FILED WAY 18 2000 THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE TREASURER ANO SURANCE COMMISSIONER BILL NELSON 10) oeated NCE COM IN THE MATTER OF: Case No. 34727-00-AG YADIN ACOSTA / i ADMINISTRATIVE COMPLAINT TO:. YADIN ACOSTA 11433 NE 11th Place Biscayne Park FL 33 161-6762 You, YADIN ACOSTA, are hereby notified that pursuant to Chapter 626, 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 1. You, YADIN ACOSTA, are currently licensed in this state as a life & variable a annuity (2-14), life, health. &. variable annuity (2-15), life (2-16), life & health (2-18), and a health (2-40) agent. 2. At all times relevant to the dates and occurrences referred to herein, you, YADIN ACOSTA, were licensed in this state as an insurance agent. 3. Pursuant to Chapter 626, Florida Statutes, the Florida Department of Insurance LA, (QO ("DEPARTMENT") has jurisdiction over your insurance licenses and appointments. 4. At all times relevant to the dates and occurrences referred to herein, you, YADIN ACOSTA, 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 or 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 626.561(1), Florida Statutes, all premiums, return premiums, or other funds belonging to others received by you, YADIN ACOSTA, in the conduct of your licensed activities constituted trust funds received in a fiduciary capacity, and you, YADIN ACOSTA, were and remain obligated to account for and pay such funds to the insurer, HMO, insured, or other persons lawfully entitled thereto in the applicable regular course of business. COUNT I _ 1. - 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. 8. On or about April 6, 1999, you, YADIN ACOSTA solicited Diana Jones of Pompano Beach, Florida to purchase medical coverage. You, YADIN ACOSTA misrepresented to Ms. Jones that she could obtain medical coverage with Neighborhood Health Partnership, Inc. LA, (Oy (NHP”), a health maintenance organization licensed in Florida, by enrolling in a group health plan, vihen in fact Ms. Jones was ineligible to be enrolled in said group health plan. 9. On or about April 6, 1999, you, YADIN ACOSTA instructed Diana Jones that she had to pay a $295.00 association fee for obtaining medical coverage. Diana Jones mailed to you a check payable to Durey Insurance in the amount of $471.00, which included the first month’s premium of $176.00 for medical coverage, and a $295.00 charge which represented an unlawful association fee for the purported group enrollment. The effective date of Diana Jones’ medical coverege was June 15, 1999. You, YADIN ACOSTA, enrolled Diana Jones in a group health plan issued to the employer, International Marketing Group (“IMG”), although you knew Diana Jones aid not work for IMG. “10, You, YADIN ACOSTA, have participated in and assisted with the illegal enrollment of Diana Jones in a group health plan with IMG. You, YADIN ACOSTA, misrepresented and/or assisted with the misrepresentation of material information to Diana Jones and to NHP in order for Diana Jones to be unlawfully enrolled in group medical coverage. 11. You, YADIN ACOSTA, participated in a scheme with other insurance agents and unlicensed individuals in which funds belonging to insureds were misappropriated or illegally converted. Diana Jones paid monthly premiums to Durey Insurance in the amount of $200.00 from ‘April 1999 (excluding June 1999) to September 1999. One or more of Ms. Jones’ premium payments were not forwarded to NHP, as evidenced by the fact that her medical coverage was cancelled effective August 14, 1999 for nonpayment of premiums. Diana Jones never received a refund of any monies paid to Durey Insurance for the time period she lacked coverage with NHP. You, YADIN ACOSTA, also participated in and assisted in the misappropriation and/or conversion of funds belonging to Diana Jones, because you collected an unlawful fee of $295.00 in excess of the premium for the procurement of medical coverage. 12. Asa result of your, YADIN ACOSTA’s, misrepresentations and activities, NHP notified Diana Jones that her medical coverage with NHP would be rescinded retroactive to June 15, 1999, the initial effective date of coverage. As a consequence, Diana Jones and NHP suffered financial harm. ‘IT IS THEREFORE CHARGED that you, YADIN ACOSTA, have violated or are accountable under the following provisions of the Florida Insurance Code, which constitutes grounds for the suspension or revocation of your licenses as an insurance agent in this state: @ 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 receivdd by the licensee in a fiduciary capacity. The licensee in the applicable regular course of businegs shall account for and pay the same to the insurer, insured, or other person entitled thereto. [Section 626.561(1), Florida Statutes]; (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 626.611(4), Florida Statutes]; © Willful misrepresentation of any insurance policy or annuity contract or willful deception with regard to any such policy or contract, done either in person or by any form of dissemination of information or advertising. [Section 626.61 1(5), Florida Statutes]; ‘(d) Demonstrated Jack of fitness or trustworthiness to engage in the business of insurance. [Section 626.611(7), Florida Statutes]; | va U i © Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.611(9), Florida Statutes}; 0 Misappropriation, conversion, or unlawful withholding of moneys belonging to insurets or insureds or beneficiaries or to others and received in conduct of business under the lic onse or appointment. [Section 626.611(10), Florida Statutes]; ‘(g) Willful 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]; ‘(h) Violation of any provision of this code or of any other law applicable to the busines 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 methots 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]; 0 Knowingly aiding, assisting, procuring, advising, or abetting any person in the volton of or to violate a provision of the insurance code or any order or rule of the department. [Section 626.621(12), Florida Statutes]; i (k) No person shall engage in this state in any trade practice which is defined in this part a, or determined pursuant to ss. 626.951 or ss. 626.9561 to be, an unfair method of co mpetition or an unfair or deceptive act or practice involving the business of insurance. [Section 626.9§21(1), Florida Statutes}; Ue, a » 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 representation on, or relative to, an application or negotiation for an insurance policy for the purpdse of obtaining a fee, commission, money, or other benefit from any insurer, agent, broker, or individual. [Section 626.9541(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 Ids than the premium or charge applicable to such insurance, in accordance with the applicable classifications and rates as filed with and approved by the department, and as specified in the policy; or, in cases when classifications, premiums, or rates are not required by this code to be a filed and approved, premiums and charges in excess of or less than those specified in the policy and as fixed by the insurer. [Section 626.9541(1)(0)(2), Florida Statutes]; : ~ (p) 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]; | Can v @ Knowingly making, issuing or circulating, or causing to be made, issued, or circulated, any estimate, illustration, circular, statement, sales presentation, omission, or compefison which misrepresents the benefits, advantages, conditions, or terms of any health maintenance contract; misrepresents the affiliation, connection, or association of any goods, servieds, or business establishment; [Section 641.3903(1)(a), (d) and (k), Florida Statutes]; o Knowingly making, issuing or circulating, or causing to be made, issued, or | circulated, any estimate, illustration, circular, statement, sales presentation, omission, or compatison 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]; © 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, | commigsion, money, or other benefits from any health maintenance organization; agent; or representative, broker or individual. [Section 641.3903(8), Florida Statutes]; () 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 fsk by the health maintenance organization, bya health maintenance contract issued by an health Inaintenance organization as permitted by this part. [Section 641.3903(10)(a), Florida Statutes]; w) 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 cover ge, in accordance with the applicable classifications and rates as filed with the department, and af specified in the health maintenance contract. [Section 641.3903(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 insurance buying public, or constitutes business operations that are a detriment to policyholders, stockholders, investors, creditors, or the public; (2) a violation of any ptovision 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]. | COUNT II | 13. 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. | 14. On or about March 15, 1999, you, YADIN ACOSTA solicited Mr. Russ Cha of Lauderhill, Florida to purchase medical coverage. You, YADIN ACOSTA, misrepresented to Mr. Cha that he could obtain medical coverage immediately without any preexisting condition “limitations, when you knew that Russ Cha had a preexisting heart condition which would limit — his coverage, ! 15. You, YADIN ACOSTA, then misrepresented to Russ Cha that he could be enrolled in a group medical plan with Humana Health Insurance Company of Florida, Inc. i ("Huntana"), an insurer licensed in this state, and that his monthly premiums would be $176.00 | Cae U i when you knew or should have known that Russ Cha was ineligible for such coverage. You, YADIN ACOSTA, also misrepresented to Russ Cha that Humana permitted the enrollment in said group plan. Thus, you, YADIN ACOSTA, made material misrepresentations to Mr. Cha in your sales solicitation. 