Ex-Pharmacy
owner arrested for Medicaid fraud
April 28, 2006, Tallahassee, Fla. -- Attorney
General Charlie Crist today announced the arrest of a former pharmacy
owner for defrauding the Florida Medicaid program out of almost
a quarter-million dollars. Paul Magnum, now a Lake County resident,
formerly owned a Miami pharmacy that billed thousands of dollars
of prescriptions to Medicaid but never provided the prescriptions
to patients. An investigation begun in April 2004 by Crist’s
Medicaid Fraud Control Unit revealed that Magnum, 50, used his Pharmacy
Depot to obtain reimbursements in the names of patients who were
not customers of the pharmacy. Billing statements sent to the Medicaid
program indicated that many of the prescription sales were made
after business hours, indicating that fraudulent billing was occurring.
California
prison guard found guilty of work comp fraud
April 28, 2006, Mule Creek, Calif. --
A former Mule Creek correctional officer was found guilty last week
on three felony insurance fraud charges after a six-day trial. John
Daniel Griffin, 50, of Ione, will be sentenced May 22 on the three
felonies. The jury hung nine to three in favor of guilt on a felony
perjury charge. Griffin faces up to five years in state prison as
a result of the jury's decision, a news release issued by Amador
County District Attorney Todd Riebe said. Griffin was initially
arrested in May 2004 after a 14-month investigation into injuries
he allegedly suffered while working at the prison. According to
court documents accumulated during the investigation, Griffin claimed
benefits stemming from two injuries sustained while working at the
prison - one in 2000 and one in 2003.
Claims
filed for dental work performed by dead doctor
April 27, 2006, Grand Rapids, Mich.
-- United States Attorney Margaret M. Chiara announced today
that Dr. Surabhi Desai, 51, a licensed dentist practicing in Bloomfield
Hills, Michigan, has pleaded guilty to one count of an indictment,
charging her with committing health care fraud, in violation of
Title 18, United States Code, Section 1347(2). Dr. Desai submitted
fraudulent claims to health care programs such as Delta Dental Plan
of Michigan and Blue Cross Blue Shield of Michigan for reimbursement
of services that she never rendered. In addition, Trilok Desai,
age 54 and Dr. Desai’s husband, pleaded guilty to one count
of an information, charging him with making a false statement relating
to a health care matter, in violation of Title 18, United States
Code, Section 1035(a)(2).
Louisiana
agent's license suspended for stealing premium
April 27, 2006, Lake Charles, La. --
A Lake Charles producer was issued a c&d and summary suspension
of his licenses for allegedly misappropriating insurance premium
payments. Darren Shawn Gaspard, 41, was served with a c&d and
summary suspension of his licenses today by Department of Insurance
Fraud Unit Investigators. They also suspended the licenses of GMA
Agencies Inc., of which he is sole owner and president. Gaspard
allegedly failed to remit to insurance companies over $50,000 in
premiums for at least six (6) different policies for commercial
and/or homeowners insurance coverage. Today's action results after
the Department of Insurance received numerous complaints following
Hurricane Rita from consumers who discovered they did not have coverage
when they filed damage claims with their insurance companies.
New
York City crasher who killed grandmother get 15 years
April 26, 2006, Queens, N.Y. --
A young man convicted of staging an auto collision that caused a
71-year-old grandmother to lose control of her car and strike a
tree, killing her, was sentenced Wednesday to five to 15 years in
prison. Prosecutors said Ward Demolaire, 22, conspired with three
other people to strike another vehicle and pretend to be hurt for
an insurance payoff. He was accused of driving the car that hit
Alice Ross' 1985 Buick on March 22, 2003. A Queens jury convicted
Demolaire of second-degree manslaughter and sixth-degree conspiracy
on Feb. 16. Demolaire plans to appeal his sentence. Demolaire's
attorney, Marlon Kirton, said he had argued from the beginning that
his client was not driving the vehicle that hit Ross' car and that
he had tried earlier on the day of the crash to turn his cousin
in to the FBI for insurance fraud.
'Operation
Spring Cleaning' busts 80 in Florida
April 26, 2006, Tallahassee, Fla. --
Florida's chief financial officer said his office has launched a
special operation targeting the arrest of nearly 80 suspects from
Miami to Pensacola for their roles in insurance fraud schemes. Dubbed
Operation Spring Cleaning, the state it is planning one of the largest-ever
statewide round-ups of suspects wanted for insurance scams costing
hundreds of thousands of dollars. State CFO Tom Gallagher estimated
all Floridians pay $1,400 a year in additional insurance costs as
a result of insurance fraud. Detectives with the Department of Financial
Services' division of insurance fraud are to make arrests for a
variety of schemes including filing fraudulent hurricane claims,
selling bogus insurance, staging auto accidents, fraudulently collecting
premiums and faking injuries to obtain workers' compensation benefits.
Dad,
son indicted for work comp fraud in New Jersey
April 26, 2006, Toms River, N.J. --
A onetime candidate for the Brick Board of Education and his police
officer son have been indicted on charges that the father fraudulently
collected more than $200,000 in Social Security and worker's compensation
benefits while earning money from home-improvement businesses headed
by his son. The grand jury handed up an indictment last week charging
Charles G. Skoog, 58, and his son, Erik G. Skoog, 34, a Brick patrolman,
in the alleged scheme. Charles G. Skoog unsuccessfully ran for the
Brick board in 2003. He had been involved in the Brick Police Athletic
League and the Brick High School PTA and was a past president of
the Brick Dragons football club.
Couple
bought coverage, filed claim after accident in N.J.
April 26, 2006, Trenton, N.J. --
Attorney General Zulima V. Farber and Division of Criminal Justice
Director Gregory A. Paw announced that a Passaic County woman has
pleaded guilty to attempting to fraudulently collect more than $23,000
in automobile insurance Personal Injury Protection (PIP) benefits.
According to Insurance Fraud Prosecutor Greta Gooden Brown, Virginia
B. Kinion, 66, of Paterson, pleaded guilty before Passaic County
Superior Court Judge Ernest M. Caposela to third-degree health care
claims fraud. The charge was contained in a June 29, 2005 Passaic
Grand Jury indictment. When sentenced on Aug. 18, Kinion faces up
to five years in state prison and a criminal fine of up to $15,000.
At the guilty plea, Kinion agreed to pay a $10,000 civil penalty.
Massachusetts
lawyer who paid runners sentenced to jail
April 25, 2006, Salem, Mass. --
A Lawrence lawyer was convicted today of conspiracy to commit insurance
fraud. Charles Lonardo was convicted in Salem Superior Court by
a jury that deliberated more than nine hours over two days. A judge
sentenced the 45-year-old Lonardo to two-and-a-half years in jail,
but stayed the sentence pending appeal. Prosecutors said that Lonardo
paid runners to bring him the so-called victims of car accidents
that were staged. The violations occurred from January 2001 to September
2004. Lonardo was charged in connection with a wide-ranging investigation
into auto insurance fraud in Lawrence. The problem was brought to
light after a 65-year-old grandmother died in what authorities said
was a staged car crash in September 2003.
