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Two-Year Florida Insurance Fraud Investigation Leads to Multiple Arrests

August 26, 2015 by  
Filed under Blog

The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) has made multiple arrests related to a large-scale personal injury protection (PIP) fraud scheme spanning across Central Florida. Five individuals have been arrested for their alleged various roles in the scheme, and arrest warrants have been issued for three additional individuals whose arrests are pending. Three related arrests have been made in the Fort Myers area.

DIF partnered with the FBI to conduct investigations into two personal injury clinics, First Medical Rehab of Bradenton (FMRB) and Kirkman Family Chiropractic Care (KFCC) in Orlando, after insurance carriers and former patients raised allegations of potential illegal activities.

In the early months of 2014, a DIF detective successfully infiltrated the Bradenton clinic by going undercover and posing as a patient. As a direct result, investigators were able to prove that FMRB was allegedly billing for medical treatments on injuries that did not exist.

The investigation into Kirkman Family Chiropractic revealed an organized plot to circumvent clinic licensure requirements set by the Agency for Health Care Administration. Because licensed health care professionals can operate clinics without the necessity of an additional clinic license, co-conspirators solicited licensed chiropractors to serve as straw owners, or owners on paper only.

To date, more than $100,000 in fraudulent claims has been paid by multiple insurance carriers.

Those who were arrested include:

  • Dadline Prospere
  • Shona S. Johnson
  • Dieufort Irilus
  • Evelyne Franclin
  • Barry Sutphin

Charges are varied based upon each individual’s alleged role and include: Patient Brokering, Conspiracy to Commit Patient Brokering, False and Fraudulent Insurance Claims, Solicitation, Grand Theft, Organized Scheme to Defraud and Conspiracy to Commit Insurance Fraud. All subjects, if convicted, face anywhere from 5-30 years in prison and could face fines as large as $10,000.

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