Insurance Fraud NEWS

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

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Attorney pleads guilty in unlicensed chiro’s $4M crime ring

November 17, 2017. Montclair, NJ-- Tapinto.net : Mark Gertner, of Montclair, has pleaded guilty to third-degree criminal running and is awaiting sentencing in a medical fraud ring that bilked nearly $4 million from insurance carriers, Attorney General Christopher S. Porrino and the Office of the Insurance Fraud Prosecutor announced Wednesday. He was named along with 5 other defendants. A former North Jersey chiropractor, who was stripped of his license to practice more than a decade ago, pleaded guilty in connection with the medical fraud ring. Philip Potacco, 65, of Kinnelon, pleaded guilty to money laundering and official misconduct in the second degree, and to third-degree practicing chiropractic without a ...


Iowan files false death claims for family members

November 16, 2017. Ottumwa, IA-- Ottumwa Courier : An Ottumwa man will spend 18 months in federal prison after his sentencing in an insurance scam. Cletus Ngwa, 34, must also pay $260,043 in restitution. The sentence was pronounced following a plea bargain. Prosecutors accused him and Venancia Rodriguez, 47, Ottumwa, of defrauding two insurance companies. The pair filed fraudulent foreign death claims for members of Rodriguez’s family whom they said died while in the Philippines. Rodriguez was sentenced in May 2016 to 24 months in prison and ordered to pay the same amount as Ngwa in restitution. The indictment against Ngwa dates to November 2016. A grand jury said Ngwa “knowingly ...


Worker claims knee injury, caught playing hockey in New York

November 16, 2017. Oneida County, NY-- Rome Sentinel : An aide for a state youth detention center has pleaded guilty in City Court to insurance fraud for stealing from the state Workers’ Compensation system. Samuel Spina, 45, of Rome, pleaded guilty before Judge Gregory J. Amoroso Nov. 8 to fifth-degree insurance fraud, according to court officials. His case was adjourned for sentencing to Dec. 11. An investigation by the Inspector General’s Office found Spina, a Youth Division aide for the state Office of Children and Family Service’s secure Taberg Residential Center for Girls in Oneida County, reported a debilitating knee injury at work in September 2015, and that the injury prevented ...


Florida child molester sets up senior for fake parking lot collision

November 16, 2017. Miami, FL-- Miami Herald : At 76, Braulio Valenzuela has a long history of evading lengthy stays in prison — despite convictions or charges in a series of serious crimes, from rape and child molestations to burglaries. He was even accused of setting fire to a trailer home because he didn’t like that lesbians lived there. But he’s off to prison for a long time now for — by comparison — a small-time scam. He got nailed faking that he was an accident victim A Miami-Dade judge on Thursday sentenced Valenzuela to 10 years behind bars for filing a bogus insurance claim after he pretended to get ...


New York fraudsters avoid jail for illegal medical transport

November 15, 2017. Binghamton, NY-- Press Connects : A husband and wife from Binghamton who operated a transportation company avoided jail terms after pleading guilty in a Medicaid fraud case tied to their business operations. Kenneth Cohn, 69, was sentenced to five years probation and Sharon Cohn, 65, was sentenced to a one year conditional discharge in Broome County Court. In October 2015, they were charged by the New York State Attorney General's Office with obtaining more than $1 million in Medicaid payments while operating Yellow Medi-Van and Taxi, Inc., without workers' compensation insurance. The Cohns operated the company from June 2012 to January 2014 in violation of Broome ...


Georgia accountant allegedly steals client IDs to buy life policies

November 15, 2017. DeKalb County, GA-- U.S. News : An accountant has been arrested for allegedly falsifying multiple life insurance applications and collecting more than $11,000 in death benefits. Insurance Commissioner Ralph Hudgens says 67-year-old Earle Turner Sr., of McDonough, was arrested Wednesday at his DeKalb County business on 19 counts of insurance fraud, 11 counts of identity fraud and one count of theft by deception. Hudgens says Mutual of Omaha in May notified the Georgia Department of Insurance it found three life insurance policies with Turner named as beneficiary. When the insurer contacted the policyholders, each stated they had not applied for insurance and had not authorized Turner to do ...


