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13-month investigation leads to 12 arrests in insurance fraud scheme

By Staff | Mar 22, 2012

Following a 13-month investigation involving multiple agencies, 12 people were federally indicted in connection to fraudulent insurance schemes.

Authorities announced Thursday the completion of Operation Whiplash. The investigation identified health care clinics, individuals and businesses involved in personal injury protection, or PIP, insurance fraud, according to officials.

“This is a huge victory for the insurance industry. It’s millions of dollars in possible savings,” said Ralph Garcia of the National Insurance Crime Bureau.

The U.S. Attorney’s Office, Middle District of Florida, has charged the following people with conspiracy to commit mail fraud and health care fraud, health care fraud aiding and abetting and mail fraud aiding and abetting:

– Joanna Capote, 23, of Cape Coral

– Stephen M. Lovell, 54, of Windermere

– Francisco Huici Fernandez, 39, of Cape Coral

– Ernesto Diaz, 30, of Cape Coral

– Karen Carmona Jackson, 29, of Lake Wales

– Jeanine Lastres Huici, 41, of Cape Coral

– Sonia Arroyo, 52, of Cape Coral

– Marylda Santana, 21, of Cape Coral

– Indra Lemus Castellanos, 19, of Cape Coral

Lovell, Fernandez, Diaz, Jackson and Huici were also charged with conspiracy to commit money laundering and money laundering aiding and abetting.

Lovell was additionally charged with money laundering.

According to Garcia, Lovell was the “nemesis” of the insurance agencies for 15 years. They believed he was involved with fraud but could not prove it.

“The significance of some of these arrests,” Garcia said.

In a second indictment, Fernandez and Santana were charged with conspiracy to commit mail fraud and health care fraud, along with the following people:

– Abel De Jesus Perez, 43, of Cape Coral

– Victor Caballero Duarte, 22, of Cape Coral

– Adrian Perez, 21, of Cape Coral

Perez, Duarte, Santana and Perez were additionally charged with health care fraud aiding and abetting, and mail fraud aiding and abetting.

Perez was also charged with conspiracy to commit money laundering.

Each of the counts carry a maximum penalty of 20 years in federal prison.

Authorities estimate that the two clinics used in the schemes may be responsible for up to $22.5 million of insurance fraud per year.

“Health care fraud permeates Southwest Florida,” Chief Assistant U.S. Attorney Nicole Waid said, adding that this type of insurance fraud puts a burden on regular ratepayers.

In February 2011, the CCPD’s Special Investigations Unit established a task force to look into staged traffic crashes and joined with other agencies tied to these incidents in an effort to create a far-reaching joint investigation.

The Hialeah Police Department, the City of Miami Police Department, United States Secret Service, Internal Revenue Service and Florida’s Department of Financial Service became involved, along with several insurance companies.

“They’re concerned, we’re concerned,” Cape Coral Police Chief Jay Murphy said. “It just shows that there is a significant problem in in this area.”

According to the indictments, Xtreme Care Rehabilitation Center and C & A Family Rehab Center were operating in the Cape as unlicensed clinics since 2009. With licensed health care practioners, like Lovell, claiming ownership of the clinics, they were able to get around Florida’s licensing requirements.

Others charged in the indictments were the true owners, officials said.

The accused reportedly recruited people to be involved in staged traffic accidents and claim to have injuries. The individuals would go to the clinics in exchange for payment, and the clinics submitted false insurance claims.

Treatment was never provided or was not medically necessary.

Once the insurance companies paid on the false claims, the monies were transferred to corporations created by those involved, according to the indictments. Payments were taken out of the corporate bank accounts.

During the course of the investigation, law enforcement observed and documented more than 200 acts of mail and health care fraud.

“This is a problem in Southwest Florida,” CCPD Det. Josh Silko said. “Major insurance companies are affected by this fraud every day.”

“This is just the beginning,” he added.

According to Silko, authorities infiltrated the scam as part of Operation Whiplash and officers took part in “a number” of staged crashes.

“Our undercover detectives were able to participate,” he said.

Afterward, they became “patients” at the involved clinics.

“It’s still an open investigation,” Silko said. “It’s still ongoing.”

There are no pending arrests, however, tied to the indictments.

As part of the operation, authorities seized a fixed wing single engine airplane that belonged to Lovell, as well as a 2010 Honda and 2004 BMW. Police also seized the clinic bank accounts and the corporate accounts.