Shayla Gaines;

iii. Chanel Akins; iv. Queena McRae; v. Shantrese Williams;

vi. Leslie Lowe vii. Henry Preval;

viii. Yvio L’esperance; and, ix. Hashley Mocombe.

720. There were numerous other agreements involving the Defendants and others, both known

and unknown to GEICO. These agreements can be inferred from, and are established by, the

conduct of the Defendants. Moreover, these agreements demonstrate the Defendants’ scheme to

perpetrate fraud against GEICO using the U.S. Mail and Wires and the interconnectedness of the

actors involved.

721. This solicitation of patients was done for the purpose of ensuring that the reported victims

of motor vehicle accidents would be sent to KJ Chiropractic and/or Wellness, who then billed

GEICO for medical treatment that was not necessary and the charges for which were not

reasonable.


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722. The treatment purportedly provided by KJ Chiropractic and Wellness was not necessary

because a large number of patients who presented for “treatment” were not injured. If any

chiropractic treatment was in fact performed it was not necessary as:

a. The treatment was performed pursuant to a predetermined protocol and not based on a patient’s clinical needs;

b. The treatment was not supported by a proper medical assessment/diagnosis; and/or,

c. The treatment did not adhere to established chiropractic guidelines and standards established by Florida law.

723. Despite knowing that the services provided by the Clinics were not compensable under

the Florida No-Fault Act (as the Clinics: paid Runners, adopted predetermined protocols and

were not properly operated in compliance with Florida law), KJ Chiropractic, Sadat Smith,

Orlene Joseph, Jean Cassamajor, Jean Dorestant, Belle Management, LLC., Esdras Pierre Louis,

Vladimir “Rico” Pierre Louis, Wellness, Arthur Vito, Elaine Felix, Robert Thelusma and Edner

Desir submitted claims, or caused claims to be submitted, to GEICO for payment of PIP benefits.

724. The objective of the scheme to defraud GEICO, which occurred from 2009-2012, was to

collect in Florida No-Fault benefits to which the Defendants were not entitled because the

medical services rendered, if at all, were not necessary and because these Defendants engaged in

fraudulent billing practices, including those discussed throughout this Amended Complaint.

725. This objective necessarily required the submission of claims to GEICO.

726. The KJ Chiropractic and Wellness Groups created, prepared, and using the Clinics

submitted false medical documentation and placed the same in the U.S. Mail and Wires to

GEICO’s attention in Florida and other states throughout the country in order to receive payment

of otherwise non-compensable PIP benefits.


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727. Almost all documents, medical records, notes, reports, CMS 1500 forms, medical

diagnoses, correspondence, and requests for payment in connection with the insurance claims

referenced throughout this Amended Complaint traveled through the U.S. Mail and Wires.

728. Every automobile insurance claim detailed herein involved at least two uses of the U.S.

Mails or wires, including the mailing of, among other things, the notice of claim, initial policies,

insurance payments, claims settlement checks.

729. GEICO estimates that the fraudulent medical billing scheme detailed herein generated

hundreds of mailings.

730. As the Defendants agreed to use (and did in fact use) the U.S. Mail and Wires in

furtherance of their scheme to defraud GEICO by seeking payment for services that are not

compensable under the Florida No-Fault Act, the Defendants committed Mail/Wire Fraud, as

defined in 18 U.S.C. §§1341 and 1343. A table detailing representative examples of the

Mail/Wire Fraud agreed to and perpetrated by these Defendants is attached hereto as Exhibit 1;

and includes specific information regarding the date, the sender, the recipient, content of such

mailings and misrepresentations contained therein.

B . SA D A T SM I T H K N E W , A ND I T W AS R E ASO N A B L Y F O R ESE E A B L E , T H A T T H E K J C H IR OPR A C T I C G R O UP W O U L D USE T H E U .S. M A I LS T O SUB M I T INSUR A N C E C L A I MS T O G E I C O

731. Based upon the corporate paperwork filed with the Florida Secretary of State, Sadat

Smith is the owner of KJ Chiropractic.

732. Thus, Sadat Smith, by and through the KJ Chiropractic Group in which he has an interest,

mailed or caused to be mailed documents, including medical reports, records, and bills, that

materially misrepresented that KJ Chiropractic was:

a. providing necessary medical treatment; and, b. that the charges for said services were reasonable.


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733. Sadat Smith knew, and it was reasonably foreseeable, that KJ Chiropractic would submit

the above-mentioned medical documentation, including the representative documentation for

No-Fault reimbursement through the U.S. Mail and Wires relating to the patients referred to the

Clinic by the Runners associated with this scheme.

734. In fact, given that their scheme was designed to violate the Florida PIP statute, all of the

Defendants knew that their misrepresentations to GEICO regarding automobile “accidents” and

chiropractic “treatment” would travel through the U.S. Mail and Wires in the ordinary course of

the PIP Claim.

735. Indeed, it was within the ordinary course of business for KJ Chiropractic to submit claims

for No-Fault reimbursement to insurance carriers, like GEICO, through the U.S. Mail and Wires.

736. Moreover, should Sadat Smith claim ignorance of the facts, it is only because he adopted

an attitude of willful blindness in operating this facility. This attitude of willful blindness

facilitated the use of the U.S. Mail and wires by the KJ Chiropractic Group in line with its

practice of wrongfully soliciting patients and fraudulently billing GEICO.

737. As KJ Chiropractic and the KJ Chiropractic Group agreed to use (and did in fact use) the

U.S. Mail and Wires in furtherance of their scheme to defraud GEICO by seeking payment for

services that are not compensable under the Florida No-Fault Act, these Defendants committed

mail and wire fraud, as defined in 18 U.S.C. §§1341 and 1343. A table detailing representative

examples of the mail and wire fraud agreed to and perpetrated by these Defendants is attached

hereto at Exhibit 1, and includes specific information regarding the date, the sender, the

recipient, content of such mailings and misrepresentations contained therein. It should be noted,

that Exhibit 1 is an illustrative, not exhaustive list of exemplar mailings/wires by the Defendants.


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738. As discussed above, the representative mailings/wires identified in Exhibit 1 contained

misrepresentations of fact regarding the medical necessity of the treatment for which GEICO

was billed.

739. GEICO reasonably relied on the submissions it received from the KJ Chiropractic Group

through the U.S. Mail and Wires and as a result caused to tender payment of insurance benefits

to KJ Chiropractic, third party diagnostic companies and other entities relating to these alleged

accidents. These payments are detailed in GEICO’s damages chart attached hereto as Exhibit 2.

740. As these Defendants agreed to pursue the same criminal objective (namely, Mail/Wire

Fraud), they committed a conspiracy within the meaning of the RICO Act, 18 U.S.C. § 1962(d),

and are therefore jointly and severally liable for GEICO’s damages.

C . A R T H UR V I T O K N E W , A ND I T W AS R E ASO N A B L Y F O R ESE E A B L E , T H A T T H E W E L L N ESS G R O UP W O U L D USE T H E U .S. M A I LS T O SUB M I T INSUR A N C E C L A I MS T O G E I C O

741. Based upon the corporate paperwork filed with the Florida Secretary of State, Arthur Vito

was the owner of Wellness.

742. Thus, Arthur Vito by and through the Wellness Group in which he has an interest, mailed

or caused to be mailed documents, including medical reports, records, and bills, that materially

misrepresented that Wellness was:

a. providing necessary medical treatment; and, b. that the charges for said services were reasonable.

743. Arthur Vito knew, and it was reasonably foreseeable, that Wellness would submit the

above-mentioned medical documentation, including the representative documentation for No-

Fault reimbursement through the U.S. Mail and Wires relating to the patients referred to the

Clinic by the Runners associated with this scheme.


