Insurance Fraud NEWS

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

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New Yorkers allegedly run pill mill, untrained staff poses as docs

January 16, 2018. Brooklyn, NY-- New York State Office of the Attorney General : Attorney General Eric T. Schneiderman today announced the indictment and arrest of Tea Kaganovich, 45, and Ramazi Mitiashvili, 57, both of Brooklyn, NY for Grand Larceny in the First Degree and other related charges for illegally billing Medicaid for fraudulent diagnostic testing services and laundering the criminal proceeds from their scheme. The Attorney General also filed a civil lawsuit seeking $24 million in damages from the defendants under the State’s False Claims Act and other laws. The indictment alleges that Kaganovich and Mitiashvili, operators of Sophisticated Imaging, Inc., East Coast Diagnostics, Inc., and East West Management, Inc., engaged in a ...


Eye doc bills for phantom treatments in Georgia

January 16, 2018. Gainesville, GA-- United States Attorney's Office : Matilda Lynn Prince has been convicted by a federal jury of twenty-nine counts of health care fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients. “Prince stole hundreds of thousands of dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak. “Through our partnership with the Georgia Attorney General’s office, we will continue to fight the costly effects of healthcare fraud in this state that divert critical resources away from citizens who ...


Trio allegedly keep seniors in Georgia dungeons, bilk Medicaid

January 16, 2018. Albany, GA-- My AJC : Three people have been arrested on allegations that they confined 14 elderly or disabled adults in middle Georgia residences, denying them food and stealing their government benefit payments, law enforcement officials said Tuesday. Georgia Attorney General Chris Carr said the defendants participated in “an organized web of abuse” by targeting the elderly in Albany and Macon. The victims “were begging for food” and didn’t receive adequate medical treatment at Miracle One Care Center Inc., an unlicensed personal care home, Carr said. “They are dungeons where elderly and disabled persons are warehoused so that their benefits can be syphoned off,” said GBI Director Vernon ...


Florida bill requires windshield checks before replacing

January 16, 2018. Tallahassee, FL-- News 4 Jax : Insurers could demand car windshields be checked for damage before they are replaced under a Senate proposal that started moving forward Tuesday to combat reported increasing cases of repair-shop fraud. But the inspections would have to be done quickly. The bill (SB 396), sponsored by Sen. Dorothy Hukill, R-Port Orange, was approved by the Senate Banking and Insurance Committee after being amended to require inspections occur within 24 hours in most cases and by adjusters employed by the insurers. Hukill, who expressed concern about the attached timelines, said she will continue to work on the proposal, which has support from Florida Chief Financial ...


California doc’s license limited in case involving baby’s death

January 16, 2018. Sacramento, CA-- OC Weekly : A Brea physician, who is being prosecuted in a baby's death and for being part of an alleged $100 million workers compensation fraud scam, recently had his medical license restricted pending the outcome of criminal proceedings. The interim suspension order agreed to by Dr. Andrew Robert Jarminski, his attorney Peter R. Osinoff and counsel for the Medical Board of California went into effect on Dec. 22, according to state records. The Weekly previously reported on the $25 million fraud/manslaughter case that prominently features Inland Empire businessman Kareem Ahmed, a major donor to Barack Obama as well as such charities as Lupus LA, ...


Arkansas man charged with faking theft of ski boats

January 16, 2018. Vilonia, AR-- TheCabin.net : A-1 Recovery Inc. owner Terry Wyatt is asking prosecutors to specify what grounds they have to accuse him of gang activity and insurance fraud. Wyatt, 57, of Vilonia faces 13 felonies — first-degree engaging in a continuing criminal gang, four counts of theft of property, three counts of theft by receiving, four counts of insurance fraud and possession of firearms by certain persons. Charges were filed against Wyatt last year in connection to several possible fraudulent insurance claims made between Feb. 22, 2014, through Aug. 2, 2015. Danny R. Crabtree, who represents Wyatt, filed a request for a bill of particulars on Monday. The ...


