Insurance Fraud NEWS

Coalition Against Insurance Fraud
Advertising

Insurance Fraud News:
A selection of daily headlines from around the nation

Click on headlines to view full article in a new tab.


TX health care provider sentenced for workers' compensation fraud

June 22, 2018. Rancho Viejo, TX-- WorkersCompensation.com : A Rancho Viejo health care worker has been sentenced for falsifying worker's compensation claims. A Travis County District Court sentenced Marcus Ricoy to three years' deferred adjudication and ordered him to pay $10,000 in restitution. Ricoy performed functional capacity evaluations -- medical exams that determine if an injured employee is physically able to perform their job duties after a work-related injury or illness. Ricoy submitted false medical claims to an insurer for more time than the services actually took to perform. “The laws and rules are here to protect injured employees and policyholders. It's important to uncover these schemes so that we can ...


Connecticut counselor allegedly bills for self, family members

June 21, 2018. Norwich, CT-- Norwich Patch : A 47-year-old Norwich counselor has been arrested and charged with first-degree larceny by defrauding a public community and other violations in connection with a nearly $200,000 Medicaid fraud case, announced the Connecticut Office of the Chief State's Attorney. Susan J. Britt, of Nemczuk Drive, is accused of billing the government-run Medicaid health care program with fraudulent claims, more than half of which were for herself and family members, according to prosecutors. Britt was arrested by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State's Attorney and charged with two counts each of first-degree larceny by defrauding a ...


Contractor in New York avoids buying comp for employees

June 21, 2018. Seneca County, NY-- WorkersCompensation.com : New York State Inspector General Catherine Leahy Scott today announced the guilty plea, restitution payment and fine of a Seneca County contractor on a felony Workers' Compensation charge for failing to provide required insurance coverage for his employees. Steven Pollot, 37, of Waterloo, owner of D&S Home Improvements-Property Maintenance, pleaded guilty in Cayuga County Court to the Workers' Compensation crime of Failure to Secure Compensation, a felony. Concurrent with the guilty plea, Pollot paid $3,500 restitution to client homeowners and was separately sentenced to a $5,000 fine and a three-year conditional discharge. An investigation by Inspector General Leahy Scott found that Pollot ...


Tenants blame hot curling iron in suspected Louisiana arson

June 21, 2018. Lafourche Parish, LA-- WBRZ 2 : After a year-long investigation, the Lafourche Parish Sheriff's Office and the State Fire Marshal's Office have arrested three people in connection with an insurance scam involving arson. On June 1, 2017, the State Fire Marshal's Office was called to assist in determining the cause of a structure fire in Houma. Investigators were told there was one occupant who left a curling iron plugged in and unattended. When they returned to the home, they noticed smoke and fire coming from the back. Three months later, investigators received information from two other tenants who lived in the burned home. They said that ...


MD Anderson to pay $4.3 million penalty for data breach

June 20, 2018. Austin, TX-- Chron.com : A federal judge imposed a $4.3 million fine against the University of Texas MD Anderson Cancer Center for failing to secure health records which led to the possible compromise of health records of 35,000 people, the U.S. Department of Health and Human Service announced Monday. The case stems from three incidents in 2012 and 2013 when an employee’s laptop was stolen at a residence and two unencrypted two thumb drives went missing. Steven T. Kessel, the HHS administrative law judge in the case, found MD Anderson’s slow implementation of security measures “shocking.” MD Anderson’s failure to encrypt health records was a violation of ...


Fraud helps boost Medicaid user costs 7.9K percent

June 20, 2018. Washington, DC-- Washington Examiner : Health care consumes 17 percent of the nation’s gross domestic product, driven in part by government control, Obamacare and massive fraud in Medicaid, once a Washington afterthought but now serving 70 million, according to a sweeping new Senate report. Set for release by the Senate Homeland Security and Governmental Affairs Wednesday morning, the investigation by Chairman Sen. Ron Johnson’s staff found that Medicaid, which initially cost just $222 per user, has soared to $7,973, a 3,491 increase. Overall cost to taxpayers for the program designed for the poor is $554 billion. And, according to the report, a major reason is fraud, overpayments ...


