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Division of Insurance Fraud Referrals

Division of Insurance Fraud Referrals. Presented to the Automobile Insurance Fraud Strike Force January 24, 2013 Captain Steven Smith Division of Insurance Fraud. DIF PIP Resources. In response to the expanding PIP fraud problem, DIF created dedicated squads around the state

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Division of Insurance Fraud Referrals

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  1. Division of Insurance Fraud Referrals Presented to the Automobile Insurance Fraud Strike Force January 24, 2013 Captain Steven Smith Division of Insurance Fraud

  2. DIF PIP Resources In response to the expanding PIP fraud problem, DIF created dedicated squads around the state Currently, we have 9 squads and 48 detectives that are dedicated to PIP fraud investigations Miami, Broward, WPB, Orlando, Tampa have dedicated squads and Ft Myers and Jacksonville have dedicated detectives In each of those jurisdictions except Ft Myers, we also have dedicated prosecutors

  3. Working with Other Agencies DIF works with various other law enforcement and regulatory agencies throughout the state, including local police departments, federal agencies like the FBI and IRS, and state agencies like DOH and AHCA We work closely with the National Insurance Crime Bureau (NICB), which operates two major task forces in Florida (Plantation and Tampa). NICB is instrumental in providing support and resources to law enforcement, including vehicles, equipment, u/c pretext policies, and is a liaison between law enforcement and the insurance companies

  4. Referrals to DIF • All licensees must report suspected acts of insurance fraud directly to the fraud division • If they deny a claim for fraud, there must be a matching referral to DIF • Referrals are automatically entered into DIF’s case tracking system and forwarded to the appropriate Captain or Lieutenant for review and assignment • More than 90% of our PIP fraud referrals come from insurance companies

  5. Volume of Referrals • We want to work the cases that have most impact on PIP fraud and we need to have a probability of successful prosecution • In 2011-12, DIF received more than 7,700 PIP referrals, which accounts for 51% of the total referrals, an increase of nearly 16% from the previous year • Statewide, we made 496 PIP-related arrests, an increase of 40% from the previous year • The PIP problem is greater than any numbers can show • Staged Accident Rings and Clinic Investigations

  6. Fraud Cases Staged Accidents and Accident Clinics Unlicensed Clinics / Straw Ownership Crash Reports / Solicitation / Patient Brokering Fraud by Patient and Jump-Ins Work these investigations up the food chain to get to the persons who are controlling the schemes and profiting from the fraud Some cases can be done relatively quickly, others can take months or even years, depending on the scope of the scheme Operation Dark Horizon

  7. Recent Impact Changes Hillsborough County PIP Ordinance – impacted and educated community, and people got involved Prosecutors working with Department of Health to take the licenses of medical personnel convicted of fraud DIF’s expansion of dedicated PIP squads throughout state Huge successes in West Palm Beach through recent actions including Operation Sledgehammer and other cases Major cases underway in Jacksonville against organized rings Major arrests in Tampa and Ft Myers Training with law enforcement agencies (increased awareness and active reporting)

  8. Potential Changes from HB 119 Shift from straw ownership of clinics by massage therapists to chiropractors and doctors Bypass billing PIP and shift to BI (bodily injury) and med pay Shift of licensing by massage therapists to chiropractic assistants State missed an opportunity – should have required that clinics obtain an AHCA license to bill for PIP, without any exemptions

  9. Education and Public Awareness In an effort to better inform the public about PIP fraud, DIF and the Florida Outdoor Advertising Association (FOAA) joined together in a statewide campaign using billboards and bus posters DIF has provided training to various law enforcement agencies including the Florida Highway Patrol, who also recently launched a website on staged crash awareness DFS has a reward hotline (800-378-0445) for the public to report fraud and has distributed more than $300,000 to citizens We publish a monthly newsletter called The PIP Source which reports on successful investigations, publishes the names of persons arrested, and provides other useful information on PIP related issues

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