WFSU News Team
Fri December 9, 2011
Leigslative testimony ties PIP fraud to organized crime
By Tom Flanigan
Tallahassee, FL – The issue of personal injury protection insurance fraud was back before legislative committees in the Florida Capitol this week. Tom Flanigan reports lawmakers heard how organized crime is now responsible for much of the fraud.
Whether they support some tweaks to Florida's present no-fault auto insurance law, or want to ditch it completely and do something else, nearly everyone in Tallahassee seems to agree on one thing ..personal injury protection fraud is out of control in some parts of the state, specifically South Florida and the Tampa Bay area. The conventional wisdom is that most of this fraud is small-time stuff. Freelance scammers staging accidents to make a quick insurance buck. But then lawmakers heard from Ronnie Cooper. He's a special investigator with the Hillsborough County Sheriff's Office.
"Myself and my partner, we've been investigating the PIP fraud for approximately two years now and in that time period we've arrested 123 people, closed down eleven clinics and we've gained a lot of intel on how these organized crime groups work and how they perpetuate the fraud."
Cooper and his partner, Jose Morales, gave their real names because they use aliases when working undercover. We've altered their voices to protect that cover.
"In some instances, we've gone into the clinics. My partner has gone undercover in several clinics. That's one way. Another way is you use confidential sources to go into clinics and record information and what the crimes are that have taken place."
And it's the clinics, Detective Cooper says, that are the real key to how PIP insurance fraud works. That's because the clinics become the provider of medical services that actually bill and collect from the insurance companies. So Cooper says it starts with an unscrupulous doctor who sells, or rents, the state-authorized exemption to open a clinic which is not subject to state oversight by the Agency for Healthcare Administration "AHCA" for short.
"If you open up a clinic - the statute of a clinic - then you're regulated by AHCA. If you don't and you're a physician, then you can sit there and say you're 100 percent wholly owned, then you can use the exemption to open up that clinic and in our experience and through our investigations, every one that we've investigated has been with the exemption rule."
Cooper says the doctors in these cases have nothing to do with the clinics. In fact, Cooper's partner Detective Jose Morales has sometimes posed as a clinic patient.
"We go in. We get treated for the first time and the subsequent treatment forms are signed on a weekly basis without getting any treatment whatsoever."
And if there's any doubt a clinic is bogus, Morales says you need only watch to see what happens when a truly injured person happens to come in.
"They'll tell you that either they're full, the doctor's not seeing anybody today, come back some other time. They'll give you any kind of excuse not to see you because you're not part of the agenda that they're trying to follow in the clinic."
That agenda, the detectives say, is simply to bilk as much money as possible out of the insurance companies. Some of that money goes to those running the bogus clinic and the doctor renting them his clinic exemption. The guys who staged the accident and pose as patients get a cut, too. But Detective Cooper says the bulk of the cash is headed elsewhere.
"These organizations are using part of this money for other things. It's been documented through investigations of this money leaving the county, leaving the state of Florida, whether it be back to Cuba, Mexico, the Cayman Islands, Costa Rica. So it's a lot bigger than what a lot of people understand and the fact that it's not just a staged crash and it's not just insurance fraud."
More aggressive law enforcement, such as Cooper and Morales do around Tampa Bay and the forty-some dedicated officers who work those cases in Miami-Dade seem to be having an impact. Apparently, Governor Rick Scott thinks so, too. His proposed budget includes seven-hundred thousand dollars to hire more personal injury protection insurance fraud investigators.