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744. In fact, given that their scheme was designed to violate the Florida PIP statute, all of the

Defendants knew that their misrepresentations to GEICO regarding automobile “accidents” and

chiropractic “treatment” would travel through the U.S. Mail and Wires in the ordinary course of

the PIP Claim.

745. Indeed, it was within the ordinary course of business for the Wellness to submit claims

for No-Fault reimbursement to insurance carriers, like GEICO, through the U.S. Mail and Wires.

746. Moreover, should Arthur Vito claim ignorance of the facts, it is only because he adopted

a readily apparent attitude of willful blindness as he left the state of Florida while Wellness was

still operating as a chiropractic facility. Notably, Vito left this facility in the hands of unlicensed

laypeople; namely, Robert Thelusma, Elaine Felix, and Edner Desir.

747. This attitude of willful blindness facilitated the use of the U.S. Mail and Wires by the

Wellness Group in line with its practice of wrongfully soliciting patients and fraudulent billing

GEICO.

748. As Wellness and the Wellness Group agreed to use (and did in fact use) the U.S. Mail

and Wires in furtherance of their scheme to defraud GEICO by seeking payment for services that

are not compensable under the Florida No-Fault Act, these Defendants committed mail and wire

fraud, as defined in 18 U.S.C. §§1341 and 1343. A table detailing representative examples of the

mail and wire fraud agreed to and perpetrated by these Defendants is attached hereto at Exhibit

1, and includes specific information regarding the date, the sender, the recipient, content of such

mailings and misrepresentations contained therein.

749. As discussed above, the representative mailings and wires identified in Exhibit 1

contained misrepresentations of fact regarding the medical necessity of the treatment for which

GEICO was billed.


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750. GEICO reasonably relied on the submissions it received from Wellness through the U.S.

Mail and Wires and as a result caused to tender payment of insurance benefits to Wellness, third

party diagnostic companies and other entities relating to these alleged accidents. These payments

are detailed in GEICO’s damages chart attached hereto as Exhibit 2.

751. As these Defendants agreed to pursue the same criminal objective (namely, Mail/Wire

Fraud), they committed a conspiracy within the meaning of the RICO Act, 18 U.S.C. § 1962(d),

and are therefore jointly and severally liable for GEICO’s damages.

D . SPE C I F I C A L L E G A T I O NS O F M ISR EPR ESE N T A T I O NS M A D E T O A ND R E L I E D UPO N B Y G E I C O .

1) M ISR EPR ESE N T A T I O NS B Y K J C H IR OPR A C T I C A ND W E L L N ESS

752. To induce GEICO to promptly pay the fraudulent charges for unnecessary medical

services, all of the Defendants submitted or caused to be submitted to GEICO false medical

documentation which materially misrepresented that the medical services they provided were

necessary within the meaning of the Florida No-Fault Act and that the charges for the same were

reasonable.

753. Each CMS 1500 form submitted to GEICO by the Defendant contained the following

warning: “NOTICE: Any person who knowingly files a statement of claim containing any

misrepresentation or any false, incomplete or misleading information may be guilty of a criminal

act punishable under law and may be subject to civil penalties.”

754. Through the submission of patient records, invoices, CMS 1500 forms, and other medical

documentation to GEICO via the U.S. Mail and Wires, the Clinics and their owners attested to

the fact and medical necessity of the visits, examinations, interviews, screenings, testing,

procedures, and ancillary services for which GEICO was billed.


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755. As KJ Chiropractic and Wellness did not render reasonably necessary medical treatment

and as they engaged in fraudulent billing practices, each bill and accompanying documentation

submitted to GEICO constitutes a material misrepresentation.

756. The facially valid documents submitted to GEICO by the KJ Chiropractic and Wellness

through their employees, agents and Runners were designed to and did in fact, induce GEICO to

rely on the accuracy of such documents.

2) GEICO’S JUSTIFIABLE RELIANCE

757. At all relevant times, the Defendants concealed from GEICO facts regarding the payment

of Runners, fraudulent billing practices and medical necessity of chiropractic procedures

performed at the Clinics to prevent GEICO from discovering that the claims submitted by KJ

Chiropractic and Wellness were not compensable under the Florida No-Fault Act.

758. These misrepresentations include submitting false medical documentation, including

CMS 1500 forms, documenting the fact and necessity of medical treatment in order to seek

reimbursement under the Florida No-Fault Act.

759. These misrepresentations include submissions and statements made to GEICO by all of

the Defendants.

760. Evidence of the fraudulent scheme detailed herein was not discovered until after patterns

had emerged and GEICO began to investigate this Staged Accident Ring and corresponding

arrangements with KJ Chiropractic and Wellness, thus revealing the true nature and full scope of

their fraudulent scheme.

761. Due to the Defendants’ material misrepresentations and other affirmative acts designed to

conceal their fraudulent scheme from both law enforcement and insurance companies alike,


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GEICO did not and could not have discovered that its damages were attributable to fraud until

shortly before it filed its Original Complaint.

762. In reliance on the Defendants’ misrepresentations, GEICO paid monies to the Defendants

and various third parties to its detriment.

763. GEICO would not have paid these monies had the Defendants provided true and accurate

information regarding the validity of motor vehicle accidents, how patients were referred to KJ

Chiropractic and Wellness and the resulting necessity of any medical services provided.

764. As a result, GEICO has paid in excess of $1,600,000.00 dollars in reasonable reliance on

the false medical documentation and other false representations regarding the validity of motor

vehicle accidents and the Clinics’ eligibility for reimbursement under the Florida No-Fault Act.

X . D A M A G ES

765. As of the date of this Amended Complaint, GEICO has received over $2,300,000.00

dollars in charges in connection with the claims listed in Exhibit 2 attached hereto.

766. GEICO, in good faith, paid $691,084.56 dollars in Clinic medical bills.

767. GEICO, in good faith, paid $1,621,225.43 dollars total for medical bills, property damage

claims, bodily injury claims, costs and other expenses relating to the claims referenced in this

Amended Complaint. See attached Damages Chart, Exhibit 2.

768. As a consequence of the Defendants’ pattern of fraudulent conduct, GEICO has suffered

damages, which include, but are not limited to, the monies detailed in the chart attached to this

Amended Complaint. See Exhibit 2.

769. Because of the Defendants’ sophisticated scheme and clandestine activities, the full

extent of GEICO’s damages is known only to Defendants and, therefore, can only be ascertained

through discovery.


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X I . C A USES O F A C T I O N

C O UN T I

V I O L A T I O NS O F 18 U .S.C . § 1962(c) (K J Chiropractic Enterprise)

Against Sadat Smith, D .C ., O rlene Joseph, Robert Cohen, Jean Cassamajor , Esdras Pierre Louis, Vladimir “Rico” Jean Pierre, Jean Dorestant, and Belle

Management, L L C .

770. GEICO re-alleges, re-pleads, and incorporates by reference paragraphs: 1-21, 23-51, 60-

63, 68-140, 246-253, 255-424, 463-468, 476-497, 506-518, 529-568, 581-608, 619-622, 638-

649, 660-677, 709-717, 719-740, 752-769 set forth above as if fully set forth herein.

771. KJ Chiropractic Center, LLC, constitutes an “enterprise,” as defined in 18 U.S.C. §

1961(4). Moreover, KJ Chiropractic constitutes an enterprise engaged in, and the activities of

which, affect interstate commerce.

772. In connection with each of the claims identified in this Complaint, The KJ Chiropractic

Group: Sadat Smith, D.C., Orlene Joseph, Robert Cohen, Jean Cassamajor, Esdras Pierre Louis,

Vladimir “Rico” Jean Pierre, Jean Dorestant and Belle Management, LLC. (Count I Defendants),

intentionally caused to be prepared and mailed false medical documentation by KJ Chiropractic,

or knew that such false medical documentation would be mailed in the ordinary course of KJ

Chiropractic’s business, or should have reasonably foreseen that the mailing of such false

medical documentation by KJ Chiropractic would occur, in furtherance of the Count I

Defendants’ scheme to defraud.

