Crackdown on Insurance Fraud; Operation Sledgehammer Yields Guilty Pleas

A three-year investigation initiated by multiple law enforcement agencies has been paying off with the arrests of groups of individuals who have been accused of their involvement in insurance fraud schemes.

These frauds were devised by the staging of automobile accidents. The investigation acquired its name in part because one of the methods of causing the apparent damage was achieved by smashing target vehicles with actual sledgehammers. The fraud was perpetrated in part by chiropractic clinics and massage therapists that worked there.

Late last month, in federal court four people pleaded guilty to the staging of some of these accidents and subsequently making fabricated insurance reimbursement requests through claims instituted by their clinics.

Maria Testa Baceiro, 29, and Luis Ivan Hernandez, 40 owned and operated the chiropractic clinics and Olinda Rodriguez, 39, and Iris Roca, 41, were the licensed massage therapists who worked there.

According to prosecutors, between October 2006 and December 2012 Baceiro and Hernandez billed insurance companies and were paid for the prepared claims that were either non-necessary or not rendered at all. They recruited people with chiropractic licenses or other types of medical licenses to pose as what were termed “nominee owners” of numerous clinics that partook in the illicit arrangement. A total of twenty-one clinics were involved in the scheme.

They also recruited people to initiate automobile accidents as well as those that would pose as the victims of the accidents. These parties were referred to as the Perro and the Perra. The Perro was known as the person who triggered the accident and the Perra was the person or persons who were the casualties’ resultant of the accident. Or in other words the victim whose car was smashed into.

It was charged that participants of these accidents were directed by their recruiters to go to chiropractic clinics that were controlled by co-defendants, according to court documents. The participants involved in the staged accidents then deceitfully finalized paperwork, proclaiming injuries that were sustained during the accidents. It was also alleged that the so called injured individuals involved were coached how to fill out the documentation and what answers to give to insurance investigators if they were questioned about the nature of their injuries or asked about any treatments they received.

Court documents also demonstrated that the staged accident participants were also advised to sign blank treatment forms that would be submitted at a later time, which specified that they had visited the clinic on frequent occasions for treatment, in spite of the detail that at the time they may have only physically have gone to the clinic once or twice.

Summing up and exemplifying these circumstances, under the Florida personal injury protection (PIP) law which was adopted in 1972 a driver’s insurance company is mandated to pay up to $10,000 to cover the costs of medical bills and lost wages after an accident, no matter who is at fault. This law was passed to make sure that anyone injured in a car accident would swiftly receive money to address their medical expenses.

As an example of the law, if a person who has 3 others in his car runs into another automobile holding 3 other persons, the insurance company could be responsible to pay out up to $80,000 based on the total of 8 persons being involved in the crash.

At the plea hearing in federal court both Baceiro and Hernandez pled guilty to one count of conspiracy to commit mail fraud, twenty-seven counts of mail fraud and one count of conspiracy to commit money laundering. Hernandez also pled guilty to twenty-one counts of money laundering and Baceiro pled guilty to twenty counts of the same charge.

Rodriguez and Roca, both licensed massage therapists both pled guilty to one count of conspiracy to commit mail fraud. They were charged in separate accusations for their involvement in the deceptively staged car accidents.

Maximum statutory sentences of twenty years for each of the following charges apply: Each count of conspiracy to commit money laundering, conspiracy to commit mail fraud, substantive mail fraud, and substantive money laundering.

Reimbursements to the victimized insurance companies are mandatory, for all deceptively acquired funds.

As demonstrated above, the consequences of a conviction for insurance fraud can be highly punitive. A conviction can include extended incarceration as well as mandatory restitution. It is imperative that if a person is charged with the crime of insurance fraud or any of the parallel crimes discussed in this article, to immediately contact a reputable defense attorney, with experience in federal cases as well as the ability to properly defend these types of accusations.
Mr. Cohen is a board certified criminal trial lawyer rated AV by Martindale Hubbel (pre-eminent) and a “Super Lawyer” recognized as being in the top 5% of his specialized field (criminal trial law) among Florida lawyers. He is considered a specialist by the Florida Bar in his field. Mr. Cohen has tried scores of cases over his 35 year career and is a member of the Florida and New York Bars. He practices in Fort Lauderdale, West Palm Beach and Miami, among other counties. He is also admitted to practice in the United States Court of Appeals for the Eleventh and Second Circuit.

Mr. Cohen’s practice has recently expanded and he is now a partner in the prestigious law firm of McLaughlin & Stern, LLP. Through this partnership, Mr. Cohen can now lead your defense in the New York Metropolitan area in addition to the Broward, Dade, or Palm Beach County areas as well as all other jurisdictions throughout the state of Florida
Mr. Cohen is also listed in the 2013 edition of “Best Lawyers in America“.

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