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Former Miami Clinic Owner Jailed in $4 M Fraud Scheme


TALLAHASSEE – A former Miami clinic owner suspected of spearheading a scheme to defraud dozens of auto insurance companies of nearly $4 million is in Dade County Jail facing a charge of first-degree grand theft, Florida Treasurer and Insurance Commissioner Tom Gallagher announced today.

Pedro Pablo Gonzalez, 67, charged in September, was taken into custody Tuesday by Miami-Dade County Police. He remains in jail with bond set at $250,000.

Department of Insurance fraud investigators said that over a two-year period – between May 1, 1997, and April 30, 1999, – Gonzalez and two associates billed 37 insurance companies $3,842,731 for treatments that never took place at a Hialeah clinic allegedly established for the sole purpose of filing fraudulent claims. The now-defunct clinic operated under the corporate names of Lyme Medical Group Inc. and MVP Mobile Diagnostic Inc. at 4294 Palm Ave. in Hialeah.

The two associates – Candido Madrigal, 49, and Julio Valle, 49, both of Miami, – identified Gonzalez as the group's leader. Both cooperated with the investigation. Madrigal pleaded guilty on Sept. 27 to one count of first-degree grand theft and was sentenced to 10 years probation and ordered to pay $50,000 in restitution as well as $2,000 in investigative costs. Valle pleaded guilty on Dec. 13 to one count of first-degree grand theft and was placed on one year of probation. Valle also was ordered to pay $50,000 in restitution and $2,000 in investigative costs.

Alberto Alem, 70, a former accountant for the clinic, is still being sought.

The investigation began with the execution of a search warrant in April 1999 at the Lyme Medical clinic and the subsequent arrests of several "runners" – individuals paid to solicit accident victims for the clinic. Solicitation is a third-degree felony under Florida law. Investigators said the runners solicited actual auto accident victims or staged accidents to create phony victims.

Madrigal and Valle said once the "patients" were referred, the clinic submitted fraudulent treatment logs, physician reports and bills for payment of personal injury protection (PIP) benefits. PIP is the portion of an auto insurance policy that covers medical bills relating to auto accidents.

The warrants were issued by Miami-Dade County State Attorney Katherine Fernandez Rundle, who also will handle the prosecution of Gonzalez.

In the past five years alone, investigators have received nearly 5,000 referrals of PIP fraud and made more than 500 arrests. The division's conviction rate for PIP fraud is nearly 80 percent.