New
Jersey chiro to serve 3 years for filing 175 false claims
April 25, 2006, Trenton, N.J. --
Attorney General Zulima V. Farber and Division of Criminal Justice
Director Gregory A. Paw announced that a Monmouth County chiropractor
has been sentenced to state prison for filing more than 175 fraudulent
Personal Injury Protection (PIP) insurance and workers compensation
claims for medical services that were never provided. According
to Insurance Fraud Prosecutor Greta Gooden Brown, Mark A. Radowitz,
45, of Monroe, was sentenced Friday, April 21, by Monmouth County
Superior Court Judge Francis P. DeStefano to three years in state
prison and ordered to pay more than $16,000 in restitution. The
sentence was pursuant to Radowitz’s guilty plea to health
care claim fraud, a charge which was contained in a July 15, 2005
state grand jury indictment.
Five
in California crime ring arrested for medical fraud
April 25, 2006, Los Angeles, Calif.
-- Five members of a Russian-Armenian organized crime ring
have been indicted for allegedly bilking Medicare of more than $20
million, authorities said. The group operated medical clinics and
laboratories in Los Angeles, Glendale and Pasadena that paid marketers
for patient referrals and billed Medicare for tests that were unnecessary
or were not done, Assistant U.S. Attorney Bruce Searby wrote in
court papers. The alleged fraud took place between 1997 and 2005.
The defendants, who were indicted Thursday, have been charged with
conspiracy, health care fraud, Medicare kickbacks, making false
statements to Medicare and money laundering.
Louisiana
agent accused of stealing $1,000 premium
April 25, 2006, Shreveport, La. --
Louisiana State Police Insurance Fraud Unit arrested a Shreveport
woman for theft after an investigation exposed her misappropriation
of insurance premium payments. Betty Sonnier, 53, of the 1100 block
of Leander, is charged with one count of felony theft. The former
clerical employee of a Bossier City insurance agency is accused
of pocketing more than $1,000 in client’s insurance premiums
during her employment, according to state police. An investigation
showed on two occasions in June 2005, Sonnier received approximately
$700 in combined automobile premiums from customers with the understanding
the money would be forwarded to the insurance company and applied
to their current policies.
Massachusetts
doctor indicted on illegal drug prescription
April 25, 2006, Boston, Mass. --
A Sandwich physician has been indicted on charges he allegedly illegally
prescribed drugs to seven of his patients, defrauded the state's
Medicaid program, and illegally possessed hydrocodone, a highly
addictive controlled substance, Attorney General Tom Reilly announced
today. Michael R. Brown, 52, of Mashpee, a physician who formerly
operated a private practice in Sandwich, was indicted by a Barnstable
County grand jury on 16 counts of violating the Controlled Substances
Act and 10 counts of violating the Medicaid False Claims Act. He
was additionally indicted on two counts each of possession of a
class C substance, hydrocodone, and violating the Medicaid False
Claims Act and one count of larceny over $250. His arraignment has
not yet been scheduled by the court.
California
chiro arrested for billing for treatment not provided
April 25, 2006, Sacramento, Calif. --
Insurance Commissioner John Garamendi announced today the arrest
of Dr. Linda Fang, a Bay Area chiropractor, for insurance fraud.
Dr. Fang was charged with eight counts of presenting fraudulent
claims; eight counts of false statements in support of insurance
claims; and eight counts of grand theft. She was booked into the
Contra Costa County Main Jail with bail set at $100,000. According
to the San Mateo County District Attorney’s Bureau of Investigations,
Dr. Fang, who was arrested on April 21, submitted billing statements
to four different insurance companies for treatment and services
she did not render to eight of her San Mateo patients.
Cancer
doc gets 15 years for diluting doses, fraud
April 25, 2006, Crossville, Tenn. --
A Crossville, Tenn., oncologist blamed her nurses, her busy schedule
and complicated billing procedures as she was sentenced to 151⁄2
years in prison yesterday after shortchanging her patients of chemotherapy
drugs. But the family members of cancer patients under her care,
in asking the judge to give Dr. Young Moon a maximum sentence, said
her greed was the reason she shorted their loved ones of life-saving
medications. "It's one thing to lose your mom, and to find
out it's because of malicious behavior just adds to it," a
choked-up Diana DeWitt, 47, a Nashville musician, told U.S. District
Judge Todd Campbell yesterday.
14
in Massachusetts arrested for destroying cars, fake thefts
April 25, 2006, Boston, Mass. --
Fourteen people were arrested after police caught them destroying
a car in a suspected insurance fraud scam on city-owned land off
Glebe Street Extension on Saturday, authorities said. "We watched
them for a while, trying to figure out what they were doing. It
was like a game for them," Detective Sgt. Richard Mulcahy said.
He said some of the participants were using four-wheel drive vehicles
to drive over a 1992 Honda Accord. Mulcahy said the owner of the
car, Kevin Figueredo, 18, of 89 Crosby St., Lowell, was among the
participants. He told police he purchased the car a week ago. Police
said Figueredo did not admit to owning the vehicle until Sunday
Fraud
wrecking auto insurance for everyone in Florida
April 24, 2006, Ft. Myers, Fla. --
Automobile insurance fraud cost $14 billion in 2004, according to
the Coalition Against Insurance Fraud. Staged accidents and fake
injuries claimed under Personal Injury Protection (or PIP) coverage
account for the majority of auto insurance fraud, and recently the
National Insurance Crime Bureau (NICB) identified the cities with
the highest number of staged auto accidents. Florida has three cities
in the top 10: Miami at No. 1, Tampa at No. 6, and Orlando at No.
8. Why should you care? With what this fraud costs the typical Florida
family each year, you could make a car payment, or buy a couple
of bottles of Dom Perignon champagne. Insurance fraud affects you,
even if you are not involved in a fraudulent accident or claim.
California
couple reverse guilty plea from fraud arrest
April 24, 2006, Riverside, Calif. --
A Riverside couple who pled guilty to felony charges in a $3.4 million
tax and insurance fraud scam allege their attorneys misled them,
and want to withdraw their pleas. Richard and Denise Mowbray, both
41, owners of Tree Company, Inc. in Norco, pled guilty on Dec. 14
to 84 counts of filing false insurance statements to the state.
Each faces a 15-year prison sentence if convicted on all charges.
Judge Gary B. Tranbarger was scheduled to hear the motion to withdraw
the pleas on Friday, but their new attorneys needed more time to
prepare and the motion was rescheduled to June 2. "They are
alleging that they were not served properly by their previous attorneys
and they were misled because they were told their case was not defensible,
but now they believe it is defensible," said Deputy District
Attorney Paul Fick.
