Insurance Fraud NEWS

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

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Insurer technology helping law enforcement crack down on fraud

August 14, 2018. Washington, DC-- Officer.com : Workers’ compensation fraud is under attack, with new technology making it easier for law enforcement agencies to find and stop those trying to manipulate the system. To gain more immediate insight into this $80-billion-dollar problem, law enforcement agencies and insurance carriers now have huge volumes of data at their disposal - claims information, national and state records, social media and third party details on relationships, criminal records and address changes. With that comes the challenge of interpreting the massive amounts of information in a way that’s actionable. As fraudsters become smarter and use sophisticated schemes more effectively, it’s essential law enforcement agencies ...


Life agent in Iowa convicted of stealing client premiums

August 14, 2018. Des Moines, IA-- The Argus-Press : A December sentencing has been scheduled for an Iowa man accused of selling fraudulent life insurance policies and keeping the money. Prosecutors say a jury last week found 59-year-old Roger Goodwin guilty of seven counts of mail fraud. His sentencing is set for Dec. 19 in U.S. District Court in Des Moines. Prosecutors say that between 2013 and August 2016, Goodwin recommended life insurance or annuity contracts to several clients and then deposited their checks in his bank account. Authorities say the Windsor Heights, Iowa, man used part of the money for his personal expenses and some of it to repay other clients ...


Ex-cop in Alabama sentenced to prison for staging burglary

August 14, 2018. Prattville, AL-- WISTV.com : A former Prattville police officer was sentenced Monday to 10 years in prison after pleading guilty in July to first-degree insurance fraud, first-degree conspiracy to commit burglary, and third-degree burglary. Judge Ben Fuller sentenced Leon “Todd” Townson, 51, to a decade on each count involving insurance fraud and conspiracy to commit burglary, and three years for third-degree burglary. Those sentences will be served concurrently, or at the same time, with the Alabama Department of Corrections. Two counts of conspiracy to commit robbery, first-degree robbery were dismissed. He will receive credit for time served in jail. Townson pleaded guilty to crimes involving a ...


Pharmacist in Illinois pleads guilty to $630K billing scam

August 14, 2018. Red Bud, IL-- Republic-Times : Steven P. Gibson, 29, pharmacist and owner of Gibson’s Discount Drugs in Red Bud, pleaded guilty in federal court Aug. 14 to charges he engaged in a scheme to defraud health care benefit programs by submitting false claims for fraudulent prescription medications to Medicare, Medicaid and private insurance companies. These claims were not authorized by a physician, nurse practitioner or a physician’s assistant as required. Gibson faces up to 10 years in prison, a fine of up to $250,000, and up to three years of supervised release on each of the two counts to which he pleaded guilty. He will be ...


Woman in Nevada pleads guilty to aiding fake pedestrian crash

August 14, 2018. Las Vegas, NV-- News3LV.com : Nevada Attorney General Adam Paul Laxalt announced that Tameka Goodwin, 30, of North Las Vegas, pleaded guilty to one count of Insurance Fraud. The crime was committed in July 2016. Goodwin participated in a pedestrian accident scheme which allegedly involved presenting false claims to insurance companies claiming that a pedestrian was hit and injured by an insured’s motor vehicle. The accidents never occurred, but the claimants are alleged to have reported medical treatment to increase their chances of a higher settlement with insurance companies. Tameka Nicole Green, a codefendant in this scheme, also pleaded guilty last week for her role. In July, the main ...


Recruiter for mental health clinic in N.C. received $393K in kickbacks

August 14, 2018. Raleigh, NC-- Cedarville News : An associate of a former North Carolina State University football player accused of providing impermissible benefits to student-athletes was sentenced Friday to a year of house arrest and five years on probation for his role in a Medicaid fraud scheme. Carlos Brown also was ordered to pay $393,000 in restitution to the state Medicaid program. Court documents state that Eric Dewayne Leak paid Brown $393,000 in kickbacks between October 2011 and December 2013 for recruiting clients for Nature‘s Reflections LLC, the behavioral health counseling business run by Leak and his wife, Emily. Leak, who played football for the Wolfpack in the late ...


