a FILED MAY 18 2000 TREAD THE TREASURER OF THE STATE OF FLORIDA DEPARTMENT OF INSURANCE OOo ) BILL NELSON IN THE MATTER OF: Case No. 34733-00-AG ° MILDREY ARMAS ADMINISTRATIVE COMPLAINT TO: MILDREY ARMAS 22304 SW 103rd Court Miami FL 33190-1403 Lael Hd 12 Wie 0 gaa You, MILDREY ARMAS, 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 4 result of which it is hereby alleged that: ERAL ALLEGATIONS GEN 1. You, MILDREY ARMAS, are currently licensed in this state as a health (2-40) “agent? nee ce tee ee —— : oe - eres a ce est usar “2 ‘At all times relevant to the dates and occurrences referred to herein, you, -MILDREY ARMAS, 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. ites Alvi 4 INSURANCE COMM: LONER Docketed bys. , f iw) \w 4. At all times relevant to the dates and occurrences referred to herein, you, MILDREY ARMAS, 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, MILDREY ARMAS, in the conduct of your licensed activities constituted trust funds received in a fiduciary capacity, and you, MILDREY ARMAS, 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. 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. , 8 On or about March 3, 1999, you, MILDREY ARMAS, solicited Janet R. Kelly of Miami, Florida to purchase of health coverage. You, MILDREY ARMAS, misrepresented to Ms. Kelly that she could obtain health coverage with Humana Health Insurance Company of Florida, Inc. ("Humana"), an insurer licensed in Florida, by enrolling in a group health plan. f Ww w You, MILDREY ARMAS, knew or should have known that Ms. Kelly was ineligible for such group coverage. 9. On or about March 3, 1999, you, MIDREY ARMAS, advised Janet R. Kelly that .. she had to pay a $100.00 enrollment fee in order to obtain health coverage. You, MILDREY ’ ARMAS, collected a check ‘payable to Durey Insurance from Janet R. Kelly for $276.00, which included $176.00 for the first month's premium and an unlawful enrollment fee of $100.00. 10. Janet R. Kelly was enrolled in a group health plan issued by Humana to the employer, International Marketing Group ("IMG"), effective April 1, 1999. You, MILDREY ARMAS, knew that Janet R. Kelly did not work for IMG. After the initial payment, Janet R. Kelly allowed monthly premium payments of $176.00 to be automatically withdrawn from her bank account for the months of May through September 1999. Janet R. Kelly's health insurance coverage with Humana was terminated May 31, 1999. 11, Janet R. Kelly's medical coverage was then transferred from Humana to Well Care HMO, Inc. ("Well Care"), an HMO licensed in this state, though a group health plan issued to the Dardick Agency. This transfer occurred without Ms. Kelly’s authorization and was effective July 1, 1999. Ms. Kelly subsequently received statements for monthly premiums in the amount of $159.34 from Well Care. 12. ~ You, MILDREY “ARMAS, “have ‘participated i in > and ‘assisted ‘with the illegal enrollment of Janet R Kelly in a Humana group health plan with IMG. You, MILDREY ARMAS, misrepresented and/or assisted with the misrepresentation of material information to Janet R. Kelly and Humana in order for Janet R. Kelly to be unlawfully enrolled in geoup medical coverage. Ma kee 8 w) wy 13. You, MILDREY ARMAS, participated in a scheme with other insurance agents and unlicensed individuals in which funds belonging to insureds were misappropriated and/or illegally converted. Janet R. Kelly paid monthly premium payments in the amount of $176.00 from April 1999 through September 1999. However, there was a lapse in Janet R. Kelly's health coverage for June 1999. Janet R. Kelly never received a refund of any monies forwarded to Durey Insurance for the June 1999 premium payment. You, MILDREY ARMAS, also participated i in and assisted in the misappropriation and/or conversion of funds belonging to Janet R. Kelly, because you collected a an , unlawful fee of $100.00 in excess of the premium. 