Employee at Munster doctor's office charged with prescription forgery

January 16, 2018. Munster, IN-- NWI.com : A former employee at a doctor's office in Munster is accused of forging prescriptions for pain medication. Michele Anna Marie Kawzinski, 25, of Hobart, was charged Friday in Lake Criminal Court with two counts of forgery, two counts of obtaining a controlled substance by fraud or forgery, unlawful possession of a legend drug and misdemeanor theft. Kawzinski is alleged to have forged prescriptions while employed at Orthopedic Specialists of Northwest Indiana, 730 W. 45th St., in Munster, according to court documents. A manager for the doctor's office told Munster police Aug. 17 that Kawzinski created several fraudulent patient accounts, and those phony patients ...


Former California med exec convicted of $500M in needless surgery

January 15, 2018. San Diego, CA-- Courthouse News : The former owner of Pacific Hospital in Long Beach was sentenced Friday to 5 years and 3 months in federal prison for a 15-year, $500 million healthcare fraud, federal prosecutors said. Michael D. Drobot, 73, of Corona Del Mar, pleaded guilty in 2014 to conspiracy and paying illegal kickbacks. “Thousands of patients received surgeries at Pacific Hospital not knowing that [Drobot] bribed their physician to perform their surgery at Pacific Hospital,” prosecutors wrote in a sentencing. They said Drobot “was motivated by greed and ultimately profited [by] millions of dollars through the scheme.” The conspiracy ran from 1997 through 2013, the U.S. Attorney’s ...


Florida chamber passes bill against illicit takeover of claims

January 15, 2018. Tallahassee, FL-- FLorida Politics.com : Right out of the gate, the Florida House took several major steps toward statewide insurance reform during the first week of the 2018 Legislative Session. On Friday, lawmakers advanced a trio of House bills: repealing the state’s motor vehicle no-fault law and PIP insurance requirements, addressing “assignment of benefits” abuse and making significant changes in Florida’s workers’ compensation system. House approves PIP repeal Lawmakers passed HB 19, from Vero Beach Republican Erin Grall, by a vote of 88 to 15. HB 19 eliminates the existing No-Fault/PIP system, replacing it with a fault-based system that requires every motorist to buy bodily injury coverage of ...


Doctor in Pennsylvania charged in patient overdose death

January 15, 2018. Punxsutawney, PA-- Sharon Herald : A Pennsylvania doctor stands accused of over-prescribing opioids that authorities say caused two siblings he was treating to overdose, including one who died. Authorities say Henry Dela Torre is charged with violations of the controlled substances act, Medicaid fraud and related offenses. Authorities say the probe into Dela Torre started in August 2016 after a female patient fatally overdosed. Punxsutawney police found multiple bottles of prescription opioids in the woman’s name, which police say were prescribed by Dela Torre. The woman’s brother overdosed the following month on opioids prescribed by Dela Torre, authorities said, but he was revived by emergency responders. ...


Expert: Health industry lags in defending against ID theft

January 15, 2018. Washington, DC-- Pittsburgh Post-Gazette : Here’s what’s worrisome: Medical records offer a mother lode of juicy data for hackers, putting health care systems at the top of the to-do list for cybercriminals. Worse, health systems have lagged in securing medical records from thieves, which means the industry is in need of a serious security reboot, said John Schoew, managing director of health cybersecurity at New York City-based digital consultant Accenture. And a simple click on an email link is often all that’s needed for crooks to get inside a hospital network. “The industry is lagging behind others in investment,” Mr. Schoew said. “Now, they’re playing catch up.” A ...


Former LAPD employee allegedly falsifies comp claim

January 15, 2018. Los Angeles, CA-- CBS Los Angeles : A retired Los Angeles Police Department civilian employee has been arrested on suspicion of workers’ compensation fraud, authorities said Monday. Gerald Pulley, 51, was arrested on suspicion of the felony-level crime on Thursday, police said. He was released the following day on $20,000 bail. No court date was set. Pulley had worked for the LAPD for 18 years, and had been assigned to the Records and Identification Division, police said. “Pulley concealed material documentation and exaggerated the extent of his injuries, while receiving Temporary Total Disability monetary benefits from the LAPD,” according to the department. “Pulley also maintained secondary employment during this time.” The ...