Anti-fraud
efforts helped to push down New York rates 3.3%
April 24, 2006, Albany, N.Y. --
In some rare good news for drivers, auto-insurance rates in New
York dropped 3.3 percent last year. It was the second straight year
auto rates dipped after three years of hefty increases, according
to figures from the state Insurance Department. Industry officials
say New York's rate decreases last year were larger than those nationally
and will save motorists between $40 and $60 a year per car. But
consumer and other groups argue the rate decreases should have been
much larger, given that the insurance industry is now paying out
substantially less in claims, thanks to a crackdown on fraud in
recent years.
Charges
dropped against Florida lawyer; investigator puzzled
April 24, 2006, Sarasoty County, Fla.
-- Trial lawyer Peter W. Martin made the state's list of
top 10 scam artists after he collected $131,557 in disability payments
and was caught on video golfing and moving boxes out of his office.
But the state attorney's office has dropped the insurance fraud
charge against Martin, 57, saying the case against him wasn't really
as strong as it seemed. Prosecutors can't find their star witness,
a back surgery legitimized Martin's claim about being injured, and
he found a doctor to testify on his behalf, said Assistant State
Attorney Peter Lombardo. The decision to drop the case surprised
the state investigator who compiled the evidence against Martin.
California
chiropractor charged with filing false claims
April 23, 2006, Walnut Creek, Calif.
-- The San Mateo County District Attorney's Office has filed
a felony criminal complaint against Bay Area Chiropractor Linda
Fang accusing her of insurance fraud, according to the district
attorney's office. Fang, who has offices in San Mateo and Walnut
Creek, is charged with eight counts of presenting fraudulent claims,
eight counts of false statements in support of insurance claims
and eight counts of grand theft, the district attorney's office
reported. All the charges stem from Fang submitting billing statements
to four different insurance companies for treatment and services
she did not render to eight of her San Mateo patients.
Kansas
governor signs bill giving insurers immunity
April 21, 2006, Kansas City, Kan. --
The Coalition Against Insurance Fraud reported that Kansas Governor
Kathleen Sebelius signed a law requiring insurers to report suspected
schemes to the state fraud bureau. SB 207 also gives insurers immunity
from reporting of suspected schemes, and requires insurers to develop
anti-fraud plans. Gov. Kathleen Sebelius is the state's former insurance
commissioner and is also a former National Association of Insurance
Commissioner president.
Washington
trooper, son implicated in fake car theft scheme
April 21, 2006, Chahalis, Wash. --
The son of a former trooper who was found dead in his car last February
is a person of interest in the case, KIRO 7 Eyewitness News reported.
Jim Varner, a 49-year-old former Washington State Patrol trooper,
was found dead in his car on a U.S. Forest Service road in the Packwood
area on Feb. 2. Police described Varner's death as "suspicious."
Varner was involved with his son, Kenneth, in an alleged insurance
fraud scheme, KIRO 7 Eyewitness News reported. The three allegedly
tried to get $60,000 by telling an insurance company a nonexistent
vehicle was stolen.
Montana
agent accused of defrauding farmers, insurers
April 20, 2006, Kalispell, Mt. -- Former
Bigfork businessman Myron “Mike” Felt has been charged
in federal court with fraud and money laundering. Felt, 77, is accused
of defrauding insurance companies through Crop Hail Management Inc.
He was president of the business. Between June 2001 and April 2003,
Felt devised a scheme to defraud insurance companies, reinsurance
brokers and state agencies, according to information filed April
14 in U.S. District Court in Missoula. No implication was made that
any farmers suffered financial losses. According to documents filed
by Kurt Alme, assistant U.S. attorney in Billings, the scheme went
like this: Farmers applied to Crop Hail Management for insurance.
Former
Louisiana cop jailing for aiding claim fraud scheme
April 20, 2006, Marksville, La. -- Herbert
Guillot, Jr., of Marksville, LA, was sentenced Wednesday to spend
15 months in prison for his role in an insurance fraud scheme. Guillot
was also ordered to pay restitution in the amount of $10,640. Guillot
was convicted by a federal jury in November 2005 on charges of conspiracy,
concealment of assets and money laundering. Evidence at trial established
that the former Marksville police officer, conspired with another
individual to file a false insurance claim alleging that over $10,000
in jewelry had been stolen. Guillot's co-conspirator was in Chapter
7 bankruptcy at the time of the filing of the flase claim.
Bill
to add 19 investigators in Florida advances
April 20, 2006, Miami, Fla. --
The Senate's no-fault auto insurance bill continued to lurch forward,
but minus most of the measures that many insurers believe are vital
for significant reform. The bill would extend the state's no-fault
law to 2009, which is now set to expire in October. Reforms were
already enacted in 2001 and 2003, aimed mainly at fighting such
auto-insurance related fraud as staged accidents. A companion bill
that gets a hearing in the state House's Commerce Council today
would extend the current law to 2012. Many lawmakers, including
state Sen. Rudy Garcia, the Hialeah Republican who chairs the Senate
Banking and Insurance Committee, believe the bill helps reduce litigation
and continues to beef up the state's efforts to fight fraud.
Fake
marriage license ued to get girlfriend health coverage
April 20, 2006, Scranton, Penn. --
A city man who pleaded guilty to forgery for using a fake marriage
license to obtain benefits for himself and his girlfriend has been
sentenced to 14 days in Lackawanna County Prison. Charles Newcomb
Jr., 28, of 230 N. Cameron Ave., who was sentenced Tuesday by Judge
Michael Barrasse, was also placed on probation for two years. Mr.
Newcomb was arrested in December for allegedly using a handwritten
marriage license bearing the forged signature of Magisterial District
Judge James Kennedy to obtain jobless benefits for himself and health
insurance for his girlfriend.
Washington
regulator sues 3 companies over failed insurer
April 19, 2006, Olympia, Wash. --
Three companies accused of defrauding a defunct Washington state
insurer were sued Tuesday by the state insurance commissioner, who
is liquidating the former Cascade National Insurance Co. The lawsuit,
filed in King County Superior Court, seeks damages of more than
$10 million, Insurance Commissioner Mike Kreidler said in a statement.
The suit alleges that investors who promised to bail out the struggling
Bellevue-based insurer didn’t fulfill their side of the deal,
leaving Cascade National with obligations it couldn’t cover.
Three firms are specifically named in the suit, along with their
principals: Kentucky-based Midwest Merger Management LLC, American
Staff Resources of California Inc., and Certified Services Inc.
