FILED THE TREASURER OF THE STATE OF FLORIDA MAY 18 2000 DEPARTMENT OF INSURANCE TREm oe ory aes BILL NELSON Docketed bye comes JONER IN THE MATTER OF: 00-AS - YR ee ; Case No. 34726-00-AG "SERGIO RAUL BARRERO 3 ! So Se " a3e = oe ADMINISTRATIVE COMPLAINT Mem { | Ben 7 eT ws TO: SERGIO RAUL BARRERO ae, 2 Oo 13976 S. Cypress Cove Circle Cae wy Davie FL 33325-6741 as 4 SERGIO RAUL BARRERO i c/o United Healthcare 75 Valencia Avenue Coral Gables FL 33134-6141 You, SERGIO RAUL BARRERO, are hereby notified that pursuant to Chapter 626, Fa Florida Statutes, the Insurance Commissioner of the State of Florida has caused to be made an investigation of your activities while licensed as an insurance agent in this state, as a result of which it is hereby alleged that: GENERAL ALLEGATIONS | no “You, SERGIO RAUL BARRERO, are re currently licensed i in this State as a life & Sem ee t variable annuity y (2- -14), life, health & variable annuity (2-15), life (2- -16), life & health (2-18), and health (2-40) agent. 2. seer At all times relevant to the dates and occurrences referred to herein you, SERGIO CPR RR eR em peo ew w RAUL BARRERO, were licensed in this state as an insurance agent. 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance ("DEPARTMENT") has jurisdiction over your insurance licenses and appointments. 4. At all times relevant to the dates and occurrences referred to herein, you, SERGIO RAUL BARRERO, engaged in insurance transactions and conducted business through Durey Insurance Group, Inc., ‘also known as Durey Insurance and Accounting (hereinafter “Durey Insurance”), located at 7575 West Flagler Street, Suite 201, Miami, Florida. 5. Pursuant to Section 641.386, Florida Statutes, all qualifications, disciplinary provisions, licensing and appointment procedures, fees, and related matters contained in the. Florida Insurance Code which apply to the licensing and appointment of health insurance agents : by insurers shall apply to persons licensed ot appointed by health maintenance organizations (“HMOs") as their agents. 6. At all times relevant to the dates and occurrences referred to herein, and pursuant to Section 626. 5611), Florida Staats, bo others received by you, , SERGIO RAUL BARRERO, in the conduct of your licensed activities constituted trust 1 funds received in a fiduciary capacity, and you, SERGIO RAUL BARRERO, were and remain obligated t to account for and pay such funds to the insurer, HMO, O, insured, or - “other persons I lawfully entitled thereto i in the applicable regular course cof business. : COUNTI 7. All General Allegations set forth in paragraphs 1 through 6 above are hereby realleged and fully incorporated in this Count as though fully set forth herein. U premiums, return premiums: or r other funds belonging ees UW Vv 8. On or about March 15, 1990, you, SERGIO RAUL BARRERO, solicited Mercedes T. Reyes of Hialeah, Florida to purchase medical coverage. You, SERGIO RAUL . BARRERO, represented to her that she could obtain medical coverage with Humana Health Insurance Company of Florida, Inc, (hereinafter referred to as "Humana"), an insurer licensed in this state, when you knew or should have known that Ms. Reyes was ineligible for such coverage. You, SERGIO RAUL BARRERO, filled out a Humana enrollment form that Ms. Reyes signed. . 9. Ms. Reyes believed she was obtaining individual health coverage with Humana. However, the documents submitted to Humana identified Ms. Reyes a as an 1 employee of Universal Marketing Partners, Ltd. ("UMP"). You, SERGIO RAUL BARRERO, knew that Ms. Reyes was not an employee of UMP. 10. On or about March 15, 1999, you, SERGIO RAUL BARRERO, advised Mercedes T. Reyes that she had to pay a $100.00 enrollment fee in order to obtain medical . coverage. As instructed, Ms. Reyes gave you, SERGIO RAUL BARRERO, a check payable to Durey Insurance for 8276. 00, “which included the first month's premium of $176. 00 and an unlawful enrollment fe ; IL. “Mercedes Reyes! health insurance coverage with ‘Humana was ef effective May 1, ~ 1999. Ms. “Reyes made monthly premium payments in 1 the amount of $176. 00 from April 1999 trough September I 1999, Mercedes Reyes coverage was terminated on May 31, 1999. 1. Mercedes Reyes was slater informed by an individual at Durey Insurance that her coverage \ was s being transferred | to » Neighborhood Health 1 Partnership, Inc., ¢ "NHP"), a health maintenance organization licensed in this state, and that the coverage and premium payments cee geen op “eg mae os gee ap ae UM were € the : same as s for Humana Ms. Reyes was sorolled in a group Plan issued by NHP to the eh: employes, International Marketing Group cM) without her rsigned authorization. Ms. Reyes did not and has not worked for IMP: 13. _ The effective date of coverage with NHP v was uly 15, 1999. Ms. Reyes! medical coverage with NEP ° was canceled on n August 14, 1999 for nonpayment of premium. NHP subsequently notified Ms. Reyes that her coverage would be rescinded retroactive to July 15, 1999. | 14. You, SERGIO RAUL BARRERO, participated in and assisted with the illegal enrollment of Mercedes Reyes in a group health plan issued to UMP. You, SERGIO RAUL BARRERO, knew that Mercedes Reyes did not work for UMP. You, SERGIO RAUL BARRERO, also misrepresented and/or assisted with the misrepresentation of material information to Mercedes Reyes and to Humana in order for Mercedes Reyes to unlawfully obtain _ health coverage. : (15. You, SERGIO RAUL BARRERO, also participated in and assisted with a scherae wath other insurance agents and unlicensed individuals in which funds belonging to insureds were re misappropriated and/or illegally converted. You, SERGIO RAUL BARRERO, collected a an 1 procurement 0 of medical a. deception with regard to any “such policy 0 or F contract, done ‘either i in n person or Wr by 3 any form of WO v _ 16. As a result of your, SERGIO RAUL BARRERO's, misrepresentations and participation in this scheme, NHP notified Ms. Reyes that her health coverage was rescinded retroactive to July 15, 1999, the initial effective date of coverage. 