Contractor allegedly avoids comp on New York roofing project

November 15, 2017. Seneca County, NY-- Finger Lakes Times : A Seneca County contractor accused of failing to provide required coverage for his employees was arrested on a felony charge Tuesday. Steven Pollot, 37, of Waterloo, was charged with the workers’ compensation crime of failure to secure compensation. The arrest was announced by New York State Inspector General Catherine Leahy Scott. Pollot is the owner of D&S Home Improvements-Property Maintenance. Leahy Scott said Pollot never obtained workers’ comp coverage for his employees, including a 2015 siding and roof repair project at a Cayuga County home when he employed seven people, not including himself. Pollot confirmed he had employees on the project including several he ...


Crony pleads in Louisiana painkiller case, officers threatened

November 15, 2017. Metairie, LA-- The New Orleans Advocate : A second defendant pleaded guilty Wednesday in federal court in a case that focused mainly on his business partner, a Metairie pain doctor who has admitted to threatening to kill law enforcement agents, committing health care fraud and conspiring to illegally distribute pharmaceutical drugs. Stephen Guilbault pleaded guilty Wednesday to plotting to use Dr. Shannon Christopher Ceasar's pre-signed prescription forms to prescribe the drugs oxycodone, hydrocodone and dextroamphetamine to himself, a girlfriend and a relative, according to documents filed in federal court. Those drugs are contained in medications such as Percocet, Vicodin and Adderall. Guilbault also pleaded guilty to conspiring to issue ...


Man back on trial for stealing $860K fire settlement in New York

November 15, 2017. Suffolk County, NY-- 27 East : After several months of freedom and the possibility that he would never see the inside of another courtroom, former Suffolk County lawmaker George Guldi learned on Wednesday that he must return to Suffolk County Criminal Court on January 2, 2018, so he can be tried a second time on felony grand larceny and insurance fraud charges. The decision to re-try the now-disbarred attorney was somewhat unexpected, as Mr. Guldi had already served more than six years of a four-to-12-year sentence at an upstate prison prior to being released on his own recognizance this July when a state appellate court threw out ...


New Yorker allegedly fakes expense vouchers after home fire

November 15, 2017. Washington County, NY-- The Post Star : Two people face a five-count felony indictment in Washington County Court alleging insurance fraud after a 2013 house fire, court records show. Robert P. Smilansky, 60, of Salem, was charged with felony counts of grand larceny, insurance fraud and forgery after an investigation by the state Department of Finance into alleged insurance fraud, according to the Washington County District Attorney’s Office. Another person was also listed as being indicted, but she had not been arrested as of Thursday and her name was not released. Washington County District Attorney Tony Jordan said the allegations related to claims that were filed by Smilansky and the ...


Idaho agent steals client premiums for personal purchases

November 15, 2017. Twin Falls, ID-- Idaho State Journal : A former south-central Idaho insurance agent who used customers' insurance premiums for personal purchases has been sentenced to 30 days in jail and five years of probation. Forty-nine-year-old Mark J. Lee received the sentence on Monday in 4th District Court and must also pay about $1,800 in restitution. He worked in the Twin Falls area. The Idaho Attorney General's Office began prosecuting Lee after an Idaho Department of Insurance investigation found Lee had diverted insurance premiums for his own use. Lee pleaded guilty in September to misappropriation or diversion of fiduciary funds. The Idaho Attorney General's Office says the fraud was discovered when one ...


Testimony conflicts for suspect’s locale in deadly Kentucky fire

November 14, 2017. Richmond, KY-- Oxford Patch : The 50-year-old Kentucky man accused of igniting the fire at his uncle's Hamilton home that killed a firefighter first told a detective he was nowhere near the blaze that fateful night in 2015. Hamilton Detective Paul Webb told jurors that Wiliam "Billy" Tucker told him he was in Richmond, Kentucky when his uncle's Pater Avenue home became engulfed in flames, killing Patrick Wolterman, 28. That testimony flies in the face of where Tucker's lawyer, Tamara Sacks, told jurors her client was in the night of the fire. Sacks said Tucker was in Hamilton that night, but he was at the home a ...