Florida
regulator bans agent for selling bogus policy
April 19, 2006, Miami, Fla. --
Tom Gallagher, Florida’s chief financial officer, has revoked
the license of a Miami area insurance agent who sold a fraudulent
certificate of insurance to a woman who was subsequently injured
in a car accident. Francois Noel, 46, of North Miami, has been banned
from selling insurance in Florida. “My heart goes out to this
victim. She sustained serious injuries in a car crash and learned
from a hospital bed that the insurance she paid for was bogus,”
said Gallagher. “It is reprehensible to me that this poor
victim is facing unpaid medical bills and lost wages as a result
of this agent’s actions.”
Four
more charged for Katrina-related fraud scams
April 19, 2006, New Orleans, La. --
Two men and a woman from the New Orleans area and a man from Pineville
have been booked with insurance fraud related to Hurricane Katrina
claims, State Police said Tuesday. A fourth man, from Convent, has
been arrested in an unrelated case for stealing at least 47 flooded
vehicles, most of them from New Orleans, to sell for scrap, according
to state police. The insurance fraud cases, from New Orleans, Kenner,
Destrehan and Pineville, bring to 20 the number of such hurricane
related arrests made by the State Police Insurance Fraud unit, said
Sgt. Stacey Pearson.
New
York 'Dyno Gyno' doc freed from prison, faces deportation
April 19, 2006, New York, N.Y. --
Dr. Niels Lauersen, the fertility doctor to the stars known as the
"Dyno Gyno," finished a five-year jail term for insurance
fraud yesterday - and was seized by immigration officials. Lauersen,
68, was sentenced to seven years in October 2001 for submitting
false bills worth $3.2 million for fertility surgery. In February
2005, a judge knocked down the sentence to five years. But when
the term ended yesterday, federal immigration agents obtained an
order to deport him to his native Denmark because he committed a
felony while in the United States on a green card. Lauersen has
lived here for 40 years, but never obtained citizenship.
Insurance
producer investigated for diverting premiums
April 18, 2006, Jefferson City, Mo. --
The Missouri Department of Insurance is seeking discipline against
an insurance producer accused of issuing phony insurance policies.
The producer (agent), Michael Spillman, of Lake Ozark, was to secure
insurance coverage for a construction client, but failed to forward
the client’s money to the insurance company. The client gave
Spillman a total of almost $16,000 to purchase an insurance policy
that would cover workers compensation claims the client may have.
Spillman failed to forward the funds to an insurance company to
ensure that the client was covered should a claim arise. After Spillman
initially received the funds, he issued a fake insurance card to
the client leading the client to believe that their workers compensation
claims would be covered by an insurance company.
TennCare
cracks down on fraud
April 18, 2006, Lenoir City, Tenn. --
A judge orders a Hamblen County couple to repay TennCare $10,700
for benefits they were not eligible to receive. 47-year-old Joe
Gibson and his 46-year-old wife Laura accepted the deal has part
of pre-trial diversion. Investigators have charged 224 people with
TennCare fraud since the Inspector General's Office opened in February
2005. So far, there have been 56 convictions. Stephen McLamb explains
how the state is cracking down. 30-year-old Jason Bergey is another
statistic now of TennCare fraud after his arrest. In this case,
the discovery of the offense came at the local level which involved
the death of Samantha McClean at a Lenoir City apartment. Authorities
say she died from an overdose of morphine allegedly sold to her
by Bergey.
Dental
fraud on the rise near U.S.-Mexico border, FBI says
April 18, 2006, El Paso, Texas --
A visit to the dentist can be painful and costly, not only for you,
but for your medical insurance company. Most medical insurance companies
will pay for procedures done in foreign countries, and it's legal
for patients to have them done abroad. The problem is the Federal
Bureau of Investigation reports dental fraud is becoming a major
problem along the U.S. -Mexico border. "What we tend to see
is that there are dentists in Mexico who are fraudulently billing
U.S. insurance companies," said Andrea Simmons, a special agent
with the FBI.
Texas
insurance department releases top ten fraud scams
April 18, 2006, Austin, Texas --
Each year the Texas Department of Insurance (TDI) investigates hundreds
of cases of suspected fraud. Its staff of fraud investigators (who
are licensed peace officers) investigate fraud alleged to have been
committed by persons engaged in the insurance business as well as
claim fraud committed by policyholders, service providers and others.
In 2005 and the first part of 2006, TDI’s Fraud Unit successfully
prosecuted 114 cases of people who got caught trying to make money
through insurance fraud. Here, in no particular order, is TDI’s
list of the top ten insurance fraud offenders: 1. Walter Neuls ,
former Colonial Casualty Insurance Company President, along with
his wife Deidra who served as Vice President, schemed to defraud
the company out of $750,000.
Sing
Sing prison guard arrest on work comp fraud charges
April 19, 2006, White Plains, N.Y. --
A former correction officer at Sing Sing was accused yesterday of
doing construction work for several years while collecting more
than $110,000 in compensation for a knee injury. Leo Coletti Jr.,
42, of 27 Shamrock Drive, Putnam Valley, was arraigned in courts
in Peekskill and Mount Pleasant. He was charged with grand larceny,
insurance fraud, perjury and tax evasion. The charges follow a lengthy
joint investigation by the Westchester County district attorney,
the Workers' Compensation Board Office of Fraud, and the New York
state superintendent of insurance. Investigators determined that
after Coletti claimed a work-related injury to his knee in June
2000, he subsequently performed nearly $750,000 in home improvement
construction work at various locations in Westchester County.
Forged
OxyContin prescriptions lead to guilty plea in Rhode Island
April 18, 2006, Providence, R.I. --
A New Jersey man has pleaded guilty in Providence to health care
fraud and using forged prescriptions to obtain a controlled substance,
OxyContin. Federal prosecutors say that 32-year-old James Barsoum
used the names and information of relatives and other people he
knew to forge prescriptions and bill health insurance company Blue
Cross Blue Shield of Rhode Island for payment. Barsoum admitted
to eight-thousand-940 dollars worth of fraudulent claims. Barsoum
faces up to 10 years in prison and a 250-thousand dollars fine for
health care fraud and up to four years in prison and a 250-thousand
dollars fine for prescription forgery. He is free on unsecured bond
pending his sentencing, which has yet to be scheduled.
New
York fraud 'princess' arrested on charges of violating parole
April 17, 2006, Jacksonville, Fla. --
A convicted New York scam artist was released Monday from the Duval
County Jail after a Jacksonville judge said New York officials were
dropping the charges that she broke the rules of her release. 'Princess
Antoinette' Antoinette Millard told people she was royalty from
Saudi Arabia, according to police. Authorities in New York thought
Antoinette Millard may have been up to some of her old tricks at
a jewelry store at the St. Johns Town Center last week. Millard
has been in trouble in the past in New York for fraud, while posing
as a Saudi Arabian princess called "Princess Antoinette."
Glass-in-food
scam alleged in five states; couple charged
April 15, 2006, San Francisco, Calif.