17. AS a /Tesult of your, SERGIO | RAUL BARRERO's, _Inistepresentations and activities, nis. Reyes lacked medical c coverage > and incurred medical bills which have not been paid. . | IT Is THEREFORE CHARGED that you, SERGIO R RAUL BARRERO, have violated or “are accountable under the following p provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: (a) All premiums, return premiums, or other funds belonging to insurers or others ~~ received by an agent, solicitor, or adjuster in transactions under his license shall be trust funds so received by the licensee in a fiduciary capacity. The licensee in the applicable regular course of business shall account for and pay. the same > to the i insurer, insured, or r other person entitled thereto. [Section 626. 5610), Florida Stans) (b) If the license or appointment is willfully used, or to be used, to circumvent any of : the requirements or prohibitions of this code. [Section 626. 61 1(4), Florida la Statutes} Z © : “Willful _misrepresentation of. any j insuran e ze policy or ranmity © contract or willful a dissemination of information or advertising (seton 626. 61 18), Florida Statutes) (d) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; ETRE Te EPR ore RR oe OU | w) (e) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes]; (69) Misappropriation, conversion, or unlawful withholding of moneys belonging to insurers or insureds or beneficiaries or to others and received in conduct of business under the _. license or appointment. [Section 626.61 1010) | Florida Statutes]; © watt failure to comply | with, or willful violation of, any Proper order or rule of the department. or willful violation of any provision of this code. [Section 626. 611(13), Florida Statutes]; oO (by Violation of any provision of this code or of any other law applicable to the business of insurance in the course of dealing under the license or appointment. [Section 626.621(2), Florida Statutes]; (i) In the conduct of business under the license or appointment, engaging in unfair methods of competition or in unfair or deceptive acts or practices, as prohibited under part X of this chapter, or having otherwise shown himself or herself to be a source of injury or loss to the public, [Section 626.621(6), Florida Statutes}: G) Knowingly aiding, assisting, procuring, advising, or abetting any person in the __ violation of or to violate a provision of the insurance code or any order or tule of the department. [Section 626.621(12), Florida Statutes]; 626.9521(1), Florida Statutes): YY ad Knowingly making, issuing, circulating, or causing to be made, issued or circulated any estimate, illustration, circular statement, sales presentation, omission, or comparison which misrepresents the benefits, advantages, conditions or terms of any insurance policy. [Section 626.9541(1)(a)(1), Florida Statutes]; (m) Knowingly making a false or fraudulent written or oral statement or _ tepresentation on, or relative to, an application or negotiation for an insurance policy for the purpose of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. [Section 626. 9s41(1)¢k), Florida Statutes]; (n) Knowingly collecting any sum as a premium or charge for insurance, which is not then provided, or is not in due course to be provided, subject ‘to acceptance of the risk by the insurer, by an insurance policy issued by an insurer as permitted by this code. [Section 626.9541(1)(0)(1), Florida Statutes]; (0) | Knowingly collecting as a premium or charge for insurance any sum in excess of or less than the Premium ¢ or charge: applicable to such insurance, in accordance with the No person, entity, or health maintenance organization shall engage in this state in any trade practice which is defined in this part as, or determined pursuant to ss. 641.3905 to be, an unfair method of competition or an unfair or deceptive act or practice involving the business of health maintenance organizations. [Section 641.3901, Florida Statutes]; W te wd (q) Knowingly making, issuing or circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or comparison which misrepresents the benefits, advantages, conditions, or terms of any health maintenance contract; misrepresents the affiliation, connection, or association of any goods, services, or business establishment; [Section 641.3903(1)(a), (d) and (k), Florida Statutes]; (r) Knowingly making, issuing or circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or “comparison which misrepresents the benefits, nature, characteristics, uses, standard, quantity, quality, cost, rate, “scope, source, or geographic origin or location of any goods or services available from or provided by, directly or indirectly, any health maintenance organization. [Section 641.3903(1)(e), Florida Statutes}; (s) Knowingly making false or fraudulent statements or representations on, or relative to, an application for a health maintenance contract for the purpose of obtaining a fee, commission, money, or other benefits from any health maintenance organization; agent; or representative, broker or individual. [Section 641.3903(8), Florida Statutes]; (t) Knowingly collecting any sum as a premium or charge for health maintenance _ coverage which is not then provided or is not in due course to be provided, subject to acceptance ~ of the risk by the health maintenance organization, by a health maintenance contract issued byan . health maintenance organization as permitted by this part. [Section 641.3903(10)(a), Florida Statutes]; ; (u) Knowingly collecting as a premium or charge for health maintenance coverage any sum in excess of or less than the premium or charge applicable to health maintenance al a RA oa tall toe - coverage, i in accordance with the applicable classifications and r rates as filed with the department, and as specified i in the health + maintenance co contract. [Section 641. 