Florida provider to repay $22.5M for needless oxygen therapy

June 20, 2018. Orlando, FL-- United States Department of Justice : The Justice Department announced today that Healogics, Inc. has agreed to pay up to $22.51 million to settle allegations that it violated the False Claims Act by knowingly causing wound care centers to bill Medicare for medically unnecessary and unreasonable hyperbaric oxygen (“HBO”) therapy. Healogics, a Florida-based company, manages nearly 700 hospital-based wound care centers across the country. “Medicare beneficiaries are entitled to care based on their clinical needs and not the financial goals of healthcare providers,” said Acting Assistant Attorney General Chad A. Readler for the Justice Department’s Civil Division. “All providers of taxpayer-funded federal healthcare services, whether contractors or ...


Coalition raises concerns about new health plans

June 20, 2018. Washington, DC-- Modern Healthcare : Regulators and insurance experts worry the Trump administration's new rule expanding association health plans for small businesses and self-employed people will lead to a spike in insurance fraud and insolvencies that plagued consumers and healthcare providers in the past. The Labor Department's 198-page final rule, issued Tuesday in response to President Donald Trump's executive order in October, will make it easier for small firms and individuals to band together across state lines in association health plans governed by the Employee Retirement Income Security Act. The administration, backed by groups like the National Federation of Independent Business, argued that allowing the formation ...


Attorney falsely bills Texas comp system more than $400K

June 20, 2018. Lewisville, TX-- Insurance Journal : Workers’ compensation insurer, Texas Mutual Insurance Co. reported that a Travis County grand jury has indicted attorney Leslie Casaubon of Lewisville, Texas, on three counts of workers’ compensation fraud-related charges The indictment alleges that, from 2010 to 2014, Casaubon billed her clients for services not rendered, with the intent to defraud and harm workers’ compensation claimants. The indictment further alleges that Casaubon submitted false attorney hours to the Texas Department of Insurance Division of Workers’ Compensation through its electronic system. Based on the hours submitted, the Division of Workers’ Compensation ordered workers’ compensation carriers to deduct up to 25 percent from her ...


Washington driver allegedly falsifies policy proof after crash

June 20, 2018. King County, WA-- Washington State Office of the Insurance Commissioner : Three men were charged in King County Superior Court with filing fraudulent insurance claims after investigations by Insurance Commissioner Mike Kreidler’s Criminal Investigations Unit (CIU). ...


Almost 80 fraudsters guilty in major insurance fraud scam

June 19, 2018. Cardiff, -- Claims Media : A series of trials has concluded in which 77 fraudsters either pleaded or were found guilty for their role in a major insurance fraud scam. The conclusion to the trials on 15 June follows the second phase of one of the largest investigations into car insurance fraud in the UK. The operation was carried out by the Insurance Fraud Bureau (IFB) in collaboration with its insurer members and Gwent Police. The original case, which concluded in 2015, saw 81 people prosecuted for their role in the crash for cash scam, in which the fraudsters staged accidents with 57 different vehicles. The investigation uncovered ...


Texas doc charged with selling signature for false scripts

June 19, 2018. Dallas, TX-- The Dallas News : Dr. Kelly Robinett's signature was worth a lot of money for one Dallas home health care company and its nurses, federal prosecutors say. They allege that the Carrollton physician put it up for sale to make a $13 million home health care scam possible over an eight-year period. With that signature, Timely Home Health Services was free to recruit able-bodied people for home health care services they didn't need, prosecutors said Monday on the opening day of trial in Dallas. Robinett, 69, never saw any of the patients he authorized home health care for, and he "didn't care to," said Assistant U.S. ...


Report: IRS vulnerable to workers-comp schemes

June 19, 2018. Washington, DC-- Federal Times : The Internal Revenue Service does not properly verify and monitor portions of its workers compensation claims system, leaving the agency vulnerable to fraudulent compensation filings, according to a June 15 Treasury Inspector General for Tax Administration report. “Based on a statistical sample of active claims, we estimate that 133 (9 percent) [of] active claims were not initiated properly. If claims are not initiated properly, the IRS may make payments for compensation and medical expenses that are not necessary. Given that some IRS employees may receive workers’ compensation benefits for decades, improperly approving even one claim could prove very costly to the ...