773. The Count I Defendants employed, knew, or should have foreseen that two or more

mailings demanding payment from GEICO on certain dates, including, but not limited to, those

dates identified in the Mail/Wire Fraud chart attached hereto at Exhibit 1, would be sent to

GEICO.


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774. Among other things, medical records, bills, invoices, applications for insurance,

applications for benefits, premium checks and various other documents were delivered to

GEICO through the U.S. Mail/Wire.

775. Policies of insurance were delivered to insureds through the U.S. Mail.

776. Payments to KJ Chiropractic from GEICO were transmitted through the U.S. Mail.

777. As documented above, the Count I Defendants, using their relationships with one

another, continuously and intentionally submitted, caused to be submitted, or knew that

documentation would be submitted to GEICO for medical expenses and/or services that were

purportedly performed at and/or by KJ Chiropractic to collect payment from GEICO under the

personal injury protection benefits portion of GEICO policies and applicable provisions of the

Florida No-Fault Act.

778. As a result of, and in reasonable reliance on, these misleading documents and

misrepresentations, GEICO, by its agents and employees, issued drafts for payment to KJ

Chiropractic for the benefit of the Count I Defendants that would not otherwise have been paid.

779. The Count I Defendants’ pattern of submitting, causing to be submitted, or knowing that

fraudulent claims that appeared legitimate on their face would be submitted, prevented GEICO

from discovering the fraudulent scheme for a prolonged period of time, thus enabling the Count I

Defendants to continue their fraudulent scheme without detection.

780. The acts set forth above constitute indictable offenses pursuant to 18 U.S.C. §§1341 and

1343 (Mail/Wire Fraud).

781. By mailing, or agreeing that the mail would be used to submit, numerous fraudulent

claims in an ongoing scheme, the Count I Defendants engaged in a pattern of racketeering

activity within the meaning of 18 U.S.C. § 1962(c).


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782. The activities alleged in this Complaint had the direct effect of causing funds to be

transferred from GEICO to KJ Chiropractic for the benefit of the Count I Defendants.

783. The Count I Defendants participated, both directly and indirectly, in the conduct of this

enterprise through a pattern of racketeering activities outlined in the balance of this Complaint.

784. GEICO is a “person,” as defined by 18 U.S.C. § 1961(3), injured in its business or

property by reason of the Count I Defendants’ fraudulent acts.

785. The Count I Defendants’ conduct in violation of 18 U.S.C. § 1962(c) was the direct and

proximate cause of GEICO’s injury.

786. GEICO is in the business of writing insurance and paying claims in the State of Florida


787. Insurance fraud schemes practiced here and elsewhere have a deleterious impact on

GEICO’s overall financial well-being and adversely affect insurance rates throughout the

country.

788. By virtue of the Count I Defendants’ violations of 18 U.S.C. § 1962(c), GEICO is

entitled to recover from them three times the damages sustained by reason of the claims

submitted, caused to be submitted, or known to be submitted, by them, and others acting in

concert with them, together with the costs of suit, including reasonable attorney’s fees.

W H E RE F O R E , GEICO demands judgment against the Count I Defendants individually, jointly

and severally as follows:

a. Actual and consequential damages to be established at trial; b. Treble damages, interest, costs and reasonable attorney’s fees, pursuant to 18 U.S.C.

§ 1964; c. Injunctive relief, as the Court deems just, enjoining the Count I Defendants from

engaging in further wrongful activities as alleged in the Complaint; and, d. All other relief this Court deems just.


116

C O UN T I I V I O L A T I O NS O F 18 U .S.C . § 1962(d)

(K J Chiropractic Enterprise Conspiracy) Against Sadat Smith, D .C ., O rlene Joseph, Robert Cohen, Jean Cassamajor , Esdras

Pierre Louis, Vladimir “Rico” Jean Pierre, Shenika Richardson, Shayla Gaines, Chanel A kins, Queena McRae, Jean Dorestant and Belle Management, L L C .


209, 246-253, 255-424, 463-468, 476-497, 506-518, 529-568, 581-608, 619-622, 638-649, 660-

677, 709-717, 719-740, 757-769 set forth above as if fully set forth herein.

790. The KJ Chiropractic Group: Sadat Smith, D.C., Orlene Joseph, Robert Cohen, Jean

Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre, Jean Dorestant and Belle

Management, LLC., along with accident participants: Shenika Richardson, Shayla Gaines,

Chanel Akins, Queena McRae, (Count II Defendants) conspired with each other to violate 18

U.S.C. § 1962(c) through the facilitation and operation of KJ Chiropractic.

791. The Count II Defendants each agreed to further, facilitate, support, and/or operate the KJ

Chiropractic, including the submission of fraudulent medical documentation through the U.S.

Mail from 2009-2012.

792. As such, the Count II Defendants conspired to violate 18 U.S.C. § 1962(c).

793. The object of the conspiracy was to obtain Florida No-Fault payments from GEICO on

behalf of KJ Chiropractic, even though KJ Chiropractic was not eligible to collect No-Fault

payments by virtue of its unlawful conduct.

794. The Count II Defendants were aware of this purpose and each agreed to perform overt

acts in furtherance of the conspiracy’s objectives, including the creation and submission, to

GEICO, of insurance claim documents containing material misrepresentations and/or material

omissions.


117

795. GEICO has been injured in its business and property by reason of this conspiratorial

conduct as the Count II Defendants induced GEICO to make No-Fault claim payments through

their unlawful submissions of fraudulent medical documentation using the U.S. Mail/Wires, in

violation of 18 U.S.C. 1962(c).

796. By virtue of this violation of 18 U.S.C. § 1962(d), the Count II Defendants are jointly and

severally liable to GEICO, and GEICO is entitled to recover from each three times the damages

sustained by reason of the claims submitted by or on behalf of the Count II Defendants, and

others acting in concert with them, together with the costs of suit, including reasonable attorney’s

fees.

W H E RE F O R E , GEICO demands judgment against the Count II Defendants individually, jointly



§ 1964; c. Injunctive relief, as the Court deems just, enjoining the Count II Defendants from


C O UN T I I I V I O L A T I O NS O F 18 U .S.C . § 1962(c)

(W ellness Enterprise) Against A rthur V ito, D . C ., Robert Thelusma, E laine Felix, Edner Desi r , Jean

Dorestant, Jean Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre,


59, 60-63, 68-69, 141-209, 254, 256-358, 383-462, 469-475, 498-528, 569-598, 606-607, 609-

618, 623-637, 650-659, 666-708, 718-730, 741-769 forth above as if fully set forth herein.


118

798. Wellness Pain & Rehab, Inc., constitutes an “enterprise,” as defined in 18 U.S.C. §

1961(4). Moreover, Wellness constitutes an enterprise engaged in, and the activities of which,

affect interstate commerce.

799. In connection with each of the claims identified in this Complaint, Arthur Vito, D.C.,

Robert Thelusma, Elaine Felix, Edner Desir, Jean Dorestant, Jean Cassamajor, Esdras Pierre

Louis and Vladimir “Rico” Jean Pierre, (Count III Defendants) intentionally caused to be

prepared and mailed false medical documentation by Wellness, or knew that such false medical

documentation would be mailed in the ordinary course of Wellness’ business, or should have

reasonably foreseen that the mailing of such false medical documentation by Wellness would

occur, in furtherance of the Count III Defendants’ scheme to defraud.

800. The Count III Defendants employed, knew, or should have foreseen that two or more

mailings demanding payment from GEICO on certain dates, including, but not limited to, those

dates identified in the Mail/Wire fraud chart attached hereto at Exhibit 1, would be sent to

GEICO.


applications for benefits, and premium checks were delivered to GEICO through the U.S. Mail.