Cop, ex-wife in Florida charged with faking homeowners claim

August 14, 2018. Miami, FL-- CBS Miami : The Miami-Dade Police Department announced Tuesday one of their own has betrayed the badge. The department said a Miami-Dade police lieutenant has been arrested and charged with scheme to defraud, insurance fraud and grand theft. Juan Perez, Director of the Miami-Dade Police Department, tweeted about the arrest on Tuesday: Lieutenant Alexander Diaz de Villegas is accused of filing false home insurance claims. He was charged along with his ex-wife, Barbara Diaz de Villegas, a public adjuster who was previously arrested for insurance fraud in May. The couple is facing 18 counts of grand theft and insurance fraud, dating back as far as 2013. The twosome filed ...


Prosecutors face setback in massive assisted living fraud case

August 14, 2018. Miami, FL-- Senior Housing News : A judge has dealt a significant blow to federal prosecutors in the nation’s largest Medicare fraud case to date. Magistrate Judge Alicia Otazo-Reyes threw out crucial evidence in a $1 billion fraud indictment against Philip Esformes, a health care executive behind more than 30 Miami-area skilled nursing and assisted living communities, reported the Miami Herald. The judge said in a 117-page ruling that a 2016 search of the Eden Gardens assisted living community by prosecutors with the U.S. Justice Department and FBI agents amounted to “misconduct.” While Otazo-Reyes didn’t dismiss the indictment outright, she did choose to suppress certain protected correspondence and ...


Assistant AG Benczkowski announces Newark/Philadelphia Medicare fraud strike force to focus on health care fraud and illegal opioid Prescriptions

August 13, 2018. Washington, DC-- United States Department of Justice : Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division today announced the formation of the Newark/Philadelphia Regional Medicare Fraud Strike Force (Regional Strike Force), a joint law enforcement effort that brings together the resources and expertise of the Health Care Fraud Unit in the Criminal Division’s Fraud Section (HCF Unit), the U.S. Attorney’s Offices for the District of New Jersey and the Eastern District of Pennsylvania, as well as law enforcement partners at the FBI, U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and U.S. Drug Enforcement Administration (DEA). Assistant Attorney General Benczkowski ...


Virginia forms task force to curb worker misclassification

August 13, 2018. Richmond, VA-- WVVA.com : Gov. Ralph Northam has signed an executive order establishing a task force to come up with a plan to prevent worker misclassification and payroll fraud. The state estimates that the misclassification of employees as independent contractors costs Virginia as much as $28 million a year in state income tax collections. A 2012 legislative report found that one-third of audited employers in certain industries misclassify their employees. By failing to purchase workers' compensation insurance, pay unemployment insurance and payroll taxes, and failing to comply with minimum wage and overtime laws, employers lower their costs by as much as 40 percent. That places other ...


Trio in South Carolina charged with staging car crash

August 13, 2018. Sumter, SC-- WACH FOX 37 : South Carolina Attorney General Alan Wilson has announced three Sumter men have pleaded guilty to insurance fraud charges. Twenty-three-year-old Tykeem Ra Hsan Jomal Sumpter, 22-year-old Raekwon Rasheen Reyes and 19-year-old Khalil Jabraun Hilton faced multiple charges. Sumpter pleaded guilty to one count of making a false statement, Owens pleaded guilty to one count of presenting a false claim for payment and one count of resisting arrest and Hilton pleaded guilty to one count of making a false statement, according to a release. “Insurance fraud may seem like a victimless crime to some because big insurance companies can afford to pay out the money, ...


Merced CEO pleads guilty in $3.7M health care scheme

August 13, 2018. Merced, CA-- The Business Journal : The CEO of a health clinic network that had a presence in Madera has pleaded guilty to a $3.7 million fraud scheme. Merced resident Sandra Haar, 57, was the founder and CEO of Horisons Unlimited, a nonprofit that provided health and dental services in Merced and surrounding communities, including Madera. According to court documents, between Jan. 1, 2014, and March 2017, Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by more than $3.7 million from her fraud. For example, Haar billed Medi‑Cal for health and dental services that were not rendered ...


New Port Richey pharmacy agrees to pay feds $2.2M

August 12, 2018. Tampa, FL-- Tampa Bay Reporter : Trinity Medical Pharmacy and several of its principals have agreed to pay the U.S. about $2.24 million to settle allegations that TMP violated federal law when it knowingly billed government programs for claims generated by illegal kickbacks, according to the U.S. Attorney’s Office for the Middle District of Florida. TMP also violated the False claims act by knowingly omitting material information from TMP’s application to become a certified Express Scripts provider. The claims resolved by the settlement are allegations only, and there has been no determination of liability, the U.S. attorney said. The settlement relates to TMP’s marketing and sale of compounded ...