Driver allegedly makes false hit-and-run claim in Carolina

June 19, 2018. Hertford, NC-- DailyAdvance.com : A Hertford woman has been charged with insurance fraud after state officials say she filed a false insurance claim for damages to her vehicle from an accident. Shar’dayzeia Lonniece Johnson, 22, of 306 Stokes Street, also was charged with attempting to obtain property by false pretense, a press release from the N.C. Department of Insurance states. According to a warrant, Johnson filed a claim with National General Insurance Co., saying her vehicle was involved in a hit-and-run traffic accident. Special agents with the N.C. Department of Insurance Criminal Investigations Division say Johnson’s claim sought $1,795.78. However, the investigators determined ...


Carolina driver charged with lying he hit deer

June 19, 2018. Pendland, NC-- North Carolina Department of Insurance : North Carolina Insurance Commissioner Mike Causey today announced the arrest of Justin Ryan Pendland, 32, of 5660 Merle Drive, Trinity. Pendland was charged by special agents with the N.C. Department of Insurance’s Criminal Investigations Division with felony insurance fraud and felony attempting to obtain property by false pretense. According to warrants, Pendland provided a false and misleading statement to Peak Property and Casualty Insurance Corp., claiming that he was driving his 2004 Buick LeSabre when it struck a deer on Oct. 3, 2017. The warrants say the car was damaged on Sept. 29, 2017, when Pendland fell asleep at the wheel ...


Police say Louisville pharmacist created fake profiles to obtain drugs

June 19, 2018. Louisville, KY-- WDRB.com : A Louisville pharmacist has been arrested after police say he created false patient profiles at the pharmacy where he was employed. Gary Yelton, 61, was arrested early Tuesday morning at the CVS Pharmacy, located at 9575 Taylorsville Road, where police say he was employed. According to an arrest report, Yelton allegedly created the fake profiles in the pharmacy's database over the course of about two years. Police say Yelton made the profiles so he could illegally get controlled substances including Hydrocodone. When confronted by store officials, police say Yelton admitted to the crime. He stated he used the drugs to treat pain and ...


Analysis: Health Data Breach Tally Trends

June 19, 2018. Washington, DC-- Govinfo Security : The addition to the federal tally in recent weeks of about three dozen major health data breaches, including many hacking and unauthorized access/disclosure incidents, pushed the total number of breach victims so far this year to almost 2.9 million. A Tuesday snapshot of the Department of Health and Human Services' HIPAA Breach Reporting Tool website - commonly called the "wall of shame," shows a total of 161 breaches added so far in 2018. "Unauthorized access/disclosure" breaches are the most common type of incident posted on the wall of shame this year. Those 73 incidents - including breaches involving email, electronic medical records ...


Soldier has toddler killed for life insurance in Tennessee

June 19, 2018. Clarksville, TN-- Clarksville NOW : Former Fort Campbell soldier Zackery Alexander has pleaded guilty to the premeditated murder of 2-year-old Joseph Bankston in 2015. According to court records obtained by ClarksvilleNow, Alexander entered a guilty plea on June 18, 2018, waiving his right to a jury trial or an appeal. As a result, Alexander was sentenced to life in prison without parole plus 66 years. Earlier this year he had filed for a motion for a venue change for his trial, but ended up making the plea deal this month. On October 4, 2015, Brandon Jimenez (also a Fort Campbell soldier) was shot several times and 2-year-old Joseph Bankston ...


Texas politico rigs bidding for school district coverage

June 19, 2018. San Antonio, TX-- My San Antonio : Former Harlandale ISD board member Joshua Cerna was sentenced Tuesday to a year in a halfway house and ordered to pay more than $40,000 in connection with an FBI investigation into millions of dollars in rigged insurance contracts at other area school districts and at the now-defunct Bexar Metropolitan Water District. Cerna, 44, pleaded guilty in September 2016 to a charge of conspiracy to commit honest services wire fraud, admitting he helped corrupt the insurance company selection process at San Antonio, Edgewood and South San Antonio Independent School Districts. He admitted that with insurance broker Sam Mullen of the Mullen Group, Cerna ...