803. Payments to Wellness from GEICO were transmitted through the U.S. Mail.

804. As documented above, the Count III Defendants, using their relationships with one

another, continuously and intentionally submitted, caused to be submitted, or knew that

documentation would be submitted to GEICO for medical expenses and/or services that were

purportedly performed at and/or by Wellness to collect payment from GEICO under the personal


119

injury protection benefits portion of GEICO policies and applicable provisions of the Florida No-

Fault Act.


misrepresentations, GEICO, by its agents and employees, issued drafts for payment to Wellness

for the benefit of the Count III Defendants that would not otherwise have been paid.

806. The Count III Defendants’ pattern of submitting, causing to be submitted, or knowing

that fraudulent claims that appeared legitimate on their face would be submitted, prevented

GEICO from discovering the fraudulent scheme for a prolonged period of time, thus enabling the

Count III Defendants to continue their fraudulent scheme without detection.

807. The acts set forth above constitute indictable offenses pursuant to 18 U.S.C. §§1341 and


808. By mailing, or agreeing that the mail/wires would be used to submit, numerous

fraudulent claims in an ongoing scheme, the Count III Defendants engaged in a pattern of

racketeering activity within the meaning of 18 U.S.C. § 1962(c).

809. The activities alleged in this Complaint had the direct effect of causing funds to be

transferred from GEICO to Wellness for the benefit of the Count III Defendants.

810. The Count III Defendants participated, both directly and indirectly, in the conduct of this

enterprise through a pattern of racketeering activities outlined in the balance of this Complaint.


property by reason of the Count III Defendants’ fraudulent acts.

812. The Count III Defendants’ conduct in violation of 18 U.S.C. § 1962(c) was the direct and



120

813. GEICO is in the business of writing insurance and paying claims in the State of Florida



GEICO’s overall financial well-being and adversely affect insurance rates throughout the

country.

815. By virtue of the Count III Defendants’ violations of 18 U.S.C. § 1962(c), GEICO is




W H E RE F O R E , GEICO demands judgment against the Count III Defendants individually, jointly



§ 1964; c. Injunctive relief, as the Court deems just, enjoining the Count III Defendants from


C O UN T I V

V I O L A T I O NS O F 18 U .S.C . § 1962(d) (W ellness Enterprise Conspiracy)

Against A rthur V ito, D . C ., Robert Thelusma, E laine Felix, Edner Desi r , Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre


59, 60-63, 68-69, 141-209, 254, 256-358, 383-462, 469-475, 498-528, 569-598, 606-607, 609-

618, 623-637, 650-659, 666-708, 718-730, 741-769 set forth above as if fully set forth herein.

817. The Wellness Group: Arthur Vito, D.C., Robert Thelusma, Elaine Felix, Edner Desir,

Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre, (Count


121

IV Defendants) conspired with each other to violate 18 U.S.C. § 1962(c) through the facilitation

and operation of Wellness.

818. The Count IV Defendants each agreed to further, facilitate, support, and/or operate the

Wellness enterprise.

819. As such, the Count IV Defendants conspired to violate 18 U.S.C. § 1962(c).

820. The purpose of the conspiracy was to obtain Florida No-Fault payments from GEICO on

behalf of Wellness, even though Wellness was not eligible to collect No-Fault payments by

virtue of its unlawful conduct.

821. The Count IV Defendants were aware of this purpose and agreed to take steps to meet the

conspiracy’s objectives, including the creation and submission to GEICO of insurance claim

documents containing material misrepresentations and/or material omissions.


conduct whereas GEICO has been induced to make No-Fault claim payments as a result of the

Count IV Defendants’ unlawful conduct described herein.

823. By virtue of this violation of 18 U.S.C. § 1962(d), the Count IV Defendants are jointly

and severally liable to GEICO and GEICO is entitled to recover from each three times the

damages sustained by reason of the claims submitted by or on behalf of the Count IV

Defendants, and others acting in concert with them, together with the costs of suit, including

reasonable attorney’s fees.

W H E RE F O R E , GEICO demands judgment against the Count IV Defendants individually,

jointly and severally as follows:


§ 1964;


122

c. Injunctive relief, as the Court deems just, enjoining the Count IV Defendants from engaging in further wrongful activities as alleged in the Complaint; and,

d. All other relief this Court deems just.

C O UN T V V I O L AT I O NS O F 18 U .S.C . § 1962(c)

(ASSO C I AT IO N-IN-FA C T E NT E RPRISE) Against KJ Chiropractic, the KJ Group, Wellness and the Wellness G roup

824. GEICO re-alleges, re-pleads, and incorporates by reference paragraphs: 1-63, 68-209,

246-769 set forth above as if fully set forth herein.

825. KJ Chiropractic, Sadat Smith, D.C., Orlene Joseph, Robert Cohen, Belle Management,

LLC., Jean Dorestant, Wellness, Arthur Vito, D.C., Robert Thelusma, Elaine Felix, Edner Desir,

Jean Cassamajor, Esdras Pierre Louis, and Vladimir “Rico” Jean Pierre (Count V Defendants)

constitute an association-in-fact enterprise as there was a discernible structure amongst the

Defendants that was distinct from the enterprise itself and the racketeering activity perpetrated

by the Count V Defendants.

826. The Count V Defendants shared the common purpose of submitting inflated and/or

completely false medical documentation and bills to GEICO in order to receive Florida No-Fault

benefits, for treatment purportedly rendered at KJ Chiropractic and/or Wellness following staged

crashes.

827. The Count V Defendants also maintained specific relationships with one another, in that

the Runners, Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis, and Vladimir “Rico” Jean

Pierre habitually funneled/referred “patients” to KJ Chiropractic, purportedly owned by Sadat

Smith, and Wellness, purportedly owned by Arthur Vito.

828. In reality, KJ Chiropractic was owned by Runner Defendant, Jean Dorestant and

Wellness was owned by Robert Thelusma, Elaine Felix and Edner Desir.


123

829. The Runners described throughout this Amended Complaint clearly had close

relationships with both Clinics, their employees and in turn their owners; without which there

would be no incentive to refer “patients” to both Clinics and thereafter submit fraudulent

bills/claims to GEICO for payment.

830. As mentioned, this solicitation was accomplished through the use of Runners.

Specifically, Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis, and Vladimir “Rico” Jean

Pierre; along with a series of individual agreements by and between:

a. Chiropractors and secret clinic operators; b. Runners and clinic operators; c. Runners and clinic employees; and/or, d. Runners and staged accident participants.

831. The agreements entered into by the Count V Defendants, along with the continuous and

interconnected pattern of activity engaged in by the same are readily apparent in GEICO’s

illustrative claims involving a common plan implemented at both KJ Chiropractic and Wellness.

832. After this continuous, interconnected and pervasive pattern of staging accidents, the next

step in the Count V Defendants’ fraudulent scheme/agreement was to create and submit bills to

GEICO for services not rendered, and/or services administered in line with a pre-programmed

treatment plan, designed to generate maximum profit as opposed to healing patients.

833. The pattern of racketeering activity, including Mail/Wire Fraud was ongoing from 2009-

2012 and is exemplified in GEICO’s Fraudulent Medical Record Analysis Chart, attached hereto

as Exhibit 6. The underlying pattern of staged accidents activity was also ongoing from 2009-

2012.

834. In each of these GEICO claims, the Count V Defendants intentionally caused to be

prepared, and mailed false medical documentation, or knew that such false medical

documentation would be mailed in the ordinary course of the Clinics’ business, or should have


124

reasonably foreseen that the mailing of such false medical documentation by the Clinics would

occur, in furtherance of the Count V Defendants’ overarching scheme to defraud.