14. As aresult of your, MILDREY ARMAS‘, misrepresentations and activities, Janet R. Kelly lacked health coverage in June 1999. Ms. Kelly and Humana have therefore suffered financial harm as a result of your, MILDREY ARMAS, actions. IT IS THEREFORE CHARGED that you, MILDREY ARMAS, 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) 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 canary: The licensee in n the applicable regular course e of : business shall account for and pay ; the s 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 626.61 1(4), Florida Statutes}; eee eee on peau tk naam v v (c) 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 626.611(5), Florida Statutes]; (d) Demonstrated lack of fitness or trustworthiness to engage in the business of insurance. [Section 626.61 1(7), Florida Statutes]; (e) Fraudulent or dishonest practices in the conduct of business under the license or appointment. [Section 626.61 1(9), Florida Statutes]; (f) 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 1(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 business of insurance in the course of dealing under the license or appointment. [Section 626.621(2), Florida Statutes]; . @ : “In the conduct of business under the license or appointment, engaging in unfair : methods of competition o or in n unfair or + deceptive acts or practices, as prohibited w “under part x of this chapter, or ‘having otherwise shown himself 0 or herself to be a source of i injury or r loss to ‘the public. [Section 626.621(6), Florida Statutes]; vu 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 rule of the department. [Section 626.621(12), Florida Statutes]; (k) ~ No person shall engage in this state in any trade practice which is defined in this part as, or determined pursuant to ss. 626.951 or ss. 626.9561 to be, an unfair method of competition or an unfair or deceptive act or practice involving the business of insurance. {Section 626.9521(1), Florida Statutes]; 0 Knowingly making, issuing, circulating, or causing to be made, issued or circulated any estimate, jllustration, 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 purpose 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 insuret, ‘by an insurance e policy “jssued by an insurer as is permited by ‘this ‘code. [Section 626. 9541(1)(0X1), 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 applicable classifications and rates as filed with and approved by the department, and as specified WV Cw in the policy; or, in cases when classifications, premiums, or rates are not required by this code to be so 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]; (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]; (nr) 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 wr provided ‘by, ‘directly or indirectly, any health maintenance organization. [Section 641. 3003(1)(€), Florida Stamnes} (© Knowingly making false or ¢ fraudulent statements or representations on, or relative to, an application’ or a hheatth 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]; wo S (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 by an 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 coverage, in accordance with the applicable classifications and rates as filed with the department, and as 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 provision of the Florida Insurance Code; (3) a violation of any rule of the department; @) a . violation of any order of the departments or (5) a breach of any written agreement with the _ department. [Section 6: 624. 310096), Florida Statutes]. WHEREFORE, you, MILDREY ARMAS, 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 Ww] oe! 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 US. 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 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. _ 2. 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 4 written statement challenging the grounds “upon which the agency has relied. While a hearing is normally not required in the absence ofa WW . wd 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. 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. avai. able. Failure to follow v the procedure outlined with regard to your response to this notice may result i 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 10 otified that mediation under Section 120. 573,. Florida Statutes, is is. “not... Ww <) of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. DATED and SIGNED this ra day of May, 2000. . white Nelbiey. & 1) . L, LL NELSON Treasurer and Insurance Commissioner “Oy. felt (nt A) 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 \QU. day of May, 2000 to the . following addressees: MILDREY ARMAS ) Certified Article Number 22304 SW 103rd Court P4979 O54 Ob4 Miami FL. 33190-1403 __ Mechele R. McBride, Es ee ov eae quare } » RED 34733-00-AG Armas | .n—-}-SENDER: Mechele R. McBride... — _[-~~~~ Falso-wish.to recei ___. following serv da. Article Number P9379 054 O64 NL UL Article Addressed to: Mildrey Armas : 22304 SW 103rd Court : Miami FL 33190-1403 and fee is paid) Domestic Return Receipt : af ad

Docket for Case No: 00-002617