California hospital chain to pay $65M for defrauding Medicare

August 11, 2018. Chino, CA-- Champion Newspapers : Prime Healthcare Services, which owns Chino Valley Medical Center in Chino and 13 other hospitals in California, has agreed to pay $65 million to settle allegations of submitting false claims to Medicare by admitting patients that only required outpatient care and were billed for more expensive patient diagnosis. The practice is known as “upcoding,” said Thom Mrosek, the spokesman for the U.S. Attorney’s office in Los Angeles. The settlement ends a False Claims Act lawsuit by a whistleblower named Karin Berntsen, a former director of performance improvement at the organization’s Alvarado Hospital Medical Center in San Diego. She will receive $17.2 ...


Former Swiss driving instructor arrested in Sattahip Please credit and share this article with others using this link:https://www.bangkokpost.com/news/crime/1519910/former-swiss-driving-instructor-arrested-in-sattahip. View our policies at http://goo.gl/9HgTd and http://goo.gl/ou6Ip. © Post Publishing PCL. All rights reserved.

August 11, 2018. Bangkok, -- Bangkok Post : A former Swiss driving instructor wanted for extradition on charges of defrauding car-insurance companies of the equivalent of 20 million baht has been caught in Chon Buri. Crime suppression police arrested... Please credit and share this article with others using this link:https://www.bangkokpost.com/news/crime/1519910/former-swiss-driving-instructor-arrested-in-sattahip. View our policies at http://goo.gl/9HgTd and http://goo.gl/ou6Ip. © Post Publishing PCL. All rights reserved. ...


Fraudsters sentenced after taking advantage of ‘honest, law-abiding’ taxi drivers in insurance scam

August 11, 2018. East Ham, -- Newham Recorder : Ajay Haque, 35, from Salisbury Road in Forest Gate, Anik Dixit, 34, from Browning Road in East Ham, and Mohammed Nur Ahmed, 33, from Walton Road in Manor Park, met while studying at Westminster University. After they’d left, they created a ghost-broking scheme where they made money by selling fake insurance policies, mainly targeted at minicab drivers. They were sentenced on August 7 for conspiracy to commit fraud. Ahmed pleaded guilty at a pre-trial hearing, while Dixit and Haque pleaded not guilty. Between June 2012 and August 2013, the men ran AHD Solutions, a scam company which offered hire and reward insurance policies ...


Floridian accused of fraud in boating death of husband

August 10, 2018. Jackson County, FL-- Tallahassee Democrat : Denise Williams, accused of the planning, cover-up and murder of her high school sweetheart Mike Williams more than 17 years ago, now faces prosecution for another serious crime – insurance fraud. She was charged Thursday with three counts of insurance fraud related to $1,750,000 in claims she made after her husband disappeared. The 48-year-old has been held in jail since her arrest in May after a grand jury indicted her on three charges related to her husband’s killing. Her arrest followed the stunning admission by Brian Winchester last year that he killed his best friend so he could be with Denise – ...


Phone scam diverts Florida county's $100k in health premiums

August 10, 2018. Collier County, FL-- Naples Daily News : The Collier Mosquito Control District was the victim of an insurance scam that resulted in the loss of almost $100,000 of taxpayers' money, according to a police report. The scam began in June when the director of administration at Collier Mosquito Control received an email about the district's health insurance. The email claimed the district was short about $12,000 for its June health insurance bill. The email also instructed the administrator to send the money to a different bank account than usual. According to the report, the administrator thought the email was "out of place" and called a supervisor from the ...


Contractor in Ohio fined $250k for comp premium fraud

August 10, 2018. Dayton, OH-- Dayton Daily News : A Dayton construction business owner was ordered to pay about $250,000 in fines and serve five years of community control after his conviction for under-reporting his payroll to avoid workers compensation premiums. Honorato Camacho, who owns Field Construction LLC, had previously pleaded guilty to a fifth-degree felony count of workers’ compensation fraud. An Ohio Bureau of Workers’ Compensation investigation found that Camacho under-reported his payroll by more than $3.5 million from 2013-15. A Montgomery County Common Pleas Court judge ordered Camacho to repay $255,434 and serve community control on July 17. Camacho was one of three defendants convicted last month of workers compensation ...