-- A couple has been charged with filing fraudulent insurance
claims that said they had eaten glass found in their food at restaurants,
hotels and grocery stores, federal prosecutors said. Ronald and
Mary Evano filed the claims in Massachusetts, Rhode Island, Virginia,
the District of Columbia and Maryland, an indictment made public
Friday said. Mary Evano is still being sought. The couple used aliases,
false Social Security numbers and identity cards, and in some cases,
had eaten glass intentionally to support their insurance claims,
prosecutors said. The glass did not come from the food they had
bought, prosecutors said.
Oklahoma
agent ordered to repay $20K she stole
April 14, 2006, Southlake, Okla. --
A former employee of Gore’s Southlake Insurance Agency was
ordered to pay $20,479.93 in restitution after pleading guilty yesterday
to six counts of violating Oklahoma’s Computer Crimes Act,
Attorney General Drew Edmondson said. Sabrina Diane Sands, 28, was
charged July 21, 2005, in Sequoyah County District Court with six
counts of violating the Oklahoma Computer Crimes Act after an investigation
by the Oklahoma Insurance Department. "Insurance fraud is a
serious problem and increases the cost of insurance premiums for
everyone," said Insurance Commissioner Kim Holland.
New
Mexico crash victims duped into visiting chiros, lawyers
April 14, 2006, Santa Fe, N.M. --
An insurance scam that started in El Paso has spread to Las Cruces,
Phyllis Bowman of the Insurance Fraud Bureau told members of the
Public Regulation Commission on Thursday. Bowman described it as
a "triangular business practice" in which a solicitation
company out of El Paso gets the names of people who have been involved
in recent accidents, and then phones them claiming to represent
their insurance company, with instructions to see a certain chiropractor.
When people resist, they are told that the insurance company will
only pay for medical expenses if the person sees that specific chiropractor,
Bowman said.
Agent
extradited from Florida to California to face theft charges
April 13, 2006, Sacramento, Calif. --
Insurance Commissioner John Garamendi announced today the arrest
of Bernard Warschaw, 78, a former Los Angeles insurance broker,
on an extradition warrant obtained by California Department of Insurance
(CDI) Investigation Division. Warschaw was arrested on April 12
by local law enforcement authorities in Sarasota, Fl. He has already
appeared in Florida court and waived his extradition. The case began
when CDI received complaints from Professional Underwriters Liability
Insurance Company (PULIC) and Western Summit Insurance Brokerage.
The companies alleged that Warschaw failed to remit thousands of
dollars in insurance premiums he had collected for the placement
of professional liability (medical malpractice) insurance policies.
Pennsylvania
chiro admits stealing millions from insurers
April 14, 2006, Burrell, Penn. --
A Lower Burrell chiropractor pleaded guilty in federal court yesterday
to defrauding an insurance company of millions of dollars by submitting
false bills. Douglas Henderson, 43, the former owner of Burrell
Chiropractic Center on Wildlife Lodge Road, waived a formal indictment
and instead pleaded guilty to all the charges against him, including
health care fraud, conspiracy and income tax evasion. According
to the prosecution, Mr. Henderson submitted false medical bills
to Highmark Blue Cross Blue Shield from 1995 through 2002. As part
of the scheme, he shared what he received from the insurance company
with his patients.
California
employer jailed for buying life policies on worker
April 14, 2006, San Antonio, Texas --
A former San Antonio wrestler was sentenced Thursday to 15 months
in prison for defrauding two insurance companies out of $504,685.
U.S. District Judge Orlando Garcia rejected a request from prosecutors
to sentence Vinnie Bilotto to 57 months and a call from Bilotto's
lawyers for probation. The judge said two insurance agents who testified
against Bilotto at trial were "not overwhelmingly reliable,"
and that one "should have been indicted." Bilotto wrestled
in the 1980s as "Flying Vinnie Valentino" and turned to
property management after retiring. In October, he was convicted
by a jury of four counts of mail fraud.
Tires
reported lost in fire allegedly re-sold in New York
April 13, 2006, Oneonta, N.Y. --
An insurance-fraud and arson case against an Oneonta businessman
includes allegations that up to 300 tires claimed as lost in a fire
were resold. Monser Bros. Tire Sales co-owner Jeffrey Gelbsman,
38, was arrested Tuesday by investigators from the state Insurance
Fraud Bureau working in conjunction with the Otsego County District
Attorney’s Office. Gelbsman was charged with second-degree
insurance fraud and third-degree arson, class C felonies, in connection
with an Aug. 16, 2002, fire that destroyed the former Wall Street
site of the tire shop he owns with his father.
Texas
clinic doc indicted for work comp billing fraud
April 13, 2006, Amarillo, Texas --
Texas Mutual Insurance Company reported that a Travis County grand
jury indicted Ihsan Shanti, M.D., and his health care facility,
Shanti Pain & Wellness Clinic, on felony workers' compensation
fraud-related charges. The indictments were the result of investigations
conducted by Texas Mutual and the State Office of Risk Management.
Shanti Pain & Wellness Clinic provides medical services to injured
workers in Texas. The indictments allege that between January 2003
and March 2006, Shanti and his clinic over-billed Texas Mutual Insurance
Company and the State Office of Risk Management for pain management
services in excess of hours actually attended by patients.
California
sheriff’s deputy gets jail for phony comp claim
April 12, 2006, Auburn, Calif. --
Former Placer County Sheriff's Deputy Lin O'Kelley was sentenced
last week following her no-contest plea to felony insurance fraud
charges. O'Kelley was placed on felony probation and received a
90-day jail sentence. She previously paid the $48,515.37 restitution
amount. While employed by the Placer County Sheriff's Department,
O'Kelley was involved in a work-related vehicle accident. Although
she did suffer injuries from the accident, and recovered, O'Kelley
continued to claim that she had severe limitations. She left work
on a Friday, indicating that her modified work duty caused her unbearable
pain. Surveillance video captured O'Kelley engaging in multiple
strenuous activities, including heavy yard work, just a few days
after she left work stating her unbearable pain.
Insurer
employee in New Jersey ordered to return $3,000 he stole
April 12, 2006, Trenton, N.J. --
Division of Criminal Justice Director Gregory A. Paw announced that
a former Essex County insurance company employee has been ordered
to repay the company more than $3,000 after pleading guilty to stealing
insurance premium monies paid by prospective purchasers of automobile
insurance. According to Insurance Fraud Prosecutor Greta Gooden
Brown, Lisa Brown, 30, Orange, Essex County, was ordered by Union
County Superior Court Judge William L’E. Wertheimer to pay
$3,000 in restitution to Union County-based Fleet Insurance Services
and to serve three years probation.
