Insurance Fraud NEWS

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

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Tipton County woman charged with TennCare drug fraud

April 25, 2019. Tipton County, TN-- Tennessee Department of Finance & Administration : A Tipton County woman is charged with TennCare fraud in connection with the sale of prescription drugs paid for by the state’s health care insurance program. The Office of Inspector General (OIG), with the assistance of the Tipton County Sheriff’s Office, today announced the arrest of Ursula Patrice Adams also known as Ursula Patrice Ponder, 51, of Covington, Tenn. She is accused of obtaining the dangerous opiate Fentanyl, and on two separate occasions she allegedly sold a portion of the drugs during an undercover investigation. According to the U.S. Drug Enforcement Agency, fentanyl is 80 to 100 times more potent than ...


UPS worker recruits cronies for false sleep studies in California

April 22, 2019. Torrance, CA-- NBC Los Angeles : A Torrance man who worked for United Parcel Service was sentenced Monday to two-and-a-half years in federal prison for his role in a fraud scheme that billed employee health coverage providers for unnecessary -- and sometimes never-performed -- sleep studies. Eddie Hernandez, 45, pleaded guilty in November in Los Angeles federal court to one count of healthcare fraud, according to the U.S. Attorney's Office. Prosecutors said Hernandez and co-defendant Anna Vishnevsky, 51 -- owner of a Studio City sleep diagnostics clinic -- helped recruit so-called patients by offering cash in exchange for participating in sleep study testing. They also offered additional cash to ...


Michigan home-health owner gets 7 years for $8.3M scam

April 22, 2019. West Bloomfield, MI-- United States Department of Justice : A Michigan home health agency owner was sentenced to 84 months in prison today for his role in an $8.3 million scheme to defraud Medicare. Assistant Attorney General Brian A. Benczowski of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Special Agent in Charge Timothy R. Slater of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement. Zahir Shah, 49, of West Bloomfield, Michigan, was sentenced by U.S. District Judge Avern ...


Michigan woman charged with trying to kill boyfriend for $440K

April 22, 2019. Redford, MI-- The Detroit News : Federal officials say a Redford woman tried to hire someone to kill her significant other so she could collect on his life insurance policy. Kersten Nicole Evans, 40, is accused of using interstate commerce facilities in the commission of murder-for-hire and soliciting another person to commit a crime of violence, according to a federal criminal complaint unsealed last week. Evans could not be reached for comment Monday. In the complaint, an FBI special agent said Evans approached a confidential source of the agency to asked him to kill "her significant other." The source is facing charges in state court on an unrelated matter ...


Agent allegedly writes bogus commercial policies in California

April 22, 2019. Southland, CA-- California Department of Insurance : California Department of Insurance alleges Angel Estrada, 22, a formerly licensed insurance producer and owner of Angel Estrada Agency, swindled a national insurer out of more than $140,000 in commissions by writing bogus commercial insurance policies to earn large commissions. According to department investigators, between 2016 and 2017, Estrada submitted 74 applications for commercial insurance policies and was rewarded for the new business with large commissions. Estrada then used a portion of his commission money to fund initial premium payments on new bogus policy applications to secure additional commissions. Investigators allege Estrada continued this practice until the insurer audited his business ...


Ohio man allegedly pays drugs, cash to have homes torched

April 22, 2019. Warren, OH-- Tribune Chronicle : A jury trial is scheduled to begin today for a Warren man accused of paying out cash and drugs to set fire to properties he owned in order to collect insurance money, according to court documents. Daryl Evans of Warren is charged with two counts of conspiracy to commit mail fraud, two counts of mail fraud, two counts of using fire in commission of a felony and two charges of destroying or damaging property used in interstate commerce in the U.S. District Court Northern District of Ohio. A fire set Aug. 19, 2013, at 1628 Hamilton St. SW, damaged parts of the ...