Rural Tennessee doc regains right to treat patients

November 14, 2017. McKenzie, TN-- FOX 17 : A small-town Tennessee doctor fought big government to treat his Medicare/Medicaid patients after clerical errors stopped him from treating elderly patients. Dr. Bryan Merrick is an old-fashioned doctor in every aspect of his practice right down to bedside manner. Long after his boys played football, Dr. Merrick has continued as the volunteer team doctor at home games. He's also treated patients in their house and his own house. He gives out his cellphone number to his patients, and he answers the phone even during Sunday church service. “It's commonplace for him to look at his cellphone and then leave sometimes he comes back, sometimes ...


Alabama pharmacy bribes docs to prescribe compound creams

November 14, 2017. Haleyville, AL-- AL.com : A salesman for an Alabama-based compounding pharmacy has pleaded guilty and agreed to forfeit more than $266,000 in a conspiracy to defraud health insurers and drug administrators out of tens of millions of dollars. Peter Eodice, a 34-year-old from Webster, New York, pleaded guilty to conspiracy to commit health care fraud, wire fraud and mail fraud, aggravated identity theft and various counts of health care fraud, the Department of Justice announced today. Eodice was accused of submitting fraudulent prescription reimbursement claims to Blue Cross Blue Shield of Alabama and forging a prescription. Eodice worked for Northside Pharmacy, an Alabama company doing business ...


Florida tackles sleazy contractor takeovers of damage claims

November 14, 2017. Tallahassee, FL-- OCALA.com : A House committee on Tuesday backed changes to a controversial practice that insurers and business groups blame for “skyrocketing” property-insurance rates in Florida. But critics contend the proposal is aimed at reducing the power of trial attorneys and would tilt settlements toward insurance companies. The House Judiciary Committee approved the proposal (PCB JDC 18-01) to revamp the insurance practice known as “assignment of benefits.” The bill, in part, would seek to curb litigation about claims and impose new reporting requirements. Rep. Jay Trumbull, a Panama City Republican sponsoring the measure for the committee, called the proposal — backed by the state insurance commissioner ...


Idaho agent steals client premiums, policy canceled for nonpay

November 14, 2017. Twin Falls, ID-- KMVT 11 : A Twin Falls insurance agent receives suspended prison sentence after pleading guilty to misappropriation or diversion of fiduciary funds. On Monday, a judge sentenced Mark J. Lee, 49, was sentenced to a minimum of one year and up to four years in prison. The judge suspended the sentenced for 30 days in jail, ordered Lee to pay $1,801 in restitution and gave him five years of felony probation. According to a news release from the Idaho Attorney General Lawrence Wasden, Lee used customer’s insurance premiums for person purchases. The former insurance agent pleaded guilty in September. The plea came after an Idaho Department ...


11th man guilty in New Jersey compound-med scandal

November 13, 2017. Galloway, NJ-- The Inquirer : A Galloway, N.J., man who worked as a pharmaceutical sales representative became the 11th person Monday to plead guilty in federal court to defrauding the New Jersey state health benefits program in a wide-ranging prescription drug scheme that authorities say pulled in hundreds of public employees in Jersey Shore towns, including firefighters, police officers and teachers. Aside from one Atlantic City firefighter, and despite federal subpoenas issued to several Jersey Shore towns and school districts, no other public employees have been charged in the case. On Monday, Andrew Gerstel, 39, pleaded guilty to conspiring to defraud the state health plan out of ...


New York contractor allegedly avoids paying comp premiums

November 13, 2017. Manhattan, NY-- Business Insurance : The owner of a Queens, New York, building contracting company has been arrested on several workers compensation fraud charges stemming from a construction project at New York University buildings in Manhattan and Brooklyn. Gerard Marino, 41, owner of GMCM Contracting Corp. in Astoria, allegedly falsified proof of insurance, left employees without workers compensation coverage, and stole more than $56,000 in insurance premiums that another construction company was ultimately forced to cover during construction at both campuses, New York State Inspector General Catherine Leahy Scott said Friday in a statement. His felony counts include grand larceny, insurance fraud, falsifying business records, and criminal ...


Contractor allegedly wrecks home, bolts job in Pennsylvania

November 13, 2017. Berks County, PA-- WFMZ.com : Two individuals are facing charges after police say they failed to perform repairs to a home they were contracted to make renovations to. The Nieveses hired Brandon Wunder, 32, of Brandon Wunder Remodeling & Repair LLC to complete house repairs to their home in Berks County. The contract was signed Aug. 7 and the work was to begin Aug. 16. In the contract, financial costs were not to exceed around $12,410 for labor nor around $7,050 for materials. Courtney Nieves indicated to police the work was supposed to take four weeks to complete. But after Wunder walked out on the job, ...