New
York businessman charged with torching his tire store
April 12, 2006, Oneonta, N.Y. --
Jeffrey Gelbsman, 38, of Oneonta, was taken into custody without
incident by investigators from the state Insurance Fraud Bureau
working in cooperation with the Otsego County District Attorney’s
Office, according to a media release from the state Insurance Department.
"Otsego County, having assessed all of the evidence gathered
to date, has charged Mr. Gelbsman with insurance fraud in the second
degree and arson in the third-degree," District Attorney John
Muehl said. "Both are class C felonies, and a conviction on
either count is punishable by up to 15 years in prison."
After
17 years on the run, Michigan doc surrenders
April 11, 2006, Lansing, Mich. --
Attorney General Mike Cox announced today that, after 17 years of
being a fugitive from justice, Joel Edward Freedland, D.O., age
57, formerly of Franklin, voluntarily appeared before Judge Thomas
E. Jackson in the 3rd Judicial Circuit Court for sentencing. On
April 28, 1982, Freedland was charged by the Attorney General's
Health Care Fraud Division with billing for osteopathic manipulative
treatments which were not provided and ordering unnecessary medical
procedures on patients. "Health care fraud drives up the cost
of health care for all of Michigan’s citizens," said
Cox. "My office will remain diligent in tracking down those
who defraud the system, no matter how old their crimes may be."
Illinois
teen, mom accused of destroying car, fake theft
April 11, 2006, Chicago, Ill. --
An Orland Park mother and her 19-year-old son are accused of destroying
a family car then reporting it stolen to collect insurance money.
Janet L. Hurta, 50, of 15607 Calypso Lane, was charged with felony
insurance fraud, police said. Her son, Matthew C. Hurta, 19, of
the same address, was charged with filing a false police report,
a misdemeanor. Matthew Hurta reported his mother's car stolen March
30, police said. Janet Hurta told police the vehicle, a 1977 Chevrolet
Camaro, was parked in her driveway at 10 p.m. March 29 but was missing
the next day.
Altered
receipts leads to arrest of California crash victim
April 11, 2006, East Palo Alto, Calif.
-- California Department of Insurance Commissioner John Garamendi
announced today the arrest of an East Palo Alto woman accused of
auto insurance fraud. Charleen Smith, 37, is charged with four felony
counts of filing a fraudulent insurance claim and three felony counts
of submitting altered and misleading receipts in connection with
a 2004 hit-and-run accident, Garamendi's office reported. According
to state insurance officials, Smith's vehicle was deemed a total
loss following the car accident on Nov. 18, 2004. She filed an uninsured
motorist claim with the California State Automobile Association,
and later submitted altered vehicle repair receipts and receipts
for items that were not on her vehicle, officials claim.
Four
charged with health care fraud in Tennessee
April 11, 2006, Clarksville, Tenn. --
Four area residents were arrested Monday and charged with TennCare
fraud, two of them for using a teenager's identity to get prescriptions
filled for his father. Anthony Todd Albright Sr., 36, of 4701 Albright
Road; his son Anthony Todd Albright Jr., 18, of 2980 Woods Road;
and a friend, Bruce Wayne Lamb of Ashland City surrendered Monday
morning to agents with the state Inspector General's Office. The
Albrights are accused of lying to a Madison Street pharmacist in
order to use the son's TennCare benefits to pay for several prescriptions
the father had gotten from a dentist, said Special Agent Manny Tyndall.
Risk
manager charged with work comp fraud in Oklahoma
April 10, 2006, Edmond, Okla. --
The University of Central Oklahoma's risk and insurance coordinator
is arrested today and charged with fraud. Campus police arrested
George Tetteh this morning after an investigation by state Attorney
General Drew Edmondson's Workers' Compensation Fraud Unit. The 61-year-old
Tetteh is charged with five felony counts of workers' compensation
fraud. Edmondson says Tetteh reportedly injured both his hands in
March 2003 and fraudulently obtained workers' compensation payments
from U-C-O's insurance carrier while he also worked and took leave
and received a full paycheck.
New
Jersey agent ordered to repay $57,000 in stolen premiums
April 10, 2006, Trenton, N.J. --
Division of Criminal Justice Director Gregory A. Paw announced that
a former Burlington County insurance agent has been ordered to repay
more than $57,000 stolen from more than four dozen policy holders
who had paid the agent for homeowners and automobile insurance.
According to Insurance Fraud Prosecutor Greta Gooden Brown, Louis
Polite, 52, Phila., PA, was ordered by Burlington County Superior
Court Judge Patricia Richmond LeBon to repay $57,400 in insurance
premium payments made by policy holders whose premium monies were
stolen by the former agent.
New
fraud prosecutor appointed in New Hampshire
April 10, 2006, Concord, N.H. --
Catherine Tucker has been appointed insurance fraud prosecutor for
New Hampshire, the Attorney General's office announced Monday. Tucker's
appointment represents a commitment between the state Insurance
and Justice departments to aggressively prosecute insurance fraud,
"estimated to account for 10 percent of all premiums paid by
residents of New Hampshire," Attorney General Kelly Ayotte
and Insurance Commissioner Roger Sevigny said in a news release.
In a typical year, "this amounts to over $20 million for New
Hampshire consumers," Ayotte said. Examples of insurance fraud
investigations undertaken by the fraud unit include workers compensation,
medical provider billing, staged automobile accidents and insurance
agent theft.
Chiro,
office manager in New Jersey guilty of using runners
April 10, 2006, Trenton, N.J. --
Division of Criminal Justice Director Gregory A. Paw announced that
an Essex County chiropractor and his office manager have pleaded
guilty to paying "runners" to illegally secure patients
and to fraudulently increase the amount of money obtained from insurance
companies. According to Insurance Fraud Prosecutor Greta Gooden
Brown, Eugene Ruta, 43, a licensed chiropractor formerly employed
at Valley Total Health Center, Orange, Essex County, pleaded guilty
before Essex County Superior Court Judge Thomas R. Vena to third
degree conspiracy and Health Care Claims Fraud. Ruta’s co-defendant,
Andrew Farro, former office manager for Valley Total Health Center,
also pleaded guilty before Judge Vena to a charge of conspiracy
to commit Health Care Claims Fraud and criminal use of runners.
South
Dakota clinic manager pleads guilty to claims fraud
April 8, 2006, Rapid City, S.D. --
A woman who worked as business office manager for the Kyle Health
Center has changed her plea to guilty in a federal case alleging
health fraud. Federal prosecutors say Patricia Twiss, 57, pleaded
guilty to one count of conspiracy to commit health fraud. She and
others conspired to defraud a health care benefit program, according
to court documents. A complaint in U.S. District Court said defendant
Gwendolyn Cuny would make copies of patient documents relating to
visits for fractures, burns and other conditions, change the names
on the forms to her name or that of family members and then get
the payments.