Rooted School becomes latest school to replace bus contractor accused of fraud

April 22, 2019. New Orleans, LA-- Nola.com : Rooted School students will now receive bus services from a new company effective Monday (April 22), after the Scholars First Transportation company cut ties with the high school last week. The three-year-old Uptown school’s board of directors voted April 16 to establish a new student transportation contract beginning April 22 through the end of the school year, according to Rooted chief operating officer Adrien Maught on April 17. The vote was in response to Scholars First announcing they would be terminating services effective April 19, Maught stated April 18. The school’s decision comes after investigators from the Louisiana Department of Insurance Fraud ...


Man wanted after attempting prescription fraud at CVS Pharmacy in Cumberland County

April 22, 2019. Cumberland County, PA-- FOX 43 : A man is wanted after attempting a prescription fraud at a CVS Pharmacy. On May 3, police received a report of a possible fraud from the CVS Pharmacy in Lower Allen Township. According to police, someone pretending to be a doctor from Washington, D.C. attempted to prescribe codeine to a “Walter Campbell” from Maryland. Campbell was to be on his way to pick up the prescription. Then, CVS was contacted by another pharmacy, and alerted to the same fraud. The suspect did not show up on May 3rd but around 3:00 p.m. the next day, a black man showed up to pick up the prescription ...


Venue change denied in giant health care fraud case

April 22, 2019. Greenville, TN-- Citizen Tribune : The federal prosecution of four Florida men charged in what officials describe as the second-largest heath care fraud case in U.S. history will remain in Greeneville, U.S. Magistrate Clifton L. Corker ruled in an order filed on Friday. It was a balancing act weighing the interest of the four Tampa-area men against the government, and Corker, who considered convenience and expense to the defendants and the prosecution and the location of the conspiracy “nerve center,” and Corker ruled in favor of the government. Larry Everett Smith, 48; Peter Bolos, 41; Michael Palso, 44; and the only health professional indicted in the case, ...


How to spot the signs of workers’ compensation fraud

April 22, 2019. Washington, DC-- Benefits Pro : Security cameras in a company cafeteria recently captured a brazen attempt to fake a workers’ compensation injury. The video shows that the man dumped a cup of ice onto the floor, disposed of the cup and then laid down on the floor as though he slipped on the ice. Prosecutors have charged the man with insurance fraud and theft by deception. ...


New documents in “How to Murder Your Husband” case

April 22, 2019. Portland, OR-- NBC : Investigators believe a woman in Oregon accused of murdering her husband planned the murder for years and purchased an untraceable gun kit before his death. Detectives believe Nancy Crampton-Brophy may have planned the shooting before she posted a 2011 article entitled, “How to Murder Your Husband.” Those revelations and more were revealed in thousands of pages of court documents Friday. Crampton-Brophy said “divorce is expensive” and “do you really want to split your possessions?” It also tells readers “if the murder is supposed to set me free, I certainly don’t want to spend any time in jail.” On June second of last year, Portland police ...


Rockland man sentenced to prison for health care fraud

April 22, 2019. Rockland, ME-- Penobscot Bay Pilot : A Rockland man was sentenced April 16 to four months in prison for health care fraud and embezzlement. Michael A. Morrison, 42, was sentenced in U.S. District Court in Portland by U.S. District Court Judge Nancy Torresen. His full sentence includes four months in prison, three years of supervised release, including four months of home confinement during the supervised release, according to U.S. Attorney Halsey Frank. Morrison was also ordered to pay $206,000 in restitution. He had pleaded guilty on Dec. 11, 2018 in U.S. District Court in Portland to health care fraud and embezzlement from a health care benefit ...


Covington nonprofit billed Medicaid for $100K in unprovided services

April 22, 2019. Covington, LA-- The New Orleans Advocate : A Covington nonprofit billed the Louisiana Medicaid Program for more than $100,000 in behavioral health services that it either didn't provide or provided by using unqualified employees, according to the state Legislative Auditor's Office. In some cases, the nonprofit Walk With Me billed for counseling services that licensed counselors said they never provided. In others, it billed for the work of staff members who weren't qualified to perform counseling and who said their duties actually involved helping with homework and supervising camp-type activities for children. The investigative audit, made public Monday, was triggered by complaints from the Medicaid Fraud Control Unit of ...