Powerful pain creams allegedly killing patients in Texas

November 12, 2017. Houston, TX-- The Dallas Morning News : Desiree Ford rubbed the pain cream on her skin and immediately wanted to wash it off. “Whoa ... time for a shower, this lotion is making me feel weird,” she texted a friend. The 22-year-old Houston woman was later found dead in her bathtub by her mother. The Harris County medical examiner ruled that Ford’s November 2014 death was caused by toxic effects of two drugs in the pain cream she used, which came from a Houston compounding pharmacy called Diamond Pharmacy. The doctor who prescribed it, Michael Kelly, never talked to or examined Ford. But he did take a kickback for writing the ...


Taxpayers own Lamborghini seized in $100M Florida pharma con

November 12, 2017. New Port Richey, FL-- WND.com : U.S. taxpayers now own some serious toys for adults: A ’36 Ford, a ’64 Corvette, an ’08 Lamborghini, one of those drooled-over ’67 Camaros, a 51-foot racing boat and much more – all as a result of a guilty plea to a $100 million pharmacy fraud case, says a report in Joseph Farah’s G2 Bulletin. A few pieces of real state, worth not quite $8 million, also were turned over. According to the U.S. Department of Justice, the president and owner of a Florida pharmacy that was at the center of a massive compounding pharmacy fraud scheme pleaded guilty. Seven others previously ...


Baton Rouge house burnings proving hard to solve

November 12, 2017. Baton Rouge, LA-- The Advocate : David Walker was shot and killed Sept. 9 — and four days later, someone set his house on fire. The arsonist remains at large, officials said this week. Less than a year earlier, the home next door to Walker's was damaged in another arson fire, officials said. Two men were shot and killed while outside working on that house the same day that Walker, 68, was found dead inside his car across town. Authorities said they have not confirmed any connections between those killings and the house fires, though investigations continue into the circumstances surrounding the incidents — all mysteriously ...


Did New York educator illegally register vehicle in Pennsylvania?

November 11, 2017. East Stroudsburg, PA-- New York Post : A controversial principal’s cozy relationship with a city vendor could be saving her thousands on car insurance. Oneatha Swinton, interim acting principal of Port Richmond HS, lives and works on Staten Island, but has registered her Lexus SUV at an East Stroudsburg, PA, address, documents obtained by The Post show. The car bears Pennsylvania license plates. The Pennsylvania address is the home of Tanya John, an educational vendor who has been hired by Swinton, The Post has learned. John, CEO of Feetz LLC, did work for the Secondary School for Law in Brooklyn, where Swinton was principal until last year. After joining Port ...


Missouri doc, fiancee make 228 false claims to steal $1.6M

November 10, 2017. Cape Girardeau, MO-- U.S. States : Jurors have found that a Missouri doctor, his fiancée and their companies conspired to submit 228 false claims to Medicare and Medicaid. The St. Louis Post-Dispatch reports that the jurors also found Thursday that the government programs should be repaid $1.6 million, although the final award will be determined later. The U.S. Attorney's office claimed in a civil whistleblower suit that Dr. Sonjay Fonn, of Cape Girardeau neurosurgeon, performed spinal fusion operations using spinal implants distributed by a company owned by his fiancée, Deborah Seeger. Federal prosecutors say Seeger's company, DS Medical, received inflated commissions when Fonn used certain implants. They say that ...


Trials for arson blast that blew up Indiana subdivision recounted

November 10, 2017. Richmond Hills, IN-- The Indy Channel : At 11:11 p.m. on Nov. 10, 2012, a two-story home on the south side of Indianapolis exploded with the force of as much as 5 tons of TNT. The blast – the product of an insurance fraud scheme – killed two people and injured dozens of others. Thirty-three homes were damaged so severely they were deemed unrecoverable, and had to be torn down to the foundation. Estimates for the total scope of the damage caused by the explosion exceeded $4.5 million. Investigators quickly honed in on the home's owner, Monserrate Shirley, her boyfriend Mark Leonard and his brother, Bob Leonard Jr., ...