News

Pharmacy owner in Maryland convicted of false billing
December 16, 2014, Baltimore, MD -- The owner of a pharmacy chain has been convicted of defrauding Medicaid and Medicare by submitting false claims for prescription refills. A federal jury in Baltimore on Monday convicted 46-year-old Reddy Vijay Annappareddy of Fallston of defrauding the programs of $1.5 million. According to evidence presented at trial, Annappareddy owns Pharmacare and Caremerica. Prosecutors say he and others identified customers at two Bel Air pharmacies who had prescription refills available. Authorities say the three would file claims for reimbursement, and restock medications that were not delivered or picked up. ...

Dentist, daughter in Tennessee charged with illegally prescribing painkillers
December 16, 2014, Hawkins County, TN -- Special agents in the Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit have obtained indictments for a Rogersville dentist and his daughter accused of committing TennCare fraud. After receiving information from the Rogersville Police Department, TBI agents began investigating Ronald James on Feb. 5. During the course of the investigation, agents developed information that in November and December 2013, James prescribed Hydrocodone for a TennCare recipient who was not his patient. Agents further learned the medications were intended for James’ daughter, Hayley Simpson, who posed as the TennCare recipient at two Hawkins County pharmacies to collect the fraudulent prescriptions. On Dec. 8, ...

Pennsylvania hospital using finger scans to prevent medical ID theft
December 16, 2014, Honesdale, PA -- Wayne Memorial Hospital is offering secure “finger scanning” to all patients at its registration points to prevent medical identity fraud, eliminate duplicate records and improve patient outcomes. Using biometric technology called SafeChx, a patient’s right index finger is scanned and given a unique code that links directly to the patient’s medical records. SafeChx is a system manufactured by CrossChx, a national company focused on verifying medical identity to help connect patients to their appropriate medical records and benefits. “We are proud to be offering this latest technology to reduce the risk of medical errors,” said David Hoff, Wayne Memorial’s CEO. “The system ...

Nevada AG warns drivers to watch out for staged crashers
December 16, 2014, Las Vegas, NV -- Nevada Attorney General Catherine Cortez Masto warns consumers to be aware of staged automobile accidents, which are intentionally created in order to defraud automobile insurance companies. According to the National Insurance Crime Bureau (NICB), the number of referrals for intentionally caused or staged accidents in Nevada increased by 21 percent from 2012 to 2013. “As consumers take the road for holiday travel, it is important to practice defensive driving and to educate themselves about staged accidents,” said Masto. “Drivers may already be distracted with inclement weather, busy streets, and holiday stress but it is equally important to be aware ...

Farmers Insurance files fraud suit against DME company in California
December 16, 2014, Washington, DC -- Farmers Insurance Exchange, Fire Insurance Exchange, Truck Insurance Exchange, Civic Property & Casualty Company, Mid-Century Insurance Company, and Neighborhood Spirit Property & Casualty Company (collectively referred to as "Farmers") have filed a lawsuit in Orange County Superior Court against two durable medical equipment companies, their owners and others, alleging they submitted false and fraudulent insurance claims for medical devices to Farmers. The detailed civil complaint seeks statutory penalties and assessments of more than $5 million against the various defendants for filing false workers' compensation claims, under the California Insurance Frauds Prevention Act (Insurance Code 1871.7), and an order directing Defendants ...

Nine charged with workers comp fraud last month in Ohio
December 15, 2014, Franklin County, OH -- Ohio Bureau of Workers' Compensation Administrator/CEO Steve Buehrer announced Monday that nine individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio's workers' compensation system in November 2014. These court actions are the result of investigations conducted by BWC's Special Investigations Department. “Investigating fraud is a vital part of the workers' compensation business,” Buehrer said. “Identifying fraud puts dollars back into the State Insurance Fund and supports our efforts to keep premiums as low as possible.” The following is a sampling of cases that resulted in guilty pleas or convictions during November: Leslie Hammond (Newark, Licking County) was sentenced Nov. ...