835. The Count V Defendants employed, knew, or should have foreseen that two or more

mailings to demand payment from GEICO on certain dates, including, but not limited to, those

dates identified in the Mail/Wire Fraud chart attached hereto at Exhibit 1.


applications for benefits, and premium checks were delivered to GEICO through the U.S.

Mail/Wire.


838. Payments to the Clinics from GEICO were transmitted through the U.S. Mail.

839. As documented above, the Count V Defendants repeatedly and intentionally submitted,

caused to be submitted, or knew that documentation would be submitted to GEICO for medical

expenses and/or services that were purportedly performed at KJ Chiropractic and/or Wellness to

collect payment from GEICO under the PIP benefits portion of GEICO policies and applicable

provisions of the Florida No-Fault Act.


misrepresentations, GEICO, by its agents and employees, issued drafts for payment to KJ

Chiropractic, Wellness and third parties submitting bills for the benefit of the Count V

Defendants that would not otherwise have been paid.

841. The Count V Defendants’ continuous and interconnected pattern of submitting, causing to

be submitted, or knowing that fraudulent claims that appeared legitimate on their face would be

submitted, prevented GEICO from discovering the fraudulent scheme for a prolonged period of


125

time, thus enabling the Count V Defendants to continue their fraudulent scheme without

detection.

842. The acts set forth above constitute indictable offenses pursuant to 18 U.S.C. §§ 1341 and


843. By mailing, or agreeing that the mail would be used to submit, numerous fraudulent

claims in an ongoing scheme, the Count V Defendants engaged in a pattern of racketeering

activity within the meaning of 18 U.S.C. § 1962(c).

844. The activities alleged in this Amended Complaint had the direct effect of causing funds to

be transferred from GEICO to KJ Chiropractic and Wellness for the benefit of the Count V

Defendants.


property by reason of the Count V Defendants’ fraudulent acts.

846. The Count V Defendants’ conduct in violation of 18 U.S.C. § 1962(c) was the direct and


847. GEICO is in the business of writing insurance and paying claims in the State of Florida.


GEICO’s overall financial well-being and adversely affect insurance rates.

849. By virtue of the Count V Defendants’ violations of 18 U.S.C. § 1962(c), GEICO is




W H E RE F O R E , GEICO demands judgment against the Count V Defendants individually,



126


§ 1964; c. Injunctive relief, as the Court deems just, enjoining the Count V Defendants from


C O UN T V I

RI C O C O NSPIR A C Y V I O L AT I O N 18 U .S.C . § 1962(d) (ASSO C I AT IO N-IN-FA C T E NT E RPRISE C ONSPIR A C Y)

(Against A ll Defendants)

850. GEICO re-alleges, re-pleads, and incorporates by reference paragraphs: 1-209, 246-769

set forth above as if fully set forth herein.

851. KJ Chiropractic Center, LLC., Sadat Smith, D.C., Orlene Joseph, Robert Cohen, Jean

Dorestant, Belle Management, LLC., Wellness, Arthur Vito, D.C., Robert Thelusma, Elaine

Felix, Edner Desir, Jean Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre, Shenika

Richardson, Shayla Gaines, Chanel Akins and Queena McRae (Count VI Defendants) conspired

with each other to violate 18 U.S.C. § 1962(c).

852. As mentioned, these Defendants, each agreed to further, facilitate, support, and/or operate

the association-in-fact enterprise.

853. As such, the Count VI Defendants conspired to violate 18 U.S.C. § 1962(c).

854. The purpose of the conspiracy was to obtain Florida No-Fault payments from GEICO on

behalf of KJ Chiropractic and Wellness when they were not eligible to collect No-Fault

payments by virtue of their unlawful practices and structure.

855. The Count VI Defendants were aware of this purpose and agreed to take steps to meet the

conspiracy’s objectives, including the creation and submission to GEICO of insurance claim

documents containing material misrepresentations and/or material omissions.


127


conduct whereas GEICO has been induced to make No-Fault claim payments as a result of the

Count VI Defendants’ unlawful conduct described herein.

857. By virtue of this violation of 18 U.S.C. § 1962(d), the Count VI Defendants are jointly

and severally liable to GEICO and GEICO is entitled to recover from each three times the

damages sustained by reason of the claims submitted by or on behalf of the Count VI Defendants,

and others acting in concert with them, together with the costs of suit, including reasonable

attorney’s fees.

W H E RE F O R E , GEICO demands judgment against the Count VI Defendants individually, jointly



§ 1964; c. Injunctive relief, as the Court deems just, enjoining the Count VI Defendants from


C O UN T V I I

C O M M O N L A W F R A UD (Against A ll Defendants)



859. The scheme to defraud GEICO perpetrated by Defendants, KJ Chiropractic Center, LLC.,

Wellness Pain & Rehab, Inc., Sadat Smith, Arthur Vito, Jean Dorestant, Belle Management,

LLC., Esdras Pierre Louis, Jean Cassamajor, Robert Cohen, Orlene Joseph, Edner Desir, Elaine

Felix, Vladimir “Rico” Jean Pierre, Robert Thelusma, Shenika Richardson, Shayla Gaines,

Chanel Akins and Queena McRae (Count VII Defendants), was dependent upon a succession of

material misrepresentations of fact, specifically enumerated throughout this Complaint (and


128

GEICO’s Mail/Wire fraud chart attached hereto as Exhibit 1), including but not limited to, that

KJ Chiropractic and Wellness were lawfully rendering medical treatment in compliance with the

Florida law and were entitled to collect benefits under Florida’s No-Fault Act.

860. The misrepresentations of fact made by the Count VII Defendants include, but are not

limited to, material misrepresentations regarding the validity of accidents, the necessity and fact

of medical services provided by KJ Chiropractic and Wellness and/or whether injuries arose out

of a motor vehicle accident.

861. The representations by the Defendants were false or required disclosure of additional

facts to render the information furnished not misleading.

862. The misrepresentations were intentionally made by the Defendants in furtherance of their

scheme to defraud GEICO by submitting, causing to be submitted, or knowing that non-

compensable claims for payment under the Florida No-Fault Act would be submitted to GEICO.

863. The Count VII Defendant’s misrepresentations were known to be false and were made for

the purpose of inducing GEICO to make payments for claims that were not compensable under

Florida law.

864. GEICO reasonably relied upon such material misrepresentations to its detriment in

paying numerous non-meritorious bills for medical expenses submitted pursuant to Florida’s No-

Fault Act.

865. As a direct and proximate result of the Count VII Defendants’ fraudulent representations

and acts, GEICO has been damaged as described throughout the balance of this Complaint. See

Exhibit 2.

866. GEICO’s damages include, but are not limited to:

a. Monies paid for medical expenses and services that were not rendered; b. Monies paid for medical services and/or expenses that were not reasonable,


129

necessary or related; c. Monies paid from fraudulent accidents for property damage claims arising out of

collision and/or liability coverage under GEICO’s automobile insurance policy; d. Monies paid in settlement of claims based upon the Count XIII Defendants’

representations that accidents actually occurred; e. Reimbursement for the fair and reasonable value of the labor and resources

expended to detect and expose the Count XIII Defendants’ scheme to defraud GEICO; and,

f. Monies incurred in connection with this suit.

W H E RE F O R E , GEICO demands judgment against the Count VII Defendants individually, jointly


a. Actual and consequential damages to be established at trial; and, b. Such other relief as the Court deems just.

C O UN T V I I I C I V I L C O NSPIR A C Y

(Against A ll Defendants)



868. Defendants, KJ Chiropractic, Wellness, Sadat Smith, Arthur Vito, Jean Dorestant, Belle

Management, LLC, Esdras Pierre Louis, Jean Cassamajor, Robert Cohen, Orlene Joseph, Edner

Desir, Elaine Felix, Vladimir “Rico” Jean Pierre, Robert Thelusma, Shenika Richardson, Shayla

Gaines, Chanel Akins and Queena McRae (Count VIII Defendants) combined and concerted to

accomplish the unlawful purpose of defrauding GEICO by submitting claims for reimbursement

under the Florida No-Fault Act to which they were not entitled because KJ Chiropractic and

Wellness:

a. did not provide reasonably necessary medical treatment; b. did not actually provide the services for which they billed GEICO; and, c. engaged in fraudulent billing practices that inflated the charges submitted to

GEICO.


