By: Jason L. Perez
Department Authorized Insurance Education Provider
⭐️⭐️⭐️⭐️⭐️ | The Insurance School .com
Florida Insurance Pre-Licensing Course
Episode Two (a)
VIOLATION | The Happy Hour Heist.
iLaw Episode TWO (a)
VIOLATION | The Happy Hour Heist.
Insurance VIOLATION
– Identity Theft & Organized Scheme to Defraud
– Submitting Fraudulent Insurance Claims
– [ Identify ] CFO / DFS’s ability to initiate an investigation.
– [ Note ] Press Release Footer / “About Jimmy Patronis”
MIAMI, Fla. –
Why is it safe to assume the LARGE Ignorantly Elaborate Scam happened around Miami?
For starters, this Fabulous Five obviously had no common sense or understanding of basic insurance industry principals. Simple things like, *Professional Accountability, Insurer Billing Practices, and income tax never crossed their minds. I’d imagine alcohol was involved because this scheme starts out a complete crime against logic.
Note to self…
*NEVER plan a $1.3 Million Dollar heist over happy hour.
Ok, let’s get to the tea. These Miamians stole the identity of a dentist. Not some random dentist from another city who didn’t know them. Those steps would insinuate someone in the fivesome had common sense. All five defendants were Management level employees at *One Care Pediatric Dental. The dentist whose identity they stole had recently resigned from One Care Pediatric Dental.
Since he was no longer at their clinic, this brilliant fivesome saw a way to make some quick cash. Although they weren’t familiar with mathematical concepts like statistics or the Law of Large Numbers… They were familiar with insurer claim handling practices.
In their minds, nobody would notice a few claims. Simply fill out some paperwork with a stolen National Provider Identification number, pocket some cash and REPEAT. WRONG! Even One or two transactions spread out over five (OR) MORE different insurers is going to be noticed.
101,000 Fraudulent Claims Later!
When I first read this CFO Press Release, I was floored and had to re-read that in super slow motion… “O N E H U N D R E D (AND) O N E T H O U S A N D F R A D U L E N T Claims submitted over Eight (8) months! This type of spirited claim submission pattern means, at no time did these people even attempt to fly under the radar. Our fivesome was familiar with insurer claim handling practices and ran with it.
Have you wrapped your head around the math associated with this scam? To hit 101 THOUSAND claims in 8-Months these geniuses had to submit AT LEAST 407 claims per day!
Now, let’s throw stones at their logic. These masterminds used the professional identity of a Real Doctor affiliated with their clinic. The fuse on this bomb was lit the moment they submitted the first FRADULENT Claim. Someone was responsible for paying the income tax associated with 1.3 Million dollars in paid claims.
HOW on Earth could they expect to get away with this?
It’s IMPOSSIBLE for five EMPLOYEES hide $1.3 Million Dollars in deposits connected to 101 thousand claims over an 8-Month period. Even a blind squirrel would have found these five nuts. Insurers are obsessed with lowering the overall cost of care. An insurers entire existence depends on their ability to predict the probability of loss associated with illnesses, accidents, and death.
Insurers track EVERYTHING.
So does the IRS.
Our fivesome was living the lifestyles of the rich an infamous until December of 2022. That’s when the DFS Division of Investigative and Forensic Services received a complaint from a dentist who claimed his identification was being used to bill numerous insurers for services.
- DentaQuest
- MCNA
- Liberty
- Sunlife
- Humana
#DFS Investigators are sworn law enforcement officers. Up until recently, DFS Investigators couldn’t initiate investigations. They only had the legal authority to engage investigations referred to them. In July of 2023, updates to the Florida Insurance Code took the CFO’s handcuffs off. NOW, his DFS investigators have the authority to Initiate an Investigation.
This case was the definition of open and closed. Detectives easily gathered enough evidence to charge all five SUSPECTS with FELONIES!
« “Identity theft and insurance fraud are serious crimes that will not be tolerated in Florida. As your CFO, I’ve made fighting fraud my top priority and will make sure that anyone who seeks to prey on innocent, hardworking Floridians will pay the price.
Excellent work by OUR FRAUD DETECTIVES for a job well done and to the Miami-Dade State Attorney’s Office for prosecuting this case. This is a reminder to scam artists in our state, if you commit fraud, you will be caught and you will be brought to justice.”
1.3-Million Dollars… A few months of the good life may cost these Miami locals up to 30-Years in PRISON. I can imagine them shopping like Julia Roberts in Pretty Woman. The theme music kicks in and the record scratches abruptly. They wake up to “WELCOME to the Turner Guilford Knight Correctional Center…
At the bottom of EVERY CFO Press Release you’ll find the short paragraph below identifying the CFO’s credentials. Can you [Identify] FOUR answers to questions ALMOST GUARANTEED to be on the Florida Pre-Licensing state exam?
– Chief Financial Officer (AND) State Fire Marshal Jimmy Patronis is a statewide ELECTED Official and a member of Florida’s Cabinet who oversees the Department of Financial Services. CFO Patronis works each day to fight insurance fraud, support Florida’s firefighters, and ensure the state’s finances are stable to support economic growth in the state.
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Sarah Insure, Independent Broker
