14 Arrested in Miami Assisted Living Facility Insurance Fraud Scheme

May 19, 2017

A year-long investigation led by insurance fraud investigators with the Florida Department of Financial Services has ended with 14 arrests of assisted living facility owners in the Miami area, according to a statement by Chief Financial Officer Jeff Atwater.

According to the statement, investigators uncovered an alleged fraud scheme in which an assisted living facility (ALF) in Miami intentionally misrepresented its business activities in an attempt to obtain an inadequate but cheaper insurance policy. ALF’s are long-term care residences that offer various services such as health and medicine management, transportation and meal services in an effort to support seniors and developmentally or physically disabled members of our local communities.

When an insurance policy is knowingly secured under false pretenses, the insurance carrier oftentimes reserves the right to deny claims for loss or injury, the statement says.

The company’s insurance carrier, Citizens Property Insurance Corporation, first discovered the fraud following the filing of a claim for a broken pipe in 2014. During the processing of the claim, Citizens suspected that the ALF had intentionally misrepresented its business activities in an attempt to secure a cheaper, residential insurance policy rather than the required commercial policy. Citizens referred their findings to the DFS’s Bureau of Insurance Fraud.

The case ultimately initiated a larger series of investigations that took place between June 2016 and May 2017 which investigators said identified a trend of misrepresentation taking place within the ALF industry.

The Department, with support from Citizens and the National Insurance Crime Bureau, identified a total of 14 ALF operators in Miami-Dade County who allegedly defrauded their insurance carrier.

Those arrested include:

  • Jose Perez – Living Well, Miami
  • Aida Salguiro – Amor Y Esperanza Home Care, Hialeah
  • Gilberto Peralta – Angel’s Home, Miami
  • Thelma Waite-Blake – B & B Home Care Service, Miami
  • Idalberto Brito – Brito Home Corp., Miami
  • Odalys Amaro & Eduardo Rodriguez – Loving Hands ALF, Miami
  • Anna Kaplan – Flamingo Care LLC, Miami Beach
  • Teresita Leon – Teresita Home Care, Inc., Miami
  • Guillermo Jesus Mendez – La Casita Nuestra Home II, Miami
  • Barbara Plaza – Cornell ALF, Miami
  • Jorge Pulido – La Casita Nuestra Home II, Miami
  • Leonel Burmudez – Bermudez Senior Care, Miami

Additionally, investigators arrested an insurance agent, Alina Fernandez, after she was found to have forged another insurance agent’s name on two fraudulent ALF insurance applications for Jorge Pulido. She was also found to have been acting without the proper license.

Fernandez was transported to Turner Guilford Knight Correctional Facility and was charged with acting as an unlicensed agent, ID fraud, and organized fraud. DFS’s insurance licensing unit has revoked her license and banned her from working in the insurance industry.

The remaining 13 subjects arrested were transported to Turner Guilford Knight Correctional Facility and have been charged with one count of application fraud, a third-degree felony. These cases will be prosecuted by the Miami Dade State Attorney’s Office and if convicted, those arrested face up to five years in prison.

Source: Florida Department of Financial Services

Latest Comments

  • May 19, 2017 at 4:36 pm
    Miami Risk Manager says:
    Pretty common practice in South Florida. There's many more that a simple Lloyds dwelling property policy and no liability at all.
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