Audit reveals more details about Medicaid fraud arrest

April 22, 2019. Baton Rogue, LA-- WBRZ : Authorities arrested two people accused of filing false records. According to arrest documents Naji Abdelsalam provided false information about his income and employment status to the Louisiana Department of Health. Authorities say since his initial application in June 2016, Abdelsalam obtained medical coverage for himself and six family members by reporting that his income was below the established thresholds required to receive coverage. Authorities say Abdelsalam didn't disclose the fact he owned several businesses including a "multi-million dollar" Medicaid provider company. Owning the company disqualified him from receiving Medicaid benefits. During their investigation, authorities discovered Abdelsalam had at least five bank accounts ...


Statewide helplines set up for patients affected by arrests of doctors and nurses

April 22, 2019. Nashville, TN-- WGNS Radio : Tennessee is activating substance abuse resources and statewide call lines to help patients affected by the arrests of doctors and nurses in a crackdown on prescription opioid abuse. Indictments were unsealed last week charging more than 30 medical professionals in Tennessee with illegally prescribing and distributing millions of painkillers. A federal grand jury indicted Dr. Harrison Yang, 75, of Manchester, Tennessee, with healthcare fraud violations. In a separate case, Nurse Practitioner Jonathan White, 49, of Tullahoma, Tennessee, was indicted on three counts of healthcare fraud and one count of conspiracy to commit healthcare fraud. According to a news release, TennCare members receiving services from ...


Medical data of patients leaked in new breach

April 22, 2019. Washington, DC-- Komando : Data breaches come in all shapes and sizes and what's worse, they're much more commonplace than ever before. While they're all inherently bad, what varies is the severity of the exposure and the impact it could have on you. You could have a breach involving millions of records, but if it's just a bunch of email addresses, that's a manageable issue. There are also those breaches that affect a smaller group of people, but the number doesn't matter if that exposed data is full of your most sensitive information -- like medical records. Sometimes the word "sensitive" doesn't do a situation justice, and ...


EmCare says February email breach exposed some patient, contractor and employee data

April 22, 2019. Washington, DC-- Becker's Hospital Review : Physician staffing company EmCare is alerting patients, employees and contractors about a Feb. 19 data breach that exposed their personal data, according to the Dallas Morning News. An unauthorized third party gained access to Social Security numbers and clinical information of some patients through employee email accounts. EmCare also found the security breach exposed names, dates of birth and drivers license numbers. It is unclear how many people were affected by the data breach. EmCare is unsure if the personal information was taken, but there has been no indication of fraud or identity theft. EmCare has since taken additional steps to ensure similar ...


Medicaid expansion, fighting fraud, equally important

April 21, 2019. Baton Rogue, LA-- Daily Advertiser : As Louisiana’s Secretary of Health and a practicing physician, my mission is to improve the health of the people of this state. I am exceptionally proud of the work we have done to increase access to health care services. Nearly 480,000 low-income Louisiana residents have gotten coverage through Gov. Edwards’ Medicaid expansion, many for the first time in their adult lives. They can now see a primary care doctor when needed and get regular preventive care, rather than waiting until they’re so sick they need to go to the emergency room. What’s more, Medicaid expansion comes at no additional cost to ...


CMS launches enhanced oversight initiative for new home health agencies

April 21, 2019. Washington, DC-- Home Health Care News : With major regulatory volleys such as the Patient-Driven Groupings Model (PDGM) and the Review Choice Demonstration (RCD) on the table, keeping track of other industry-shaping issues can often feel like a losing battle. For some home health stakeholders, that may have meant missing a subtle yet important announcement from the Centers for Medicare & Medicaid Services (CMS) from earlier this year. In a February Medicare Learning Network (MLN) publication, CMS highlighted a new initiative that would place certain home health care agencies under “enhanced oversight” for a set period of time. Specifically, the initiative applies to all newly enrolled home health agencies, ...


