of an overall claims population of more
than 70.5 million—or 0.164 percent. The
volume of QC referrals can increase or
decrease over a given period of time and
may be caused by a number of factors,
including better reporting by the industry
and an increase or decrease in fraudulent
activity, and so on.
South Florida easily led the state in
QCs in 2012, with 4,686—up from the
4,349 reported in 2011 and 3,033 in
2010. The Tampa Bay area came in second, at 1,260, although QCs there have
declined by 39. 4 percent over the past
Miami-Dade County led the state
with 3,530 questionable claims in 2012,
followed by Orange County at 1,097, Hillsborough County at 983, Broward County
at 929 and Palm Beach County at 755.
unilaterally before the seat had been given
up, and it was then that the “FIO director
had the audacity to demand that he take
the seat held by our NAIC CEO.”
He said the lack of due process in the
appropriate committees resulted in a
blunder that was one of the “most stra-
tegically important decisions/mistakes in
the organization’s 130 year history.”
Various state commissioners defended
their roles, and while many support cor-
porate-governance oversight and a pos-
sible consultant, most at the NAIC meet-
ing did not want to participate by name
in the article.
Kansas Insurance Commissioner Sandy Praeger, who Leonardi said made the
“egregious and unfortunate choice” to
shut off public discussion, did say that
she was using a procedure after the different sides had been aired and it seemed
that this debate should be done through
the regular process. Commissioners like
Praeger asked what the rush was to hire
a consultant before first nailing down the
issues and making proposals.
Leonardi clearly feels attacked, many
observers said at the meeting, aware of
the changing dynamics in NAIC leader-
ship with the ascension of Adam Hamm
of North Dakota as NAIC president. Lou-
isiana Commissioner Jim Donelon, who
supports Leonardi, sunsets as top leader.
He also made it clear that he thinks
someone else is running the table now
without regard to procedure, whether
through a “cabal,” or through other means
that could use a good impartial review
and overhaul in administrative processes.
“My efforts as the chair of the NAIC’s
International Committee (and as someone widely recognized as a credible and
able defender of and spokesman for our
national state-based system of insurance
regulation) have also been undermined by
this so called leadership,” Leonardi said.
Leonardi | continued from p. 11
The story is all too familiar, especially in Florida, a state riddled with abuse of its personal injury protection (PIP) system: Recruit volunteers to rchestrate auto accidents. Direct “victims” to a
preferred clinic to treat their purported “injuries.” Bill insurers for services either never rendered or grossly inflated. Then
collect proceeds to be divvied amongst conspirators.
That’s the recipe David Rodriguez Lopez, the owner of a
now-defunct massage therapy clinic in Jacksonville, followed
until time—and the law—caught up with him. Of course, the
46-year-old didn’t bank on the next steps: arrest, conviction, and sentencing. But that’s
exactly what happened after a Florida court convicted Lopez of schemes to defraud
more than $50,000, filing false insurance claims exceeding $100,000, and knowingly
participating in an intentional motor vehicle crash.
Lopez worked as the behind-the-scenes owner of Indian Rehabilitation Center,
Inc. (IRCI), a licensed massage therapy clinic. The Jacksonville, Fla. clinic was in
operation from March 2012 until October 2012, when the state attorney’s office and
Florida’s Division of Insurance Fraud shut it down. But by then, IRCI had billed
insurers for a whopping $228,000.
According to a press release issued by the state attorney, Lopez participated in a
fraud scheme involving 30 people. Along with four cohorts, he staged an auto accident and subsequently filed a PIP claim for which IRCI received $35,000.
During the course of the investigation, authorities learned that it was Lopez who
controlled IRCI’s bank accounts, and that he instructed a straw owner about deceptive practices and how to go about bilking insurers.
After spending six months searching for Lopez, authorities found him at a secluded fish farm outside of Tampa. Having been found guilty of the charges against
him last month, Lopez will now serve a 15-year prison sentence.
Former Clinic Owner Gets 15
Years for Defrauding PIP System
By Christina Bramlet, PropertyCasualty360.com
David Rodriguez Lopez
Just over 89 percent
of the questionable
claims were related to
personal auto policies.
That’s one reason
policies are so expensive
in South Florida.