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Medical Professionals Charged with PIP Fraud

4/8/2003

CONTACT: Justin Glover
(850) 413-2842

MIAMI—A former Miami clinic owner and two of his medical staff have been charged with fraudulently billing four insurance companies for treatments never provided.

Investigators with the Department of Financial Services' Division of Insurance Fraud say 41-year old Juan Carlos Delgado, former owner of A&A Re-Establishment Medical Center in Hialeah, billed for treatments for six patients who were covered by personal injury protection (PIP) benefits totaling $37,000. Several patients provided statements that the treatments were never provided. In addition, one patient told investigators he was paid $1,000 to allow his insurance company to be billed for phony medical procedures. Delgado was charged with six counts of insurance fraud, six counts of grand theft and one count of organized scheme to defraud.

Also arrested and charged with insurance fraud were Dr. Ulises Pichardo, 67, and physician's assistant Danilo Bravo, 65, who signed phony medical reports citing non-existing injuries. The two then submitted the reports in support of insurance claims filed by the clinic. Pichardo was charged with four counts of insurance fraud and four counts of grand theft. Bravo was charged with two counts each of insurance fraud and grand theft.

"The cost of fraudulent claims eventually gets passed on to consumers through increased premiums and increased costs for services," said Chief Financial Officer Tom Gallagher.

It's estimated that PIP fraud adds as much as $240 to the average family's auto insurance premium each year. The Florida Legislature is currently debating legislation that would increase penalties for the solicitation of accident victims.

El Departamento de Servicios Financieros, División de Fraude de Seguros, investiga varias formas de fraude en seguros, incluyendo seguros de salud, de vida, de autos, de propiedad y de compensación por accidentes de trabajo. Cualquier persona con información acerca de este caso u otra posible confabulación de fraude debe llamar a la Línea de Ayuda al Consumidor del departamento de Fraude al 1-800-378-0445. Se ofrece una recompensa de hasta $25,000 a cambio de información que conduzca a una condena en casos de fraude de seguros.