16. | You, YADIN ACOSTA, advised Mr. Cha that he had to pay an application fee in’ the amount of $295.00. You, YADIN ACOSTA, collected a check from Russ Cha payable to Durey/ Insurance in the amount of $471.00. Said amount included the April 1999 premium of $176.00 and the $295.00 charge for the unlawful application fee. After the initial payment via check, Mr. Cha continued to make monthly premium payments in the amount of $176.00 to Durey Insurance via automatic withdrawals from his bank account from May 1999 to September 1999. , | 17. Russ Cha’s medical coverage with Humana was effective April 1, 1999. Mr. Cha was enrolled in a group health plan issued by Humana through the employer International Marketing Group ("IMG"). You, YADIN ACOSTA, knew Russ Cha did not work for IMG. The medical coverage with Humana was cancelled effective May 31, 1999 for nonpayment of premium. You, YADIN ACOSTA, never informed Russ Cha of the cancellation of his medical co verage, 18. | Russ Cha was then informed by Durey Insurance that his medical coverage with Humana was being switched to NHP. The effective date of medical coverage with NHP was July 15, 1999. Mr. Cha did not sign any documents pertaining to the transfer of medical coverage from Humana to NHP. You, YADIN ACOSTA, as Russ Cha’s insurance agent, failed to inform Mr. Cha that due to the transfer of medical coverage from Humana to NHP, there would be a lapse in coverage for the month of June 1999, since the Humana coverage ceased on May 81, 1999. / 19. You, YADIN ACOSTA, have participated in and assisted with the illegal enrollment of Russ Cha in a group medical plan issued to IMG. You, YADIN ACOSTA, knew Mr. Cha did not work for IMG. You, YADIN ACOSTA, also misrepresented and/or assisted with the misrepresentation of material information to Mr. Cha, Humana and NHP in order for Mr. Cha to unlawfully obtain medical coverage. | 20. You, YADIN ACOSTA, also participated in and assisted in a scheme with other insurance agents and unlicensed individuals in which funds belonging to insureds were misappropriated and/or illegally converted. As instructed by you, YADIN ACOSTA, Russ Cha paid premiums for his insurance coverage to Durey Insurance in the amount of $176.00 from April! 1, 1999 to September 30, 1999 for his medical coverage, initially with Humana and subsequently with NHP. Russ Cha was unaware that he paid a premium for the month of June 1999 ‘for which he did not have coverage. Russ Cha never received a refund for the June premium payment. Additionally, you, YADIN ACOSTA, collected an unlawful fee of $295.00 in exdess of the premium for the procurement of medical coverage. Cha was notified by NHP that his medical coverage would be rescinded retroactive to July 15, 1999, the initial effective date of coverage. iF | | 22. Asa result of your, YADIN ACOSTA’s, misrepresentations and activities, Russ Cha lacked medical coverage and incurred medical bills which have not been paid. Mr. Cha and NHP have therefore suffered financial harm as a result of your activities. 10 21. As a result of your, YADIN ACOSTA’s, misrepresentations and activities, Russ _ LW VY IT IS THEREFORE CHARGED that you, YADIN ACOSTA, have violated or are accountable under the following 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) — Sections 626.561(1); 626.611(4), (5), (7), (9), (10) and (13); 626.621(2), (6) and (12); 626.9521(1), (1)(a)(1), (100), (1)(0)(1) and (1)(0)(2); 641.3901; 641.3903(1)(a), and (1)(k); 641.3903(1)(d), (1)(e), (8), (10)(a), and (10)(b); and 624.310(3)(a), Florida Statutes 1999, which have been fully and specifically set forth in Count I above, and are hereby realleged and fully incorporated herein by reference. WHEREFORE, you, YADIN ACOSTA, 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 626.611, 626.621, 626.622, 626.681, 626.691, 626.9521, and 641.3901, Florida Statutes, under the procedures and rules set forth in this Administrative Complaint. NOTICE OF RIGHTS Pursuant to Sections 120.569 and 120.57, Florida Statutes, and Rule Chapter 28-106, Florida Administrative Code (F.A.C.), you may elect a 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 USS. 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 or hand delivery is utilized, the Petition or Election should be delivered to 612 Larson Building, 200 East Gaines 11 Ww U Street, Tallahassee, Florida 32399-0333. The Petition or Election must be received by, and filed in the Department within twenty-one (21) days of the date of your receipt of this 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 is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, one will be conducted in Tallahassee, Florida or by telephonic conference call upon your request. If you dispute material facts which are 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 _ you dispute and the nature of the dispute; - b) An explanation of what relief you are seeking and believe you are entitled to; and c) Any other information which you contend is material. 12 ran had 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. 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 \Ghe day of May, 2000. ; bly: Treasurer and Insurance Commissioner 13 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 |G4wu day of May, 2000 to the following addressees: ADIN ACOSTA 11433 NE 11th Place Pe Osh oa Biscayne Park FL 33161-6762 Mechele R. McBride, Sot Division of Legal Services 612 Larson Building 200 East Gaines Street Tallahassee FL 32399-0333 (850) 413-4114 | RE 34727-00-AG Acosta _ SENDER: Mechele R. McBride : lalso wish to receive the: following service (for an-extra fe 3, Article Addressed to: 4a. Article Number : Yadin Acosta P 979 054 O91 -ean cre eco 4b. Service Type _ CERTIFIED | 7. Date of Delivery, 2 —_ ( 8. Addressee’s Address (Only if requested) and feeispaid) — 7 (Print Name) {\ Domestic Return Ri « 14

Docket for Case No: 00-002609