130

869. The Count VIII Defendants worked together to achieve an unlawful purpose (namely,

defrauding GEICO for their financial gain). This purpose was known to all of the Defendants

and intentionally pursued.

870. KJ Chiropractic, Wellness, Sadat Smith, Arthur Vito, Jean Dorestant, Belle Management,

LLC., Robert Cohen, Orlene Joseph, Edner Desir, Elaine Felix and Robert Thelusma, utilized

Runners, Esdras Pierre Louis, Jean Cassamajor, Vladimir “Rico” Jean Pierre and others both

known and unknown to GEICO agreed to stage accidents and thereafter refer patients to KJ

Chiropractic and Wellness for the purpose of submitting documentation to GEICO representing

that PIP claims and Florida No-Fault benefits were due and payable.

871. The Count VIII Defendants’ fraudulent scheme was achieved through a series of

individual agreements by and between:

a. Sadat Smith, Jean Dorestant, and Orlene Joseph regarding ownership/control of KJ Chiropractic;

b. Sadat Smith, Jean Dorestant, Orlene Joseph and Robert Cohen regarding KJ Chiropractic’s payment of Runners/patients and fraudulent unlawful billing practices at KJ Chiropractic;

c. Sadat Smith, Jean Dorestant, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Jean Cassamajor regarding the KJ Chiropractic’s payment of Runners/patients;

d. Arthur Vito, Elaine Felix, Robert Thelusma, and Edner Desir regarding Wellness’ payment of Runners/patients, ownership/control of Wellness facility and fraudulent unlawful billing practices at Wellness;

e. Arthur Vito, Robert Thelusma, Elaine Felix, Edner Desir, Jean Dorestant, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Jean Cassamajor regarding the Wellness Group’s payment of Runners;

f. Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis and Vladimir “Rico” Jean Pierre regarding the staging of accidents and payment of accident participants who would present for “treatment” at KJ Chiropractic and/or Wellness including, but not limited to:

i. Shenika Richardson; ii. Shayla Gaines;

iii. Chanel Akins; iv. Queena McRae; v. Shantrese Williams;


131

vi. Leslie Lowe vii. Henry Preval;

viii. Yvio L’esperance; and, ix. Hashley Mocombe.

872. There were numerous other agreements involving the Defendants and others, both known

and unknown to GEICO. These agreements can be inferred from, and are established by, the

conduct of the Defendants. Moreover, these agreements demonstrate the Defendants’ scheme to

perpetrate fraud against GEICO and the interconnectedness of the actors involved.

873. When “patients” like Shenika Richardson, Shayla Gaines, Chanel Akins, Queena McRae,

Hashley Mocombe, Henry Preval, Yvio L’esperance, and Leslie Lowe were referred to KJ

Chiropractic and/or Wellness, they received services, if at all, that were not medically necessary

as:

a. the patients were referred to the Clinics for medical services pursuant to arrangements respectively established by the KJ Chiropractic and Wellness Groups that did not take into account the patient’s individual needs; b. the services were performed by the Clinics, at the direction of and/or under pressure from non-licensed individuals like, Jean Dorestant, Orlene Joseph, Jean Cassamajor, Elaine Felix, Robert Thelusma, Edner Desir and others; and, c. the treatment did not adhere to established medical practices and guidelines in compliance with Florida law.

874. The Clinics, their employees and operators also engaged in fraudulent billing practices

when submitting claims to GEICO, including but not limited to, up-coding and billing for

therapies, modalities and office visits not performed as documented.

875. Despite knowing that KJ Chiropractic and Wellness were not entitled to reimbursement

under Florida’s No-Fault Act, the Clinic employees and Operators billed for services that were

not reasonably necessary and as they engaged in fraudulent billing practices, the Count VIII

Defendants nonetheless caused claims to be submitted (with accompanying false medical

documentation) to GEICO seeking payment for both KJ Chiropractic and Wellness.


132

876. In reasonable reliance on the false medical documentation submitted or caused to be

submitted by the Count VIII Defendants, and in an effort to swiftly pay PIP benefits in line with

Florida law, GEICO paid certain claims submitted, including those amounts identified in Exhibit

2.

877. All of the Count VIII Defendants benefitted from the payments wrongfully procured from

GEICO.

878. KJ Chiropractic, Sadat Smith, Jean Dorestant, Belle Management, LLC, Orlene Joseph,

Jean Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and Robert Cohen directly

benefitted from the payments made to KJ Chiropractic.

879. Wellness, Arthur Vito, Elaine Felix, Robert Thelusma, Edner Desir, Jean Cassamajor,

Esdras Pierre Louis and Vladimir “Rico” Jean Pierre directly benefitted from the submission of

bills and subsequent payments made to Wellness.

880. Jean Dorestant, Jean Cassamajor, Esdras Pierre Louis, and Vladimir “Rico” Jean Pierre

also benefitted from the submission of bills and subsequent payments made to the Clinics as they

would receive Runner kick-backs for routinely furnishing “patients” for “treatment at both KJ

Chiropractic and/or Wellness.

881. Shenika Richardson, Shayla Gaines, Chanel Akins, Queena McRae and other staged

accident participants, both known and unknown to GEICO, benefitted from the submission of

bills and subsequent payments made to the Clinics as they would receive payment from Runners

for presenting for “treatment” at KJ Chiropractic and/or Wellness.

882. The staged accidents organized by the above-referenced Runners (who link the Clinics

together) encouraged the Clinics to submit more bills and pursue more PIP Claims from GEICO.

The conduct of the Defendants laid out in the balance of this Amended Complaint demonstrates


133

that the Defendants agreed and took affirmative steps in furtherance of their overall

conspiratorial goal, to defraud GEICO.

883. Therefore, the Count VIII Defendants agreed to and committed acts that caused damage

to GEICO.

884. All of the Count VIII Defendants actively and intentionally partook in the scheme to

defraud GEICO. The Count VIII Defendants also encouraged and aided one another in the

commission of the abovementioned acts, done for their own benefit, to the unjustified detriment

of GEICO.

885. Accordingly, the Count VIII Defendants are equally liable for the fraud perpetrated on

GEICO pursuant to the conspiracy laid out above.

W H E RE F O R E , GEICO demands judgment against the Count VIII Defendants individually,


a. Actual and consequential damages to be established at trial; and, b. Such other relief the Court deems just.

C O UN T I X V I O L A T I O N O F F L A . STAT. §501.204(1)(a)

UN FA IR A ND D E C EPT I V E T R A DE PR A C T IC ES (Against The KJ Chiropractic, KJ Chiropractic G roup Wellness C linic,

Wellness G roup)


246-716, 765-769 set forth above as if fully set forth herein.

887. KJ Chiropractic, the KJ Chiropractic Group, Wellness and Wellness Group (Count IX

Defendants) were actively engaged in trade and commerce in the State of Florida as regulated by the

Florida Department of Health and Florida Board of Medicine, Chiropractic, Physical Therapy and

Massage Therapy.


134

888. GEICO and its insureds are consumers as defined by Fla. Stat. §501.203.

889. The Count IX Defendants engaged in unfair, deceptive and unconscionable acts or trade

practices in their trade or commerce in the specific ways alleged in the balance of this Complaint.

890. The above-described acts and omissions of the Defendants offend the established public

policy of the State of Florida and are illegal, immoral, unethical, oppressive, unscrupulous and

substantially injurious to GEICO and its insureds.

