News

Louisiana man gets probation for staging auto crashes
July 25, 2014, Lafayette, LA -- One of six defendants who pleaded guilty earlier this year to insurance fraud for helping stage accidents was sentenced to probation by a federal judge Friday. Wardell Lockett will spend the next three years on probation and pay more than $2,000 in fines and restitution, U.S. District Judge Richard Haik ordered. Haik said federal sentencing guidelines, which take into account mitigating and aggravating factors about the crime and the criminal, showed Lockett’s sentencing range should have been six to 12 months. “You really were the least culpable” of the defendants who took part in the fraud, Haik said. Lockett was one of 10 defendants ...

Transportation worker in Vermont charged with false auto claim
July 25, 2014, Barton, VT -- A Vermont Transportation Agency foreman is facing charges he lied to police and his insurance company after reporting damage to his personal truck was a hit-and-run accident, when it was hit by a new employee. Roger Daigle, of North Troy, allegedly told police he lied to protect the worker. The 48-year-old Daigle pleaded not guilty to misdemeanor charges of insurance fraud and providing false information to a police officer after the December 2012 crash in a Barton highway garage. The Caledonian Record reports police received an anonymous letter in April that said the worker had hit Daigle's pickup at the highway garage. The worker ...

Physician in Alaska charged with $300K Medicaid scam
July 25, 2014, Anchorage, AK -- An Anchorage grand jury indicted a physician Thursday on multiple felony charges accusing him of fraudulently billing Medicaid, tampering with physical evidence and misconduct involving a controlled substance. Charging documents accuse Dr. Shubhranjan Ghosh, 39, of billing Medicaid more than $300,000 for services he never provided. During Ghosh’s bail hearing in April, reports of a conversation that the doctor had with an employee wearing a wire revealed that the overpayments from the government program may have exceeded $1 million. The most accurate dollar figure will remain veiled until the state Department of Law releases a completed audit. By Friday, the document had ...

Indiana mom, daughter charged with torching their home
July 25, 2014, Danville, IN -- An Indiana mother and daughter have been charged with arson and fraud after family members told police they intentionally set their house on fire to collect insurance money. Police tell The Indianapolis Star that 53-year-old Deborah Willison and 35-year-old Lanna Brown had previously talked about burning down their Danville home before the fire broke out July 11. Brown's 17-year-old daughter also told police the pair transported valuables to a storage unit weeks before the fire. Police say Willison and Brown initially said they were out of town on the night of the fire. Police say Brown later admitted that she drove her ...

Former Waretown homeowner found guilty of insurance fraud
July 24, 2014, Ocean County, NJ -- A jury in Ocean County has convicted a former Cranford man of submitting fake documentation to try to get paid for the kitchen floor of his summer home in Waretown, authorities said today. Jurors found Edwin Pastrof, 51, guilty on Wednesday of insurance fraud relating to a claim submitted by the company that installed a dishwasher that leaked and damaged his kitchen floor, said Ocean County Prosecutor Joseph Coronato. Coronato said Pastrof in October 2009 bought a new dishwasher that leaked four months later because of an installation problem. The installer’s insurance company, Mercer Insurance Group, sent an adjuster to view the ...

Two insurance agents in Georgia charged with stealing premiums
July 23, 2014, Toombs County, GA -- Insurance Commissioner Ralph Hudgens announced today that warrants have been issued for two Toombs County insurance agents on multiple counts of insurance fraud. Linda Louise Smith, 60, (left) owner of LLS Insurance Agency, 106 Broad Street, Lyons, Ga., and her sub-agent Pamela Marie Blount, 40, of Vidalia, are charged with 56-counts each for felony insurance fraud. “This office will not tolerate any insurance agent stealing from his or her customer, neither will this office tolerate an agent misleading a customer,” Hudgens said. “Such actions constitute a violation of a trust between an agent and policyholder, a violation we take very seriously.” Both ...