Driver in Connecticut charged with lying about car crash

August 10, 2018. East Hartford, CT-- Journal Inquirer : On the afternoon of April 7, East Hartford resident Presilla Rivera called police to report someone had crashed into her car parked in front of her apartment, then left the scene, according to police. But Officer Jason Kaplan who responded to the call knew better because he’d seen a heavily intoxicated Rivera early that morning at a local bar and believed he heard her crash her car into a dumpster in the rear lot when she left, he wrote in the affidavit supporting her arrest. Rivera, 25, of 210 Main St., Apt. 2, was charged July 20 with insurance fraud and second-degree ...


Long Valley Doc Has License Revoked: NJAG

August 10, 2018. Long Valley, NJ-- Long Valley Patch : A Long Valley doctor has permanently lost his medical license for illegally prescribing opioids, New Jersey Attorney General Gurbir S. Grewal said. Dr. Jose Leyson, 72, officially lost his license in June, after voluntarily letting it expire in June 2017. He pleaded guilty in federal court to writing illegal prescriptions for Oxycodone and conspiring to commit health care fraud at his Newark medical clinic. In addition to losing his license, he was sentenced to two years probation and ordered to pay $45,000 in fines and restitution. Between Nov. 2013 and Jan. 2014, Leyson wrote prescriptions for an undercover law enforcement source ...


Randolph man charged with insurance fraud

August 10, 2018. Randolph, NJ-- Parsippany Focus : Morris County Prosecutor Fredric M. Knapp announces the arrest of Shamus McGuire, 48, Randolph, for three counts of fraud. Shamus McGuire was charged with one count of second degree Insurance Fraud, one count of second degree Healthcare Claims Fraud, and one count of third degree Obtaining a Controlled Dangerous Substance by Fraud. The investigation was initiated by the Morris County Prosecutor’s Office Insurance Fraud Unit following notification to this Office by the New Jersey Division of Consumer Affairs Prescription Monitoring Program (NJPMP) of potential illegal activity involving fraud. During the course of the investigation, it was determined that Shamus McGuire allegedly ...


United States settles false claims act allegations against Trinity Medical pharmacy And principals for more than $2.2M

August 10, 2018. New Port Richey, FL-- United States Department of Justice : United States Attorney Maria Chapa Lopez announces today that Trinity Medical Pharmacy, LLC, (TMP) and several of its principals have agreed to pay the United States $2,244,270.14 to resolve allegations that TMP violated the False Claims Act by knowingly billing TRICARE and other government programs for claims generated by illegal kickbacks and by knowingly omitting material information from TMP’s application to become a certified Express Scripts provider. The settlement relates to TMP’s marketing and sale of compounded medicine that should be uniquely tailored to an individual patient’s need and is often extremely expensive. Between 2013 and 2015, TMP, formerly located in ...


Eldorado woman pleads guilty to federal charges in Medicaid fraud scheme

August 10, 2018. Eldorado, IL-- The Southern Illinoisan : An Eldorado woman pleaded guilty Thursday in federal court to charges that she stole from a federal health care program. According to a news release from U.S. Attorney Steven D. Weinhoeft, Betsy J. Gutowski, 45, is in custody with her bond revoked until her sentencing, which is set for November. In her plea hearing, according to the release, Gutowski admitted she submitted false and fraudulent bills for personal assistant services in the Home Services Program, which is a Medicaid waiver program designed to allow people to stay home rather than go to a nursing home. Gutowski admitted she falsely billed the program ...


Abuse treatment center fined in Medicaid fraud case Read more: http://www.lowellsun.com/news/ci_32061635/abuse-treatment-center-fined-medicaid-fraud-case#ixzz5O4M2b6HT

August 10, 2018. Andover, MA-- Lowell Sun : A North Andover-based substance abuse treatment center with patients from the Greater Lowell area will pay $612,000, after unlawfully charging cash for opioid addiction treatment already covered by the state's Medicaid Program, Attorney General Maura Healey's Office announced Thursday. From October 2010 to November 2015, the court found Center for Psychiatric Medicine, or CPM, and its owners -- Joseph Campione of Merrimac, and Thomas J. McLaughlin of Lincoln -- charged its patients cash fees to receive Suboxone treatment. Patients struggling with opioid addiction are prescribed Suboxone to suppress withdrawal and cravings for opioids. "This center stole from its own patients seeking treatment ...