Fraud of the Month archives


May 2019: Bribes grease large-living exec’s $1.3-billion Medicare gouging

Bills forged for skilled nursing, assisted living that patients didn’t even need

Tanned, obsessive and Ferrari-driving, Phil Esformes was a peak achiever as an insurance thief in South Florida. No small feat in a region that’s one of America’s largest hubs of large-dollar insurance scamming.

Running his healthcare empire with an iron fist, the wealthy Miami executive launched a $1.3-billion rifling of taxpayer-funded Medicare and Medicaid. It was one of the largest health-insurance crimes in U.S. history — all at taxpayer expense.

Esformes ran dozens of corrupt skilled-nursing and ...



April 2019: Taxpayer money frittered away by phony disability claims

Compound meds, fake injuries drain insurance plans funded by honest taxpayers

Honest taxpayers hand over good money to support government employee health and disability plans. Yet millions of tax dollars at a time are squandered when cheaters soak the plans by claiming fake illnesses and crippling medical conditions.

New Jersey’s state health plan is the latest victim. Nearly 2 dozen people were convicted in a plot that stole $50 million from the state health system and private insurers.

Gooey and expensive compound creams were charged to health plans in the names of employees ...



March 2019: Mansion burns, socialite steals $20 million in bogus flame claims

Hides jewelry, inflates drapery and mural invoices, threatens adjuster

Socialite and political fundraiser Claire Risoldi lived larger than life — and her bank account.

Small wonder the family matriarch also stole large. Risoldi lifted $20 million of false insurance claims after fire chewed through her family’s 5,600-foot mansion in the Philadelphia suburbs. She loaded up a pasha’s ransom of dodgy claims for jewelry, a large ceiling mural, draperies and other bling.

Risoldi’s high-flying social empire finally crash-landed. Investigators found a long trail of bloated claims that convinced a jury she needs ...



February 2019: Educator scams health policy to help sick student

Good choice, bad choice? Community role model triggers debate over ethics of insurance fraud

An educator thought she did an act of kindness for a sick student by scamming a health policy out of $233 to get the kid urgently needed antibiotics.

Casey Smitherman’s choice ignited vigorous debate in her community, school system and prosecutor’s office — making national headlines. She was a public figure and role model who openly admitted she committed insurance fraud — a felony. Yet she had seemingly good intentions, and made no personal profit.

So what to ...



January 2019: Politicos sell out trust, integrity for insurance money

imageInsurance scams, bribery and graft mark downfall of politicos embroiled in fraud schemes Tony Matula wants his job back. He was a councilman for the city of Lebanon, Pa. Then panic and greed derailed his career when he made a false damage claim after crashing his car into a utility pole. Matula say he’ll run for re-election to the council in 2020. He resigned when prosecutors leveled the fraud charges in 2016. Elected or appointed, our political leaders take office to solve civic problems and build prosperity. Yet some politicians like Matula badly stub their toes while in office. ...



December 2018: Sick health plan sticks desperate victims with large medical bills

imagePromises full benefits, bilks 17,000 consumers with fake health coverage Oklahoma real-estate agent Bob Harper was desperate. His heart was failing. He was just days from having his heart pacemaker implanted, only to discover his health policy was worthless. A Houston man had emergency back surgery, and his health plan refused to pay his $105,000 bill. They were among more than 17,000 luckless Americans who Bart Posey duped into buying fake health coverage in a $22-million theft binge. The Springfield, Tenn. man’s heart-breaking scam is a consumer warning to avoid discount health deals that seem too perfect to be real. Posey ran ...



November 2018: Disabled Kentuckians destitute when $550-million disability con busted

imageLawyer bribes judge, docs to game federal disability and steal large payouts Impoverished Kentucky coal miners scraped by with crippling injuries and pain, scratching out a sparse living in a declining industry with jobs disappearing. Along came flamboyant lawyer Eric Conn. He launched an ad blitz that promised folks he’d get them federal disability money to ease their difficult lives. The glitzy ads set up a $550-million disability insurance flimflam. It was the largest such ripoffs in U.S. history. In the process, Conn drove many clients into deeper despair when their disability money was denied after he was arrested. Some even ...



October 2018: Two firefighters die as burning nail salon collapses

Owner made living torching salons for insurance, handed 74 years in prisonimage

What desperate emotions flashed through firefighters Larry Leggio and John Mesh as the burning nail salon’s brick wall crashed down on them? Did they even have time for such emotions?

Flames shot through a nail salon that Thu Hong Nguyen set to steal a $40,000 insurance payout. The Kansas City, Mo. woman poured gallons of acetone and isopropyl alcohol into the stock room of her LN Nails and Spa. She lit the fire just before leaving work at 7 p.m. Nguyen was the last one out.

The fire ...



September 2018: Home arsons are fiery family affairs in West Virginia

imageLester family buys three homes for cheap, torches for inflated claims The Lesters were a well-known family in parts of Southern West Virginia. Especially, patriarch Windel Lester sat on the board of a local bank. He also owned a hardware store and sold mobile homes. Windel thought big, as community pillars should. Except he slid off the railroad tracks of respectability, deciding that burning homes for insurance money would be his next business venture. The whole clan joined in, burning down three homes and trying to walk away with more than $556,000 of insurance money. Windel had it all figured ...



August 2018: Sprinklers splash doomed pizzeria insurance arson

Owner muffs blaze ineptly planned to look like a grease fire

If Mustafa Zabana cooked pizza with the skill he used to fry his pizza shop, he should be selling furniture or shoes instead.

The Iraqi national owned Bruno’s Pizza in a strip mall in Enfield, Conn. Zabana was ambitious. He wanted to build a bigger and better pizza emporium. Insurance money was his meal ticket, literally.

So Zabana decided to torch the place and use the insurance money to build a fancier eatery. Except Zabana had little idea how to burn ...



July 2018: Flames, floods engulf Florida homes in adjuster's $14M plot

Give corrupt public adjuster Jorge Fausto Espinosa credit for one thing — maybe he wasn’t honest, though he was certainly prolific with wrecking homes. The South Florida man recruited dozens of homeowners to burn or flood their places for about $14 million of inflated insurance claims in one of the most legendary plots by an adjuster in a state known for brazen insurance scams. Espinosa may go down as arguably the Dangerous Don of shady adjusters in Florida annals. Espinosa was an independent (or “public”) adjuster. He made his living by earning a percent of insurance payouts he ...



June 2018: Parachutist survives 4,000-foot drop, husband disables chutes

Deeply in debt, UK husband tries to kill wife for life insurance, run away with mistress

skydiver_life_fraudWhat fearful emotions raced through parachutist Victoria Cilliers as she tumbled 4,000 feet toward almost certain death? The UK woman was an experienced parachute instructor and army physiotherapist with 2,600 jumps to her credit. Yet the impossible had happened. Both her main chute and backup had failed on a routine jump at the Netheravon Airfield, home of the Army Parachute Association.  Time for final prayers, really. Yet the impossible happened, again. Victoria slammed into a newly plowed field. The churned soil cushioned her body like ...