Roofing fraud defendant in Florida looking for a new line of work
December 15, 2014, Pinellas County, FL -- The Statewide Prosecutor said Monday that entrepreneur Carlton Dunko, who made a fortune in the roofing business, now wants to get into a new game to make ends meet. She told a judge Dunko wants to get into business selling the "Cornhole" game. "Selling what," asked Judge R. Timothy Peters. "He and his wife wish to go to trade shows in order to sell that game," said Statewide Prosecutor Diane Croff. "My client has some employment opportunities that would require travel throughout the State of Florida," said Dunko's attorney Steve Crawford. Crawford insisted that Dunko needs permission to travel so he can make a living ...

NAIC names fraud coalition to consumer advisory panel
December 15, 2014, Washington, DC -- The National Association of Insurance Commissioners (NAIC) recently named 30 consumer liaison representatives for 2015. The 20 funded and 10 unfunded consumer representatives begin their terms Jan. 1, 2015. Eighteen of the funded consumer representatives participated in the program in 2014. Established in 1992, the program promotes consumer interaction with the NAIC's members, the insurance industry and interested parties through the individuals' dedication and commitment to serving the public interest. “Our consumer liaison representatives play an integral part in helping the NAIC and regulators protect U.S. insurance consumers,” said Monica J. Lindeen, NAIC President-Elect and Montana Commissioner of Securities and Insurance. “This ...

Contractor in New York charged with workers comp premium fraud
December 12, 2014, Mount Vernon, NY -- Derrick Williams, 50, of Mount Vernon was charged with first-degree offering a false instrument for filing, a Class E felony, on Wednesday according to state police. The arrest stems from a complaint received from the New York State Workers' Compensation Board Fraud Inspector’s Office, which indicated Williams unlawfully presented fraudulent insurance documentation, according to state police. Williams, a sub-contractor, presented altered documentation fraudulently indicating he had valid workers’ compensation insurance when in fact there was no insurance coverage, according to police. Williams was issued an appearance ticket ordering him to appear Monday in the City of Mount Vernon Court. ...

Dentist in Indiana charged with $260,000 in false Medicaid billings
December 12, 2014, Indianapolis, IN -- An Indianapolis dentist has been charged with falsely filing nearly $262,000 in claims from the Indiana Medicaid program for treatments that were never performed. Marion County Prosecutor Terry Curry said Dr. Bernice Avant was charged Thursday with one count of Medicaid fraud and four counts of theft. Avant could not be reached for comment Thursday by The Associated Press because no one answered the phone at Avant's Oakbrook Dental Center and no message could be left because the message box was full. According to a probable cause affidavit, from 2010 to 2013 Avant submitted falsified Medicaid forms to the Indiana Medicaid Program and ...

Town worker in Connecticut charged with faking comp injury
December 12, 2014, Weston, CT -- A Weston town employee was arrested today and charged with Workers’ Compensation fraud after he was observed coaching youth hockey while collecting benefits for an injury that supposedly rendered him unable to work. MICHAEL J. SCHNEIDER, age 32, of 119 Milwaukee Avenue, Bethel, was charged with one count of Fraudulent Claim or Receipt of Workers’ Compensation Benefits, a felony carrying a maximum of 20 years incarceration if convicted. According to the arrest warrant affidavit, Schneider reported suffering a work-related injury in September 2013 while employed as a grounds worker for the Weston Board of Education. Schneider was placed on temporary total disability ...

Report: Disability programs highly susceptible to physician-assisted fraud
December 12, 2014, Washington, DC -- Today, Senate Finance Committee Ranking Member Orrin Hatch (R-Utah) and House Ways and Means Subcommittee on Social Security Chairman Sam Johnson (R-Texas) highlighted a new Government Accountability Office (GAO) report detailing how the Social Security Administration's (SSA) $200 billion disability benefits programs are at risk for physician-assisted fraud. The GAO found that SSA's current anti-fraud efforts are hindered by inadequate employee training and disincentives for employees to report fraudulent activity. In addition, the GAO found that SSA's new initiatives to combat physician-assisted fraud are fraught with inadequate planning, data and coordination, thereby placing the nearly bankrupt Disability Insurance (DI) Trust Fund ...