Convicted doc appears in opioid-talk video

April 20, 2019. Western Slope, CO-- Montrose Press : A former Western Slope physician who was found to have prescribed drugs without a legitimate medical purpose briefly resurfaced — on YouTube, discussing the opioid crisis. Sam Jahani, who settled a 2011 federal indictment with a plea in 2016 to a charge of conspiracy involving health care fraud, appeared in a 2018 New Year’s Eve clip, which surfaced in the area community earlier this week. The video was no longer on YouTube as of Friday, but was recorded by the Montrose Daily Press. In the clip, a man introduced as “Dr. Sam Jahani” discusses with an interviewer the opioid crisis and what ...


Vegas hospice doc falsely bills Medicaid $7.1M

April 19, 2019. Las Vegas, NV-- Insurance News Net : The U.S. Attorney for the District of Nevada, Nicholas A. Trutanich, issued the following news release: A former medical doctor and his business partner were sentenced Tuesday to 33 months in prison for their individual roles in a $7.1 million Medicare health care fraud scheme that occurred at three Las Vegas hospice and home healthcare agencies, announced U.S. Attorney Nicholas A. Trutanich for the District of Nevada. Camilo Q. Primero, 76, of San Dimas, California, and Aurora S. Beltran, 63, of Glendora, California, each pleaded guilty conspiracy to commit health care fraud and money laundering. In addition to the prison term, U.S. ...


Oregon woman allegedly buys untraceable gun, shoots hubby

April 19, 2019. Portland, OR-- KATU 2 : Investigators believe Nancy Crampton-Brophy, the author accused of murdering her husband, a beloved local chef, planned the murder for years and purchased an untraceable gun kit before his death. Detectives believe Crampton-Brophy, 68, may have planned the shooting before she wrote and published a 2011 article entitled, "How to Murder Your Husband." Those revelations and more came in 12 search warrant affidavits a Multnomah County judge unsealed Friday. Investigators say Crampton-Brophy lied to them multiple times regarding where she was the morning her husband's body was found and about life insurance. "I spend a lot of time thinking about murder," Crampton-Brophy wrote in the ...


Washington driver accused of collision con is on the run

April 19, 2019. Yakima County, WA-- Washington Office of the Insurance Commissioner : Roberto Roman, 22, of Granger, has been added to Insurance Commissioner Mike Kreidler’s insurance fraud most wanted after he failed to appear in Yakima County Superior Court to face charges of first-degree attempted theft and filing a false insurance claim. A bench warrant for his arrest was issued on April 15 and bail is set for $10,000. If you have information that may lead to his arrest, please contact your local law enforcement agency or contact Kreidler's Criminal Investigations Unit (CIU). Roman was charged in March after an investigation by Kreidler’s CIU. According to the investigation, Roman totaled his uninsured ...


Duo suspected of torching car for insurance in Michigan

April 19, 2019. Adrian, MI-- Lenconnect.com : Two men have been accused of setting fire to a vehicle in an effort to make an insurance claim. Josiah Arnold Meiring, 24, of Toledo and his cousin, Zane Jerome Stevens, 18, of Erie are charged with arson of insured property, according to a news release from the Michigan State Police post in Monroe. They were arraigned Tuesday in Lenawee County District Court. Bond for each was continued at $5,000. Meiring, the car’s owner, has a preliminary hearing scheduled for April 30 before District Judge Jonathan L. Poer. Stevens has a preliminary hearing scheduled for Tuesday, April 23, before Poer. Both are represented by ...


Five Memphis doctors, nurses indicted in federal opioid sting

April 19, 2019. Memphis, TN-- Daily Memphian : Three Memphis-area doctors and two nurses have been indicted as part of one of the country’s largest federal drug busts for illegal distribution of prescription opioids. A total of 53 doctors and other medical professionals nationwide were charged earlier this week, including the five Memphis doctors and nurses, for their alleged participation in distributing illegal opioids and other narcotics. Sixteen doctors and medical professionals in West Tennessee were charged in the sweep, said Michael Dunavant, the U.S. Attorney for the Western District of Tennessee. “Opioid misuse and abuse is an insidious epidemic, created in large part by the over-prescribing of potent opioids ...