Staged and paper automobile crashes said to be rising in Utah
July 23, 2014, Salt Lake, UT -- In a new trend, crooks are trying to rip off insurance companies by targeting motorists and their cars. Planned auto insurance fraud has been huge in large cities for decades, but investigators say it now has established a real presence in Utah. “All types of people commit insurance fraud,” said Armand Glick, head of the Utah Insurance Department's fraud division. Last month, his agency filed charges against 19 people in Utah and Summit counties for staging nearly 80 crashes and filing fraudulent claims. He accused them of “moving these vehicles back and forth amongst the different involved persons, to take turns insuring the vehicles ...

Toronto-Area Rehabilitation Clinic Fined $200,000 for Auto Insurance Offences
July 23, 2014, Toronto, none -- Ontario Rehab Centre, a Toronto-area rehabilitation clinic, has been convicted of auto insurance offences resulting from co-operative investigations involving the Financial Services Commission of Ontario (FSCO), the Insurance Bureau of Canada, multiple insurers, and the Toronto Police Service. Ontario Rehab Centre was charged with two offences under the Insurance Act: Knowingly making false representations to State Farm to obtain payments for services provided to auto insurance claimants; and Charging amounts to State Farm for the payment of services that were not provided. The Ontario Court of Justice found Ontario Rehab Center guilty on both counts and imposed the maximum fine of $100,000 on each ...

Businesswoman in Washington charged with $100K disability fraud
July 22, 2014, Spokane, WA -- A Spokane woman stands accused of raking in more than $100,000 in disability benefits while working with her husband to operate his motel, and their nightclub and apartment building. The Washington Attorney General's Office has charged Mistie S. Crosby, 52, with one count of first-degree, felony theft. Crosby is slated to appear on the charge in Spokane County Superior Court on July 23. The case resulted from a Washington State Department of Labor & Industries (L&I) investigation. Crosby said she hurt her back, neck and shoulder in September 2010 while working at Sunset Junction, a nightclub in Spokane that has since closed. According ...

Farmers subsidiary sues two docs in New Jersey for useless testing
July 22, 2014, Morristown, NJ -- 21st Century Insurance, a group of insurers which are a part of the Farmers Insurance Group of Companies®, has filed a lawsuit in the Superior Court of New Jersey against two medical doctors and their professional organizations alleging that they knowingly submitted false, fraudulent and misleading billing, treatment and testing records to obtain payment for Electromyography/Nerve Conduction Velocity (EMG/NCV) studies that it is alleged were not medically valid for the reasonable and necessary treatment of patients. The complaint also alleges that the EMG/NCV tests were performed inaccurately and interpreted in such a manner as to misrepresent the clinical condition and ...

South Carolina lawyer tied to $28-million bogus health policy scam
July 22, 2014, Richland County, SC -- A Richland County attorney who served on Blythewood Town Council has been linked to an alleged $28 million health care embezzlement scheme that bilked more than 17,000 customers before authorities shut it down. The scheme, in which attorney Kathleen Devereaux Cauthen faces federal felony charges, also involved shell corporations – some set up to allegedly launder money – in various states, including South Carolina, as well as in the Bahamas and possibly Pakistan, according to documents filed in federal court in Nashville, Tenn. Efforts to reach Cauthen, who was suspended from the practice of law by the S.C. Supreme Court late last ...

Woman in New Jersey charged with faking theft of her crashed car
July 22, 2014, Williamstown, NJ -- A Williamstown woman has been indicted for allegedly attempting to steal approximately $18,000 from an insurance company by falsely claiming that her vehicle was stolen, Acting Attorney General John J. Hoffman announced on Tuesday. Taqiyyah Gerald, 24, was actually storing her car at a body shop after she had been involved in an accident. She was indicted on second-degree insurance fraud, third-degree attempted theft by deception and third-degree tampering with witnesses. Between Feb. 4 and June 26, 2013, she allegedly attempted to steal $18,328 by creating the false impression to Progressive Garden State Insurance Company that her 2013 Hyundai Elantra had been stolen. ...