Home
contractor arrested during Katrina victims meeting
April 8, 2006, Pittsburgh, Penn. --
State and federal prosecutors announced this week more Hurricane
Katrina-related fraud arrests, including the arrest of a contractor
at a meeting called for homeowners to discuss home repair fraud.
Joseph Patrick Gately, 38, of Milford, Mass., was arrested Tuesday
in Biloxi and charged with two counts of embezzlement and one count
of fraud. In addition, Gately faces one count of being a fugitive
and one count of failure to register as a convicted felon. Gately
was being held in the Harrison County jail in lieu of $202,000 in
bonds. No court date has been scheduled. Mississippi Attorney General
Jim Hood said the arrest was unusual.
Indiana
funeral director arrested for premium theft
April 7, 2006, Morocco, Ind. --
A funeral director faces charges that he pocketed money for prepaid
funeral plans instead of forwarding it to insurance companies, state
police said. H. Robert Lang, 41, of Morocco, was arrested Friday
on 13 felony counts of insurance fraud following a three-month investigation
by state police. The charges each carry a potential sentence of
two years to eight years in prison. Lang was being held Friday on
$100,000 bond at the Newton County Jail in Kentland. Police alleged
that Lang, owner of Lang Funeral Home in Morocco about 50 miles
northwest of Lafayette, collected payments from clients for prepaid
funeral agreements but failed to turn the money over to insurance
companies.
D.C.
agent jailed for 108 months for $1 million theft
April 7, 2006, Washington, D.C. --
A District of Columbia Insurance Agent, Brittian Perry Day, has
been sentenced to 108 months in prison for stealing more than $1
million from 32 employee benefit plans and a charity, United States
Attorney Kenneth L. Wainstein and Ann L. Combs, Assistant Secretary
of Labor for the Employee Benefits Security Administration, announced
today. Day, 62, of the 4800 block of 43rd Street, NW, Washington,
D.C., received the sentence yesterday before the Honorable Paul
L. Friedman. In April 2005, a federal jury found Day guilty of 22
counts of mail and wire fraud, as well as thefts from an employee
benefit plan.
Chiro
who taught hundreds how to steal pleads guilty
April 7, 2006, Pittsburgh, Penn. --
The jailed owner of the Hemorrhoid Relief Centers of Pittsburgh
is set to plead guilty today in Columbus, Ohio, to multiple charges
in connection with his role as an orchestrator of one of the largest
health care fraud cases in the United States. Markell D. Boulis,
45, a former chiropractor from Collier who ran seminars across the
country designed to illegally boost revenue for chiropractic practices,
has informed federal authorities that he will enter a plea in two
federal cases in Pittsburgh and Columbus. Federal prosecutors won't
comment on pending cases, although they did confirm the anticipated
plea.
Prison
guard arrested for comp fraud in California
April 6, 2006, Sacramento, Calif. --
Insurance Commissioner John Garamendi announced today the arrest
of Sacramento resident and California Department of Corrections
and Rehabilitation Correctional Sergeant Steven Michael Shadden,
32, on April 4, 2006, on workers’ compensation insurance fraud
charges. Shadden was booked into the Sacramento County Jail with
$115,000 bail. He was charged with one felony count of knowingly
preparing or making a false written or oral statement in support
of an insurance claim; one felony count of knowingly concealing
an event that would affect a person’s right to an insurance
benefit; and one felony count of knowingly making or representing
a false or fraudulent statement or representation for the purpose
of obtaining insurance compensation.
Car
arsons in Texas pushing up rates for all drivers
April 6, 2006, San Antonio, Texas --
They pretend their cars were stolen, torch them, and then try to
make an insurance claim. The Bexar County District Attorney’s
office says this scheme is illegal and costing law-abiding tax payers
money. "We’re gonna catch them sooner or later,"
Bexar County Fire Investigator Ted Manganello tells News 4 WOAI.
Manganello is one of a handful of investigators cracking down on
arson cases on so called "stolen cars." He says car
owners and people they knew, conspired to torch their vehicles and
make false insurance claims.
Agent
in California sentenced for aiding scam
April 6, 2006, Los Angeles, Calif. --
Insurance Commissioner John Garamendi announced today the sentencing
of licensed insurance agent Sherry Ann Shuster, 55, of Northridge,
on March 24, 2006, after an investigation revealed she was aiding
and abetting an unlicensed person, Pamela Gedalia, 35, in selling
insurance. As part of a plea agreement, Shuster pleaded no contest
to one count of transacting insurance without a license, due to
the fact that she aided and abetted an unlicensed person in selling
insurance. Shuster was sentenced to three years of summary probation,
with the condition that she either serve 30 days in the county jail,
perform ten days of CalTrans service or 100 hours of community service.
New
Jersey to crackdown on bus. owners avoiding comp prem’s
April 6, 2006, Trenton, N.J. --
Employers who pay their workers "under the table," beware:
The Corzine administration is looking for you. State labor officials
said yesterday they will intensify enforcement of laws prohibiting
employers from classifying workers as "independent contractors"
-- rather than full-time employees -- to get out of paying certain
benefits. Common offenders are smaller, nonunion construction companies
that get around paying for benefits such as unemployment or disability
insurance or Social Security. By cutting costs, they pose an unfair
advantage to companies complying with the employment laws, according
to officials. The latest action was spelled out in a memo Gov. Jon
Corzine sent to the state Treasury Department and the state Department
of Labor and Workforce Development.
Pennsylvania
man burns home for insurance
April 6, 2006, Westchester, Penn. --
The West Nottingham man behind a plot to burn down his home so he
could collect an inflated insurance claim was sentenced to three
to 10 years in prison Wednesday. Steven J. Menasion, 47, had pleaded
guilty in February to arson, insurance fraud and related charges
for the 2001 blaze and subsequent fraudulent $261,000 homeowner’s
filing. He was sentenced by Common Pleas Court Judge Anthony A.
Sarcione. To date, Menasion has repaid $130,000 to his former insurance
company, and he was ordered by the judge to return the rest.
California
man pleads guilty to fake med claims
April 5, 2006, San Diego, Calif. --
A "capper" who recruited patients for a Lemon Grove
clinic that allegedly billed Medicare for services never performed
pleaded guilty Wednesday to insurance fraud and offering illegal
medical kickbacks. Alicia Leonardo, 72, is one of nine people, including
the clinic's operators, to be indicted in what prosecutors called
a $2 million conspiracy. Leonardo is scheduled to be sentenced May
5 by Judge David Danielsen. A grand jury issued the 47-count indictment
last month, charging the defendants with conspiracy, insurance fraud,
capping, tax evasion, grand theft and operating a business without
workers' compensation insurance.