891. The above-described actions and representations not only violated Florida public policy, but

also violate numerous Florida Statutes, including, but not limited to §817.234 (False and Fraudulent

Insurance Claims), §627.736 (Personal Injury Protection Benefits), §607.0831 (Liability of

Directors) and the Disciplinary Action Statutes Fla. Stat. §§ 458, 460, and 480.

892. GEICO was damaged as a direct and proximate result of the above-described deceptive and

unfair trade practices of the Defendants.

893. GEICO has retained the services of the undersigned counsel to represent it in this matter and

agreed to pay this firm a reasonable fee for their services for which Defendants are liable pursuant

to Fla. Stat., §501.2105.

W H E RE F O R E , GEICO demands judgment against Defendants for:

a. actual damages to be determined at trial; and, b. all other relief this Court deems just.


135

C O UN T X UNJUST E NRI C H M E N T

(K J Chiropractic, The K J Chiropractic G roup, W ellness and the W ellness G roup)



895. KJ Chiropractic, The KJ Chiropractic Group, Wellness and Wellness Groups (Count X

Defendants) were unjustly enriched by their fraudulent activities described herein.

896. KJ Chiropractic, Sadat Smith, Jean Dorestant, Belle Management, LLC., Robert Cohen,

Orlene Joseph, Jean Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others

both licensed and unlicensed routinely caused unnecessary chiropractic treatment to be

performed in line with KJ Chiropractic Group’s scheme to defraud GEICO. As a result, medical

documentation and bills were generated and sent to GEICO using the U.S. Mail/Wires, under the

guise that they were in compliance with Florida law and therefore due and payable.

897. Wellness, Arthur Vito, Elaine Felix, Edner Desir, Robert Thelusma, Jean Cassamajor,

Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others both licensed and unlicensed

routinely caused unnecessary chiropractic treatment to be performed in line with Wellness

Group’s scheme to defraud GEICO. As a result, medical documentation and bills were generated

and sent to GEICO using the U.S. Mail/Wires, under the guise that they were in compliance with

Florida law and therefore due and payable.

898. Both KJ Chiropractic and Wellness rendered medical treatment pursuant to a fraudulent

scheme whereby “patients” were referred to the Clinics by Runners like Jean Dorestant, Jean

Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others for the purpose of

generating claims to GEICO, and not for the purpose of providing reasonably necessary medical

treatment.


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899. Pursuant to Fla. Stat. §627.736, medical benefits shall be reimbursed only for such

services and care that are lawfully provided. Moreover, any treatment or services rendered were

reasonable and necessary and were incurred as a result of an automobile accident.

900. Pursuant to Fla. Stat. §627.736(4)(e), Florida No-Fault benefits are only compensable for

accidental bodily injury. Moreover, pursuant to Fla. Stat. §627.736(2)(b) an insurer may exclude

these benefits if a claimant intentionally causes injury to him/herself or is injured while

committing a felony.

901. As the Count X Defendants have engaged in a pervasive scheme to defraud insurance

companies, like GEICO, by staging accidents, referring “patients” to Clinics, paying runners and

administering treatment pursuant to pre-programmed treatment plans in order to submit

fraudulent claims and medical bills to GEICO, these bills are not lawful and therefore not

compensable under Florida law.

902. At the time the foregoing material misrepresentations, were made by the Count X

Defendants, they were known by the Count X Defendants to be false. The misrepresentations

have been specifically enumerated in the balance of this Complaint and in GEICO’s Mail/Wire

Fraud chart attached hereto as Exhibit 1. The Count X Defendants nevertheless submitted the

claims for insurance benefits with the intent to deceive and defraud GEICO and to induce

GEICO to pay fraudulent claims, which GEICO did in fact pay in reasonable reliance thereon,

which GEICO would not have otherwise paid at all had GEICO known the facts.

903. Moreover, pursuant to Fla. Stat. §400.990 and §460.4167(1), a corporation that is not

wholly owned by one or more chiropractic physicians licensed under this chapter may not

employ a chiropractic physician to establish a chiropractic clinic and thereafter, provide services

for a lay person’s benefit.


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904. KJ Chiropractic was not wholly owned by Sadat Smith pursuant to Florida law.

905. While Sadat Smith placed his name on the corporate paperwork of KJ Chiropractic and

had some control at the Clinic, it is GEICO’s position that KJ Chiropractic was not wholly

owned in compliance with Fla. Stat. §400.9905 and §460.4167(1), as a lay person named Jean

Dorestant conceived the idea for KJ Chiropractic and directly profited from its operation.

Moreover, as the true but secret owner, Dorestant controlled certain aspects of the Clinic’s

operation, including but not limited to, hours of operation, what treatment plans would be

administered to “patients,” and hiring and firing of employees at the Clinic.

906. As such, the KJ Chiropractic Group submitted bills with knowledge that KJ Chiropractic

was not wholly owned by a licensed chiropractor in compliance with Florida law and were

thereafter receiving payment that was not otherwise compensable.

907. Wellness was not wholly owned by Wellness pursuant to Florida law.

908. While Arthur Vito placed his name on the corporate paperwork of Wellness and had an

initial presence at the Clinic, Wellness was not wholly owned in compliance with Fla. Stat.

§400.9905 and §460.4167(1), as lay persons, including Elaine Felix, Robert Thelusma, Edner

Desir and possibly others not presently known to GEICO had a vested interest in the Clinic’s

profits. Moreover, these lay persons controlled certain aspects of the Clinic’s operation,

including but not limited to, hours of operation, what treatment plans would be administered to

“patients,” payment of employees and hiring and firing of employees at the Clinic.

909. As such, the Wellness Group submitted bills with knowledge that Wellness was not

wholly owned by a licensed chiropractor in compliance with Florida law and were thereafter

receiving payment that was not otherwise compensable.


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910. GEICO paid monies in response to the claims submitted, or caused to be submitted, by

KJ Chiropractic and Wellness in reasonable belief that it was legally obligated to make such

payments based upon the Count XVI Defendants’ fraudulent misrepresentations/omissions.

911. GEICO’s payments constitute a benefit which the Count X Defendants aggressively

sought and voluntarily accepted.

912. The Count X Defendants wrongfully obtained payments from GEICO through the

fraudulent scheme detailed herein.

913. The Count X Defendants have been unjustly enriched by receipt of these wrongfully-

obtained payments from GEICO.

914. The Count X Defendants’ retention of these payments would violate fundamental

principles of equity and justice.

W H E RE F O R E , GEICO demands judgment against Count X Defendants for:

a. actual and consequential damages in an amount to be determined at trial; and, b. all other relief as this Court deems just.

C O UN T X I D E C L A R A T O R Y R E L I E F PURSU A N T T O 28 U .S.C . § 2201

(K J Chiropractic, The K J Chiropractic G roup, W ellness and W ellness G roup)



916. As described throughout the balance of this Complaint, the fraudulent activities of the KJ

Chiropractic and Wellness Groups (Count XI Defendants) have given rise to circumstances

requiring declaratory relief from this Honorable Court.

917. KJ Chiropractic, Sadat Smith, Jean Dorestant, Belle Management, LLC., Robert Cohen,

Orlene Joseph, Jean Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others

both licensed and unlicensed routinely caused unnecessary chiropractic treatment to be


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performed in line with KJ Chiropractic Group’s scheme to defraud GEICO. As a result, medical

documentation and bills were generated and sent to GEICO using the U.S. Mail/Wires, under the

guise that they were in compliance with Florida law and therefore due and payable.

918. Wellness, Arthur Vito, Elaine Felix, Edner Desir, Robert Thelusma, Orlene Joseph, Jean

Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others both licensed and

unlicensed routinely caused unnecessary chiropractic treatment to be performed in line with

Wellness Group’s scheme to defraud GEICO. As a result, medical documentation and bills were

generated and sent to GEICO using the U.S. Mail/Wires, under the guise that they were in

compliance with Florida law and therefore due and payable.