Massachusetts contractor lies he’s employee to get surgery

January 15, 2018. Middleton, MA-- Wicked Local : A Middleton man, who posed as a licensed building contractor and left his victims financially ruined, homeless and questioning their faith in humanity, was sentenced to state prison after pleading guilty to 42 charges including larceny, forgery, insurance fraud, asbestos violations, perjury, and being a common and notorious thief. Judge Thomas Drechsler sentenced Jaime Ford, 49, to a term of 2 to 2 and half years in state prison at a sentencing hearing Jan. 11 in Salem Superior Court. Ford pleaded guilty to 42 of 80 indictments on Nov. 20, one week before he was to stand trial. The remaining indictments ...


This former identity thief now fights the crimes he helped perfect

January 14, 2018. Washington, DC-- NBC News : Few people know more about identity theft than Brett Shannon Johnson, a convicted identity thief who was once on the Secret Service’s Most Wanted list. Johnson made millions developing online fraud techniques and creating two major online crime syndicates, before getting busted (several times) and spending more than six years behind bars. “I didn't care who the victim was,” Johnson said. “I always tried to justify it. I told myself, I'm not ripping off the person, I'm ripping off the store or the government or the bank… and they could afford it.” He went by the nickname Gollumfun and the Secret Service ...


Former Michigan doc a fugitive for more than 5 years

January 13, 2018. Lansing, MI-- Breaking Belize News : Dr. Errol Elrington, brother of Foreign Affairs Minister Wilfred “Sedi” Elrington, remains a fugitive on the run for almost 5 years. He is featured on the top-10 wanted list by the United States Office of the Inspector General (OIG), because of allegations that he was involved in healthcare fraud. According to the OIG, on October 7, 2013, an arrest warrant was issued for his arrest on charges of racketeering, Medicaid fraud, and healthcare fraud. However, less than a day after being interviewed by Federal and State agents, he fled to Belize. The OIG revealed that Elrington was also charged in a separate Michigan case ...


Wisconsin man allegedly lies that phones lost, broken in shipping

January 12, 2018. Madison, WI-- Wisconsin State Journal : A Madison man, charged with defrauding a parcel delivery insurer out of more than $360,000 by filing false insurance claims on phantom packages, was arrested Thursday by federal authorities. Scott Reaston, 40, an Australian who lives in Madison, was indicted last week in U.S. District Court, but the indictment remained under seal until his arrest Thursday morning outside a business in Madison, U.S. Attorney’s Office spokeswoman Myra Longfield said. Reaston appeared briefly in court Thursday, but will be back in court Friday for a hearing to determine whether he’ll remain in custody while his case is pending after prosecutors requested that he ...


Maine woman allegedly has crony burn van for insurance

January 12, 2018. Somerset, ME-- Central Maine : Two people have been indicted by a Somerset County grand jury on felony arson and conspiracy charges in connection with alleged insurance fraud July 24 in Bingham. Anthony E. Salisbury, 24, of School Street, Solon, and Jennifer M. Sandoval, 30, of Pleasant Street, Solon, each are charged by the grand jury with class A arson, class B conspiracy to commit arson and theft by insurance deception, a class C felony, in the alleged arson-for-hire scheme. The class A charges carry a maximum of 30 years in prison upon conviction, while the class B and class C charges are punishable by 10 ...


AG indicts unlicensed plastic surgeon for fraud a second time

January 12, 2018. Westbury, NY-- New York State Attorney General : Attorney General Eric T. Schneiderman today announced the arrest on a 21-count indictment of unlicensed plastic surgeon Brad Jacobs, 56, of Westbury, NY, for engaging in a massive disability insurance fraud and welfare fraud scheme. In November 2017, Jacobs, together with licensed physician Nicholas Sewell, were indicted in New York County on charges that they engaged in a four-year scheme to illegally perform plastic surgeries on over 60 patients, including causing permanent disfigurement to one patient. The Attorney General’s second indictment, filed today in Nassau County, charges Jacobs with concealing his ongoing illegal practice of medicine and his associated income ...