New
Jersey man charged with fake auto claims
April 5, 2006, Hillside, N.J. --
Hillside man was arrested over the weekend and charged in an elaborate
insurance scam that nearly bilked his insurance carrier out of $3,635
last year. Union County Prosecutor Theodore J. Romankow said Marco
Trancho, 24, of 205 Hollywood Ave., is named in a complaint charging
second-degree insurance fraud. The complaint was signed by Detective
Jamieson Antonio of the Union County Prosecutor’s Office.
He said the defendant, who is facing up to 10 years in state prison
if convicted, surrendered to detectives from the Insurance Fraud
Unit Friday afternoon and was taken to the Union County Jail in
Elizabeth.
4
in California charged with filing false disability claims
April 5, 2006, Los Angeles, Calif. --
Four Southern Californians have surrendered to face charges that
they filed false dismemberment claims that cost insurance companies
more than $1.8 million, authorities said. Wanda and Willie Cleveland,
a married couple from Whittier, and brothers Farrell Cobbs of Victorville
and Wade Cobbs III of Los Angeles, turned themselves in on March
22, California Insurance Commissioner John Garamendi announced Tuesday.
The state Attorney General's Office charged them earlier in March
with 58 felony counts including insurance fraud, grand theft and
tax fraud.
Florida
no-fault fraud bill advances in legislature
April 5, 2006, Tallahassee, Fla. --
A bill to extend the state's controversial no-fault auto insurance
law for two more years cleared one more hurdle in the Senate, gaining
approval from the healthcare committee. ''This bill is all about
fighting fraud,'' said state Sen. Rudy Garcia, a Hialeah Republican
who sponsored the bill, which would provide more funding for fraud
investigations. The current no-fault law is set to expire in October
2007 unless lawmakers take action during this legislative session.
Reforms were already enacted in 2001 and 2003, aimed mainly at fighting
such auto-insurance related fraud as staged accidents.
Mother/son
team guilty of inflating BWM damage
April 4, 2006, Boston, Mass. -- A jury has convicted a mother and
son and the owner of a Stoughton auto body repair shop on charges
they conspired to defraud an insurance company by inflating damages
to a BMW convertible, Attorney General Tom Reilly announced today.
After a seven-day trial, a jury convicted Filomena Joaquim Fontes,
46, of Brockton and her son, Timilty Fontes Veiga, 23, of Taunton,
on one count each of motor vehicle insurance fraud, attempted larceny
over $250, conspiracy to commit motor vehicle insurance fraud, and
conspiracy to commit larceny over $250.
New
York City contractor charged in 21-count fraud indictment
April 4, 2006, Albany, N.Y. --
Albany County District Attorney P. David Soares Tuesday announced
a 21-count indictment against Vasilios Tsimitras, 50 of Brooklyn,
NY. The indictment includes multiple counts of False Filing, Grand
Larceny, and Insurance Fraud, allegedly committed by Vasilios Tsimitiris
and his Construction Companies—Olympia and Thettalia Construction
against New York State agencies and individual laborers, in the
course of obtaining and working on 73 emergency contracts worth
more than 7 million dollars.
Maryland
driver gets 3 years in prison for false claims
April 4, 2006, Gaithersburg, Md. --
Maryland Attorney General J. Joseph Curran, Jr. announced today
that Darryl R. Hardy, 40, of the 9900 block of Forest View Place
in Gaithersburg was sentenced in the Circuit Court for Montgomery
County after having pleaded guilty to felony insurance fraud last
October. That conviction followed a joint investigation conducted
by the Office of the Attorney General, the Insurance Fraud Division
of the Maryland Insurance Administration and the Maryland State
Police. The Honorable D. Warren Donohue sentenced Hardy to ten years’
incarceration suspending all but three years of that sentence. Upon
his release, he will be placed on five years probation and required
to pay restitution.
New
York man accused of inflating home damage claim
April 4, 2006, Newbury, Mich. --
An Upper Peninsula psychologist is sentenced to two and-a-half years
in prison for health insurance fraud. Herman Rummelt pleaded guilty
in October to filing false claims for reimbursement totaling 853-thousand
dollars. At his sentencing in federal court yesterday, the 63-year-old
Rummelt also was ordered to repay the money. He'll also spend three
years on probation once he's freed from prison.
New
Jersey dental assistant stole checks, filed bogus claims
April 4, 2006, Trenton, N.J. -- Division
of Criminal Justice Director Gregory A. Paw announced that the former
office manager for an Essex County dentist has pleaded guilty to
stealing more than $37,000 in insurance claim checks. According
to Insurance Fraud Prosecutor Greta Gooden Brown, Cindy Crissien,
23, Clifton, Passaic County, pleaded guilty before Essex County
Superior Court Judge Nancy Sivilli to an accusation which charged
theft by deception and insurance fraud (3rd degree). Crissien faces
up to ten years in state prison, a fine of up to $15,000, and possible
civil insurance fraud fines when sentenced on May 12.
New
Jersey court upholds conviction against optometrist
April 4, 2006, Asbury Park, N.J. --
A state appeals court has upheld the sentence and conviction of
John C. Amabile, an optometrist with offices in Neptune City and
Long Branch who in 2001 received a seven-year prison term for insurance
fraud. Amabile was convicted in state Superior Court, Monmouth County,
in October 2001, following a two-month trial, of conspiring to defraud
insurance companies between January 1994 and July 1996 by falsifying
records for his offices, Monmouth Visual Diagnostic Center of Long
Branch and Spectacles Inc. and Visual Analysis of Neptune City.
His license had been revoked in 1998. In addition to the jail term,
Amabile was fined $100,000 and ordered to make nearly $98,000 in
restitution.
Virginia
arson specialist sniffs out fraudsters
April 3, 2006, Richmond, Va. --
Frank Dunton is an insurance investigator and arson specialist.
He catches bad guys whose fraud, deceit and, in some cases, organized
criminal behavior is paid for directly by consumers in the form
of higher insurance premiums. "It's not a victimless crime,"
said Dunton, who has a passion for his work that many would envy.
"Let people know that if they are committing insurance fraud,
there is a great possibility they are going to get caught,"
he said earnestly. Illegal acts such as burning down a house or
business or faking an auto accident for an insurance payout constitute
insurance fraud. But there is another "soft" kind of fraud
that some people might not recognize so readily.
Article:
Most insurers lack technology to combat fraud
April 1, 2006, Washington, D.C. --
According to the coalition Against Insurance Fraud, insurance fraud
is an $80-billion crime wave. Unfortunately, most insurance carriers
have neither the processes nor technology they need to stop fraud.
Even so, as fraud schemes become more sophisticated, insurance carriers
must examine an even wider array of data to identify fraud trends
and detect fraudulent claims. To do this, they must institute a
set of technology best practices and techniques to automatically
detect fraud and abuse early in the claims process. A business rules
management system (BRMS) that enables organizations to develop,
deploy and manage applications for automating decisions can serve
as the technology basis for this approach.