1 3903(10)(b), Florida Statutes]; (v) | The department may issue and serve a complaint stating charges upon any licensee or upon any affiliated party, whenever the department has reasonable cause to believe that the person or individual named therein is engaging in or has engaged in conduct that is: (1) an act that demonstrates a lack of fitness or trustworthiness to engage in the business of insurance, is hazardous to the i insurance buying public, or constitutes business operations that are a detriment to policyholders, stockholders, investors, creditors, 0 or the public; (2) a violation of any provision of the Florida Insurance Code; (3) a violation of any rule of the department; (4) a violation of any order of the department; or (5) a breach of any written agreement with the department. [Section 624.310(3)(a), Florida Statutes]. WHEREFORE, you, SERGIO RAUL BARRERO, are hereby notified that the Treasurer and Insurance Commissioner intends to enter an Order revoking or suspending your licenses as an insurance agent in this state or to impose such lesser penalties as may be proper under the Provisions of Sections 626. 6il, 626. 621, 626. 622, 626. 681, 626.691, 626.9521, and 641.3901, Florida Statutes, under r the procedures a and { rules set forth in this Administrative Complaint. le ¢ AC), you may elec a 2 proceeding to contest this action by the Department. You may elect a proceeding by completing the attached Election of Rights form or filing a Petition. Your Petition or Election of a proceeding must be in writing and must be filed with the General Counsel acting as the Agency Clerk, Department of Insurance. If served by ad U.S. Mail, the Petition or Election should be addressed to the Florida Department of Insurance at 612 Larson Building, Tallahassee, Florida 32399-0333, if Express Mail on hand delivery is . utilized, the Petition or Election should be delivered to 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399- 0333. The Petition or Election must be received by, and filed in the Department within twenty-one ey days of the date of your receipt of this n notice. YOUR FAILURE TO RESPOND TO THIS ADMINISTRATIVE COMPLAINT WITHIN TWENTY- ONE (21) DAYS WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF REVOCATION WILL BE ENTERED AGAINST YOU. . Ifa proceeding is requested and there is no dispute of fact, the provisions of Section 120.57(2), Florida Statutes, would apply. In this regard you may submit oral or written evidence in opposition to the action taken by this agency or a written statement challenging the grounds upon which the agency has relied. While a hearing i is normally not required in the absence of a dispute of fact, “if 5 you feel ‘that a hearing is is necessary, ‘one 2 will be conducted i in Tallahassee, “Florida o: or by telephonic conference call upon your request. If you dispute material facts which are e the basis for this agency's action, you may request a formal adversarial proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes. If _ You request this type of proceeding, the request must comply with all of the requirements of Rule __ Chapter 28- 106, F. A. C:, , and contain: _ a “A ’statement ‘identifying with particularity the allegations of the Department which ; ea dispute and the nature of the dispute; b) An explanation of what relief you are seeking and believe you are entitled to: and 10 c) Any other information which you contend is material. These proceedings are held before a State Administrative Law Judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere the Department will request that the hearing be conducted in Tallahassee. | If you request a hearing, you have the right to be represented by counsel or other qualified representative, to take testimony, to call and cross-examine witnesses, and to have subpoena and subpoena duces tecum issued on your behalf | You are hereby notified that mediation under Section 120.573, Florida Statutes, is not available. oo — Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied. All prior correspondence in this matter shall be considered freeform agency action, and no such correspondence shall operate as a valid request for an administrative proceeding. Any request for administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the . guidelines as set out above. DATED and SIGNED this {day of May, 2000. ILL NELSON Treasurer and Insurance Commissioner it CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been furnished by certified mail on this mice day of May, 2000 to the following addressees: Sersio Raul Barer 13976 S. Cypress Cove Circle P 979 g5y bh Davie FL 33325-6741 Sergio Raul Barrero ; nite ae je c/o United Healthcare Mechele R. McBride, E. 75 Valencia Drive ; Division of Legal Services Coral Gables FL 33134-6141 ; 612 Larson Building Certified Article Number 200 East Gaines Street P4979 054 4492 Tallahassee FL 32399-0333 SENDERS RECORD 4 (850) 413-4114 FE RS RR IT meen ere rer ene eo pce oe

Docket for Case No: 00-002548