Lab in Virginia settles charges it bribed nurses to get patients
July 22, 2014, Greene County, VA -- A Virginia company has agreed to pay the United States more than $343,000 to settle claims that it ripped off Medicare through genetic tests marketed under false pretenses by one of its contract agents at the Greene County offices of a Green Tree medical practice. The U.S. Attorney's Office said American International Biotechnology, through a contract sales agent named Jason Hoover, violated the False Claims Act by obtaining improper referrals for genetic tests billed to Medicare. The complaint said Mr. Hoover also tried to bribe a nurse to help him recruit patients for the testing. The scheme was initially raised in a ...

Undercover investigation busts auto crash ring in Houston
July 22, 2014, Houston, TX -- An undercover, multi-agency investigation two years in the making has resulted in charges against three individuals tied to an insurance fraud scheme. The case began when agents with the National Insurance Crime Bureau began investigating vehicle accidents whereby the victims were ushered to a Houston chiropractic clinic and then guided to an attorney with ties to the clinic. On July 17, 2012, an individual was involved in an automobile accident in the 22000 block of U.S. 59 in Richmond. A wrecker driver solicited the victim to receive medical services at Integrity Health Clinic, located at 6250 Westpark, Suite 100, Houston, and to ...

Bauer Investigations acquired by Claims Verification, Inc.
July 21, 2014, Fort Lauderdale, FL -- Claims Verification Incorporated (CVI), a leading national supplier of special investigation and surveillance services to the insurance industry, has announced its acquisition of all of the assets of Bauer Investigation of Albuquerque, New Mexico. CVI was founded in 1976 and has operations, including offices and field personnel strategically located throughout the United States. Bauer, a national investigation supplier for more than 20 years, is well known for its strong presence in the western and mid-western United States. In particular, Bauer has long been a source for investigative services in the more rural and remote areas of the country that have ...

Deaf workers accused of 'new whiplash' claims in insurance fraud
July 21, 2014, London, none -- Compensation claims for industrial deafness have risen by two thirds over the past two years, according to insurance and legal experts. Despite the increase, however, only one in 10 cases are being paid out amid claims of widespread fraud. An estimated 80,000 claims were made last year, compared with 55,000 in 2012, according to the Institute of Actuaries. With only 10 per cent successfully receiving payouts, Industrial Deafness cases have been dubbed "the new whiplash" by some insurers. AXA insurance had more claims for industrial deafness than any other type of workplace injury or illness in 2012, at a cost of ...

Agency owner in Florida accused of stealing $1.1 million in premiums
July 21, 2014, Miami, FL -- Carlos Gutierrez, the former president and owner of G.M. Underwriters in Miami, was arrested on grand theft and fraud charges after an investigation revealed he stole nearly $1.1 million in insurance premiums from seven insurance and premium finance companies, according to an announcement by Chief Financial Officer Jeff Atwater. An investigation led by the Department of Financial Services’ Divisions of Insurance Fraud and Agent & Agency Services found that Gutierrez directed his staff to divert insurance premiums between March and August 2012 to pay his own business debts. Gutierrez, his agency and top staff have been permanently banned from the insurance business ...

Home health agency owner in Michigan convicted of massive fraud scheme
July 21, 2014, Livonia, MI -- The owner of a Livonia home health care agency and several pharmacies was convicted of health care fraud charges Friday after a seven-day jury trial, United States Attorney Barbara L. McQuade announced today. McQuade was joined in the announcement by Acting Special Agent in Charge James V. Allen, Drug Enforcement Administration, Special Agent in Charge Paul M. Abbate, Federal Bureau of Investigation, and Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services Office of Inspector General (“HHS-OIG”). Vinod Patel, 41 of Canton, was the 38th defendant convicted out of the 39 defendants charged in a massive health care ...