Missouri cop steals disability, works elsewhere as cop

June 19, 2018. Kinloch, MO-- Riverfront Times : An former police captain in scandal-scarred Kinloch pleaded guilty this morning to federal fraud charges, admitting he collected thousands in disability benefits even as he worked multiple jobs. Everett James, 60, claimed to the U.S. Social Security Administration in 2014 that he wasn't physically able to work as a corrections officer, but that didn't stop him from working in Kinloch as well as a part-time cop for other north county departments in Hillsdale and Wellston. James had battled with Kinloch in past years over benefits. He had been injured on the job in 2007 during a violent confrontation with a suspect, whom ...


North Side prescription opioid dealer gets 5 years for 35th conviction

June 18, 2018. Pittsburgh, PA-- TribLive : A North Side man convicted of his 35th offense will spend five years behind bars for his role in an illegal drug ring that trafficked prescription opioid pills in greater Pittsburgh, federal prosecutors said. Jeremiah Davidson, 62, of the Manchester section of Pittsburgh's North Side, was convicted of health care fraud, perjury and conspiring to possess and distribute oxycodone and oxymorphone through a criminal network of drug dealers, U.S. Attorney Scott W. Brady said Friday. Davidson obtained the pills from “various sources” — including his own prescription — then took them to a dealer for further distribution to users, prosecutors said. In December ...


Trump plan could lead to wave of fake health scams

June 18, 2018. Washington, DC-- Bloomberg BNA : A pending Department of Labor final rule would lower state oversight of association health plans and loosen the definition of what constitutes an employer, two moves that could open the floodgates to fraud, some people in the industry told me. The Department of Labor final rule would expand small business access to so-called association health plans, which allow small businesses to band together and offer health insurance. The White House Office of Management and Budget completed a review of the rule June 13, and publication of the final rule is imminent. The proposed rule included sections that would exempt some self-insured association ...


California doc gets 10 years for paying referral kickbacks

June 18, 2018. Beverly Hills, CA-- United States Department of Justice : Beverly Hills Radiologist Ronald Grusd and two of his corporations, California Imaging Network Medical Group and Willows Consulting Company, were sentenced in federal court today after a jury trial in December resulted in convictions on 39 felony fraud counts. U.S. District Judge Cynthia A. Bashant imposed a sentenced of 10 years in custody and a fine of $250,000, and remanded Dr. Grusd into custody. His companies, California Imaging Network and Willows Consulting Company, were each required to pay a $500,000 fine, and an additional $15,600 in special assessments. According to evidence presented at trial, Dr. Grusd and his companies paid kickbacks for ...


Florida state attorney lauds Coalition fraud-fighting award

June 18, 2018. Palm Beach, FL-- Palm Beach Post : Palm Beach County State Attorney Dave Aronberg received an award this month for his work tackling fraud in the sober home community across the county. Aronberg received the Apollo award from The Coalition Against Insurance Fraud, a Washington-based policy and research group, in Orlando on June 5 for his “distinction in combating insurance fraud.” Aronberg helped create the Palm Beach County Sober Homes Task Force to help combat those sober home owners and treatment centers who profited off their patients’ insurance claims and those who received kickbacks for referring patients. A Palm Beach Post investigation revealed details about local sober homes ...


Here's how the Massachusetts House and Senate hope to tackle health care costs

June 18, 2018. Boston, MA-- Mass L\ive : The Massachusetts House Committee on Health Care Financing released a major bill last week aimed at containing health care costs. House lawmakers are expected to vote on the bill this week. The House bill would then have to be reconciled with a health care bill passed by the state Senate. Both the House and the Senate address similar issues in attempting to drive down Massachusetts' notoriously high health care costs. They are looking at, among other things, how to help community hospitals remain financially viable, how to increase the use of telemedicine, how to contain the cost of drugs, and how ...