Miami Herald: Workers’ comp fraud targeted in Miami-Dade

The Miami Herald published this article on January 14, 2009.

BY DAVID OVALLE
dovalle@MiamiHerald.com

A workers’ compensation insurance company spent more than $28,000 on Helmuth Droege after the Miami computer salesman claimed he broke his arm during a fall at work last year.

Now, he’s a fugitive — after co-workers told detectives that Droege, 37, actually broke his arm wrestling on the job.

The Miami-Dade State Attorney’s Office filed charges against Droege under a pilot program aimed at aggressively prosecuting employees who swindle workers’ compensation insurance companies, as well as companies illegally avoiding paying premiums.

For the first time, a Miami-Dade prosecutor — Ankur Sevak — has been assigned to pursue workers’ comp fraud cases, which are usually pursued piecemeal in criminal courts. Funded through the state’s Division of Insurance Fraud, the $136,686 program is the only of its type in Florida.

“With the economic situation deteriorating, people are finding all kinds ways to get quick money,” Miami-Dade State Attorney Katherine Fernández Rundle said. “But nothing is slipping through the cracks. These cases are being intensely investigated and prosecuted.”

The program is under way as state officials work to ramp up workers’ comp investigations, targeting everyone from fibbing employees to crooks using shell companies to illegally insure workers in high-risk construction jobs.

The state requires most businesses to carry workers’ compensation insurance, usually through private companies that pay for medical care and lost wages for employees injured on the job.

High-risk industries such as construction must have more comprehensive — and expensive — coverage, spurring the potential for fraud either for companies avoiding paying premiums or employees faking injuries to get money.

During the fiscal year that ended June 30, prosecutions statewide netted 532 convictions — including 20 in Miami-Dade and 13 in Broward — and $34 million in court-ordered restitution.

A streamlined state bureau of workers’ comp fraud investigators, assisted by Sevak and a team of detectives in South Florida, hopes to double arrests this year.

Miami-Dade’s addition of a dedicated workers’ comp prosecutor also will make larger and more complex probes of companies more likely, said Maj. Geoffrey Branch, who heads the state Division of Finance’s workers’ comp fraud bureau.

“It’s very important to be able to pick up the phone and talk to a prosecutor who is well versed in the workers’ comp fraud arena, and whose resources are 100 percent dedicated to doing just that,” Branch said.

Broward County does not have a dedicated workers’ compensation prosecutor; its cases are handled through its white-collar crimes unit. The Miami-Dade program, which includes one non-lawyer staff member, is supported financially by a state trust fund paid for by insurance companies.

Sevak has filed 11 cases since he began in August and obtained four arrest warrants for defendants who remain fugitives, including Droege.

He hopes to recover more than half a million dollars in restitution for insurance companies in cases that are extremely complicated.

“The files are huge. There are a lot of medical records, accident records, civil depositions, videotapes,” Sevak said.

So far, cases have only been filed against employees suspected of making false claims. When insurance companies grow suspicious, they refer cases to the state workers’ comp detectives, who number 10 in Broward and Dade.

Some defendants — like engineering firm laborer Hymy Mayorquin, 30 — are arrested after detectives say they spy them doing strenuous activity.

Mayorquin claimed a work accident left him with severe back pain, unable to lift more than five pounds. Detectives said they videotaped Mayorquin playing baseball, changing a tire and carrying bags of ice.

He has pleaded not guilty and is awaiting trial. The case’s victim: FCCI Insurance Group, which says it was scammed out of more than $30,000.

Mayorquin’s lawyer, Mark Douglas, said the videos were made before a doctor-recommended surgery, and that Mayorquin’s interviews with an insurance company rep was botched by a Spanish interpreter.

“He didn’t understand many of the questions. Certainly, there is a lot that gets lost in translation,” Douglas said.