Chiropractor in Kansas pleads guilty of defraud insurers of $1.3 million
July 21, 2014, Wichita, KS -- A Wichita chiropractor pleaded guilty Monday to defrauding health care insurers of more than $1.3 million. Jeffrey D. Fenn, 33, Wichita, pleaded guilty to one count of health care fraud, two counts of aggravated identity theft and one count of tax evasion. In his plea, he admitted that from March 2011 to October 2013 he executed a health care fraud scheme through his businesses, including Wichita Health and Wellness, Fenn Chiropractic, P.A. and Wichita Pain Associates, P.A. Fenn submitted false claims to Medicare, Blue Cross/Blue Shield of Kansas and Coventry Health Care of Kansas, Inc., and the Federal Employees Health Benefits Program. Sentencing ...

Utah officials warning drivers about windshield schemes
July 21, 2014, Salt Lake, UT -- When faced with the need to replace a windshield, many car owners look for the least expensive option. But in a scam that's hitting Utah, crooks present a nearly irresistible option: replace it for free. “You don’t need to do anything, just give us your personal information, give us your insurance information and your date of birth and those types of things,” said Armand Glick, director of the Utah Insurance Department's fraud division. The division recently investigated six people who were arrested after going door-to-door with offers of windshield replacement. “Initially, those windshields were actually repaired,” he said. “But the sales agent called ...

Ohio logs a dozen convictions against comp fraudsters last month
July 21, 2014, Columbus, OH -- Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced that 12 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in June 2014. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate and prosecute workers’ compensation fraud. “Our investigators received more than 3,400 tips last year and take each one very seriously in order to protect the State Insurance Fund,” Buehrer said. “BWC staff is always on the lookout for the telltale signs of fraud, and welcome tips through our ...

Utica Physician Acquitted Of Health Care Fraud
July 21, 2014, Utica, NY -- A federal jury in Utica has found Dilip D. Kachare, a Utica physician, not guilty of three counts of health care fraud and 16 counts of mail fraud following a four week trial in U.S. District Court. The verdict follows a prior three week trial in October/November 2013, when a mistrial was declared after a jury was unable to reach a decision after three days of deliberation. Kachare, 58, had been indicted in November 2012, by a federal grand jury on three counts of health care fraud and 16 counts of mail fraud. Kachare maintains an outpatient and inpatient practice in internal medicine. ...

Man in New Jersey accused of selling Mercedes he reported stolen
July 21, 2014, Essex County, NJ -- An Essex County man pleaded guilty Monday to trying to obtain about $45,000 from an insurance company by falsely reporting the vehicle had been stolen, the Attorney General's Office said. Jabbar Y. Mercer, 26, of Newark, pleaded guilty to third-degree attempted theft by deception. Sentencing is scheduled for Sept. 15. The Office of the Insurance Fraud Prosecutor is expected to recommend a sentence of five years probation. Acting Insurance Fraud Prosecutor Ronald Chillemi said there is a presumption under New Jersey law against any sentence of incarceration for a person convicted of a third-degree crime who has not previously been convicted of ...

Smart cards are helping states to curb Medicaid fraud
July 21, 2014, Austin, TX -- States are exploring the use of smart cards to verify Medicaid recipients' identities and foil fraud, according to NJ.com opinion piece. Smart cards are plastic, pocket-sized identifications embedded with integrated circuits. The cards also may store biometric data. They can prove an insured customer's presence and thwart illegal lending of membership cards to uninsured people for use at the point of healthcare service delivery. Texas began using smart cards with fingerprints 10 years ago in its Medicaid program. While pilot programs required providers to use biometric scanners to read fingerprints, state officials later dropped this requirement. Similar smart card implementation decisions occurred ...

Drug dealers and addicts flocking to Missouri to stock up on painkillers
July 20, 2014, Sikeston, MO -- On his office phone at L & S Pharmacy, Richard Logan listened as a doctor’s office detailed how a patient had just left with her third prescription for painkillers in only nine days — and was quite possibly getting more, illegally, elsewhere. Mr. Logan, 61, holstered two guns, slipped on a bulletproof vest and jumped into his truck. Because in his small corner of America’s epidemic of prescription drug abuse, Mr. Logan is no ordinary pharmacist. He is also a sheriff’s deputy who, when alerted to someone acquiring fraudulent drug prescriptions, goes out to catch that person himself. “I’m only one guy, ...