Two convicted in torching Ohio restaurant for insurance money
December 12, 2014, Youngstown, OH -- Two more people have been convicted of charges filed in connection with an arson at a Boardman Township restaurant. Investigators the Spice of India restaurant on Market Street was set on fire in October of last year. The damage was so extensive that the remnants of the building were demolished. Prosecutors told 21 News that 23-year-old Jessie Winphrie, and 21-year-old Christopher Reynolds, both from Youngstown, were paid to torch the business. Winphrie pleaded guilty to arson in October. Now Reynolds has also pleaded guilty to arson, and 24-year-old Sonia Bhatia of Boardman pleaded guilty to arson and insurance fraud. Sentencing has not been scheduled ...

FBI says doctor in Buffalo, NY billed for when he was abroad
December 12, 2014, Buffalo, NY -- A Buffalo doctor is facing a large fine, long time in prison or both after he was charged with health care fraud. Sreekrishna M. Cheruvu, M.D., is a 58-year-old doctor in East Amherst N.Y. who is facing charges after a federal grand jury decided he should be charged with health care fraud and submitting false statements relating to health care matters. Cheruvu is facing up to 10 years in prison and a $250,000 fine for his alleged crimes which deceitfully elicited payments from three insurance companies with false payments. Those payments totaled $800,000. An investigation revealed the doctor — who treated patients for ...

Former 'Bridezilla' in California charged with defrauding workers comp
December 10, 2014, Los Angeles, CA -- A woman featured on the hit TV show "Bridezillas" was ushered into a Los Angeles courtroom Tuesday on charges she engaged in insurance fraud. Anita Maxwell, 55, surrendered herself on 14 felony counts associated with the alleged scheme, the California Department of Insurance said Wednesday. Officials claim Maxwell, who appeared in season four of the WE reality series, submitted fraudulent documents and made false claims to receive more than $40,000 in undeserved workers' compensation benefits. "Taking advantage of the workers' compensation system is not only illegal, but costly to all Californians who pay for this fraud through higher premiums," Commissioner Dave Jones said ...

Woman in Connecticut arrested for helping friend get rid of her car
December 10, 2014, Bridgeport, CT -- A Bridgeport woman was charged on a warrant Wednesday for conspiring with a local friend to defraud an insurance company. Jenny Valentin, 35, of Connecticut Avenue, was charged with conspiracy to commit insurance fraud. She was released on a promise to appear Dec. 22 at state Superior Court in Bridgeport. Valentin's arrest stems from a February incident when a Nordstrand Avenue woman reported that her 2009 Jeep Patriot was stolen from her driveway. The Fairfield resident said she went out around 3:30 a.m. to start the vehicle, and left it running. She came back about 30 minutes later and the Jeep was ...

Nursing assistant in Miami sentenced to 12 years for aiding Medicare scam
December 10, 2014, Miami, FL -- A Miami certified nursing assistant was sentenced to more than 12 years in prison Monday for his role in the nation’s biggest-ever Medicare scam, according to the U.S. Department of Justice. In exchange for kickbacks, Rodolfo Santaya, 55, recruited Medicare patients who suffered from Alzheimer’s, dementia and other maladies for treatment at a mental health clinic in Homestead, prosecutors said. The clinic overbilled Medicare while failing to provide basic care to its elderly patients, according to the government’s case. “They were using trashcans as restrooms,” federal prosecutor Nicholas Surmacz told the jury at Santaya’s trial. Santaya, who maintained his innocence, was convicted along ...

Woman in Maryland accused of killing cousin for $100K in life insurance
December 10, 2014, Silver Spring, MD -- As a manager at a Maryland Applebee’s restaurant, Claire Rice built a comfortable home for herself and her longtime partner in their three-bedroom home on a tree-lined street called Classical Lane in Silver Spring. The home was adorned with fine art and the couple took long vacations to destinations such as India. But Rice’s comfortable life was spiraling into a financial tailspin as she fell some $14,000 behind in her mortgage payments and was about to lose her home, local prosecutors told a D.C. Superior Court jury Wednesday. Rice, prosecutors say, was growing increasingly desperate and decided killing was the way out. Prosecutors ...