919. Both KJ Chiropractic and Wellness also rendered medical treatment pursuant to a

fraudulent scheme whereby “patients” were referred to the Clinics by Runners like Jean

Dorestant, Jean Cassamajor, Esdras Pierre Louis, Vladimir “Rico” Jean Pierre and others for the

purpose of generating claims to GEICO, and not for the purpose of providing reasonably

necessary medical treatment.

920. Pursuant to Fla. Stat. §627.736, medical benefits shall be reimbursed only for such

services and care that are lawfully provided. Moreover, that any treatment or services rendered

were reasonable and necessary and were incurred as a result of an automobile accident.

921. Pursuant to Fla. Stat. §627.736(4)(e), Florida No-Fault benefits are only compensable for

accidental bodily injury. Moreover, pursuant to Fla. Stat. §627.736(2)(b) an insurer may exclude

these benefits if a claimant intentionally causes injury to him/herself or is injured while

committing a felony.

922. As the Count XI Defendants have engaged in a continuous, interconnected and pervasive

scheme to defraud insurance companies, including GEICO, by staging accidents, referring


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“patients” to the Clinics, paying runners and administering treatment pursuant to pre-

programmed treatment plans in order to submit fraudulent claims and medical bills to GEICO,

these bills are not lawful and therefore not compensable under Florida law.

923. At the time the foregoing material misrepresentations were made by the Count XI

Defendants, they were known by the Count XI Defendants to be false. The Count XI Defendants

nevertheless submitted the claims for insurance benefits with the intent to deceive and defraud

GEICO and to induce GEICO to pay fraudulent claims, which GEICO did in fact pay in

reasonable reliance thereon, which GEICO would not have otherwise paid at all had GEICO

known the facts.

924. Moreover, pursuant to Fla. Stat. §400.9905 and §460.4167(1), a corporation that is not

wholly owned by one or more chiropractic physicians licensed under this chapter may not

employ a chiropractic physician to establish a chiropractic clinic and thereafter, provide services

for a lay person’s benefit.

925. Neither KJ Chiropractic nor Wellness was wholly owned by Sadat Smith or Arthur Vito,

respectively.

926. While Sadat Smith placed his name on the corporate paperwork of KJ Chiropractic and

had some control at the Clinic, it is GEICO’s position that KJ Chiropractic was not wholly

owned in compliance with Fla. Stat. §400.9905 and §460.4167(1), as a lay person named Jean

Dorestant conceived the idea for KJ Chiropractic and directly profited from its operation.

Moreover, Dorestant, as the true but secret owner, controlled certain aspects of the Clinic’s

operation, including but not limited to, hours of operation, what treatment plans would be

administered to “patients,” and hiring and firing of employees at the Clinic.


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927. As such, the KJ Chiropractic Group submitted or caused bills to be submitted with

knowledge that the Clinic was not wholly owned by a licensed chiropractor in compliance with

Florida law and was thereafter receiving payment that was not otherwise compensable.

928. While Arthur Vito placed his name on the corporate paperwork of Wellness and had an

initial presence at the Clinic, it is GEICO’s position that Wellness was not wholly owned in

compliance with Fla. Stat. §400.9905 and §460.4167(1), as lay persons, like Elaine Felix, Robert

Thelusma, Edner Desir and others had a vested interest in the Clinic’s profits. Moreover, these

lay persons controlled certain aspects of the Clinic’s operation, including but not limited to,

hours of operation, what treatment plans would be administered to “patients,” payment of

employees and hiring and firing of employees at the Clinic.

929. As such, the Wellness Group submitted or caused bills to be submitted with knowledge

that the Clinic was not wholly owned by a licensed chiropractor in compliance with Florida law

and was thereafter receiving payment that was not otherwise compensable.

930. The Count XI Defendants continue to submit claims under the Florida No-Fault Act for

unnecessary and/or unlawfully rendered medical services to GEICO, and other claims remain

pending with GEICO.

931. The Count XI Defendants, their employees, agents and others will continue to bill

GEICO and attempt to collect No-Fault benefit payments absent a declaration by this Court that

their activities are unlawful and that GEICO has no obligation to pay pending, previously-

denied, and/or any future No-Fault claims submitted by any of the Defendants or third parties

involved in or related to this scheme.


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932. Accordingly, GEICO requests a judgment pursuant to the Declaratory Judgment Act, 28

U.S.C. § 2201, declaring that the Count XI Defendants provided medically unnecessary

treatment that is not compensable under Florida’s No-Fault Act.

933. GEICO requests a judgment pursuant to the Declaratory Judgment Act, 28 U.S.C. § 2201,

declaring that KJ Chiropractic was not wholly owned by a licensed chiropractor in compliance

with Fla. Stat. §460.4167.

934. GEICO requests a judgment pursuant to the Declaratory Judgment Act, 28 U.S.C. § 2201,

declaring that Wellness was not wholly owned by a licensed chiropractor in compliance with Fla.

Stat. §460.4167.

935. GEICO further requests a judgment pursuant to the Declaratory Judgment Act, 28 U.S.C.

§ 2201, declaring that the Count XI Defendants were engaged in a fraudulent scheme whereby

they provided medically unnecessary treatment and submitted charges for the same to GEICO.

936. As such, the Count XI Defendants have no standing to submit, pursue, or receive

assigned No-Fault benefits from GEICO.

W H E R E F O R E GEICO seeks declaratory relief from the Count XI Defendants in the form of a:

a. Declaration that the KJ Chiropractic Group fraudulently submitted or caused bills to be submitted for medical treatment that was not reasonably necessary and, therefore, not compensable under the Florida No-Fault Act;

b. Declaration that the Wellness Group fraudulently submitted or caused bills to be submitted for medical treatment that was not reasonably necessary and, therefore, not compensable under the Florida No-Fault Act;

c. Declaration that KJ Chiropractic was not wholly owned as defined by Fla. Stat. §400.9905 and §460.4167, and therefore all bills submitted by KJ Chiropractic were not compensable under the Florida No-Fault Act;

d. Declaration that Wellness was not wholly owned as defined by Fla. Stat. §400.9905 and §460.4167, and therefore all bills submitted by Wellness were not compensable under the Florida No-Fault Act;

e. Declaration that the activities of the KJ Chiropractic Group specifically described in the balance of this Complaint were fraudulent;

f. Declaration that the activities of the Wellness Group specifically described in the balance of this Complaint were fraudulent;


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g. Declaration that GEICO has no obligation to pay pending, previously-denied, and/or future No-Fault insurance claims submitted by:

i. KJ Chiropractic Center, LLC.; ii. Wellness Pain & Rehab, Inc.;

iii. Any member, employee, agent, or third party involved in the KJ Chiropractic Group’s fraudulent practices;

iv. Any member, employee, agent, or third party involved in the Wellness Group’s fraudulent practices; and/or

v. Grant all other relief as this Court deems just and appropriate.

JURY D E M A ND

GEICO DEMANDS A TRIAL BY JURY ON ALL ISSUES SO TRIABLE.

Respectfully submitted,

For the Plaintiffs, GOVERNMENT EMPLOYEES INSURANCE COMPANY, GEICO GENERAL INSURANCE COMPANY, GEICO CASUALTY COMPANY AND GEICO INDEMNITY COMPANY By their attorneys, David O. Brink Mass. BBO No.: 547370 SMITH & BRINK, P.C. 350 GRANITE STREET, SUITE 2303 BRAINTREE, MASSACHUSETTS 02184 /s/ Dorothy DiF iore Dorothy DiFiore Fla. Bar No.: 962139 HAAS, LEWIS & DIFIORE, P.A. 4921 MEMORIAL HIGHWAY, SUITE 200 TAMPA, FLORIDA 33634

Dated: July 12, 2013


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