Pittsburgh man admits guilt in health care fraud scheme

January 12, 2018. Pittsburgh, PA-- United States Department of Justice : A resident of Pittsburgh, Pennsylvania pleaded guilty in federal court to one count of conspiracy to distribute oxycodone and oxymorphone, one count of health care fraud, and one count of perjury, United States Attorney Scott W. Brady announced today. Jeremiah Davidson, age 61, of Pittsburgh, Pennsylvania pleaded guilty to a one-count information and two counts of a Superseding Indictment before United States District Judge Mark R. Hornak. In connection with the guilty plea, the court was advised that Davidson obtained opioid prescription pain medication through physicians, often paid by taxpayer funded insurance programs, and sold the medication to a conspirator for later ...


Philly woman pleads guilty to leading prescription fraud ring

January 12, 2018. Philadelphia, PA-- WDEL.com : A 49-year-old Philadelphia woman who led a forged prescriptions ring while working at a Wilmington doctor's office pled guilty to fraud charges, the Delaware Department of Justice announced Friday. According to the DOJ, Annette Bryant, also known as Annette Scott, was employed in 2017 at a Foulk Road doctor's office from which she stole a blank prescription pad and, over the course of two months, conspired with co-defendants to present more than 25 fake prescription submissions to pharmacies around New Castle County. She pled guilty to solicitation of multiple prescription drug crimes, theft of less than $1,500, second-degree forgery, second-degree ...


Former nursing home employee arrested for prescription fraud

January 12, 2018. Lawton, OK-- KSWO.com : A Lawton woman has been issued an arrest and summons after attempting to obtain schedule II drugs with a fraudulent prescription. The suspect, Heather Hale, was stopped by police outside of Anderson’s Pharmacy. The pharmacy was previously notified that Hale had terminated her job at Cedar Crest Nursing Home at the beginning of December and any prescriptions filled after that date were not given to the patients they were intended for. Authorities say Hale showed up at the Pharmacy yesterday claiming to work at the Nursing Home with prescription forms. One of the prescriptions was even for a deceased patient. Upon further investigation, ...


Northwestern DA’s office awarded $25K to crackdown on insurance fraud

January 12, 2018. Northhampton, MA-- WWLP.com : The Northwestern District Attorney’s office was awarded thousands of dollars to crackdown on insurance fraud. The Insurance Fraud Bureau gave the DA’s office a $25,000 grant to support efforts to identify and prosecute schemers who commit auto insurance fraud. Assistant Northwestern DA Steve Gagne said Helen Chen defrauded the state out of more than $100,000. Gagne said Chen fraudulently obtained insurance policies in western Massachusetts for more than 50 people in New York. “They were obtaining insurance policies for vehicles, by claiming they lived in Greenfield, Easthampton or Northampton,” said Gagne. Chen was found guilty, and the IFB of Massachusetts has awarded the DA’s ...


Citizens rewarded with $20K for busting Florida Medicaid scam

January 11, 2018. Tallahassee, FL-- Florida Office of the Attorney General : Attorney General Pam Bondi's Medicaid Fraud Control Unit rewarded two citizens with $20,000 each for reporting Medicaid fraud committed by Tranquility Healthcare Solutions. As a Florida Medicaid provider operating out of the Raleigh, NC, Tranquility targeted homeless adults, offering free hotel rooms and cell phones, in exchange for billing the homeless adults’ Medicaid numbers for psychosocial rehabilitation services. Both citizens provided information vital to the investigation and instrumental in the arrests of numerous Tranquility employees. On May 13, 2014, Tania Medina-Carmenate called the Fraud Hotline and complained that Tranquility billed her for more than $11,000 in services not received. On ...


Michigan woman helps pay kickbacks in $131M opioid con

January 11, 2018. Oakland County, MI-- The United States Department of Justice : A Michigan clinic office manager pleaded guilty today for his role in a health care fraud scheme that involved the unnecessary prescription of controlled substances and that resulted in a $131 million loss to Medicare. Attorney General Jeff Sessions, Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Division, 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 and Special Agent ...


South Carolina woman allegedly steals ID to buy auto coverage

January 11, 2018. Darlington, SC-- WBTW : The Darlington Police Department is asking for help in locating a woman wanted for multiple counts of fraud. Sharina Dersteria Denise Pugh, 31, is wanted for two counts of financial identity fraud. She allegedly used another person’s personal information to obtain car insurance and open an account with an electrical service. If you know the location of Pugh, you are asked to call the Darlington Police Department at 843-398-4026. ...