Brits launch new system to better detect auto point-of-sale fraud
December 09, 2014, Dundee, none -- A new system to prevent motor insurance fraud has been launched. Called MyLicence, the system involves a partnership between the Motor Insurers' Bureau (MIB) and the Driver and Vehicle Licensing Agency (DVLA). The two groups will supply a data-sharing service to the motor insurance industry with insurers able to use accurate information about drivers' records to assess risk and prevent fraud at the point of quote or renewal. It was developed in partnership with the Association of British Insurers (ABI) in response to the Government's Insurance Industry Access to Driver Data programme and the DVLA's ongoing aims to digitalise the data it holds. DVLA ...

Los Angeles doctor get two years for accepting illegal kickbacks
December 09, 2014, Los Angeles, CA -- A Los Angeles-area physician whose referrals led to more than $1.7 million in fraudulent Medicare billings was sentenced this afternoon to 24 months in federal prison for his role in a conspiracy to defraud Medicare related to medically unnecessary power wheelchairs and other durable medical equipment. Charles Okoye, a 52-year-old Carson resident who formerly operated a medical clinic in South Los Angeles, was sentenced by United States District Court Judge Michael W. Fitzgerald, who also ordered the defendant to pay $931,118 in restitution. Okoye pleaded guilty in August and admitted that he referred Medicare beneficiaries to a Gardena durable medical equipment ...

Former owner of California hospital sued over workers comp scam
December 09, 2014, Long Beach, CA -- A law firm has filed two lawsuits against the former owner of Pacific Hospital of Long Beach, who was implicated in a multi-million dollar workers' compensation scam affecting some 300 people. AgnewBrusavich, based in Torrance, filed two suits on behalf of former patients Abraham Pena and Frank Gomez, against former hospital owner Michael Drobot Sr., his son Michael Drobot Jr., Dr. Simon Lavi and Dr. Edward Kolpin. The civil lawsuits allege Drobot worked a scheme to steer workers' compensation patients to Pacific Hospital for spinal fusion surgeries performed using defective screws and other surgical hardware. In total, nearly 300 patients were involved ...

Charges dropped against Miss. cop because fraud statute too narrow
December 09, 2014, Madison County, MI -- The charges against a Madison County sheriff’s deputy who was accused of fraud were dropped last week; however, Saundra Bundy could be indicted on different charges later, according to court documents obtained by her attorney Michael Weinman. Bundy, 47, was charged with insurance fraud and theft of property in July. She pleaded not guilty on July 7. The charges were dismissed Dec. 2. Bundy reported she was injured while working at the sheriff’s office on May 9. After an investigation conducted by the sheriff’s office, Bundy was accused of workers’ compensation fraud because investigators believe her injuries did not occur while she ...

Insurance fraud said to be 'rampant' in Utah
December 09, 2014, Salt Lake, UT -- Insurance fraud is not just faking an injury to get extra money. Insurance fraud includes agents who sell bogus policies to consumers, or agents who create fake policies and submit them to insurance companies. It includes doctors who bill insurance companies for procedures they never did, and patients who fake illnesses to receive prescriptions. Insurance fraud is also when a person who no longer can pay for a car claims it is stolen, or a group of people working together faking accidents in order to get money. And insurance fraud of all types have been on the increase for the past several ...

Man in New York charged with torching his car for insurance money
December 09, 2014, Westchester, NY -- Yonkers resident Raymond Sosa, 28, is alleged to have purposely set his car on fire to collect insurance money, according to state police from North Salem who arrested him Monday. The incident occurred in late October of this year. Following a “lengthy investigation,” police said they discovered that Sosa totaled the 2008 Toyota Camry by setting it on fire using gasoline he poured over the interior. He then reported car stolen and filed a claim with his insurance company. Details of how police came to charge Sosa were not disclosed. He faces felony charges of third degree arson and third degree insurance ...

Insurance agent in California accused of stealing $1M in life premiums
December 09, 2014, Orange County, CA -- Orange County insurance agent Mario Ferreri, 60, was arrested on Tuesday for defrauding clients of his financial services company, Financial Management Resources, out of more than $1 million in life insurance premium payments. According to a release from Florida Chief Financial Officer Jeff Atwater, an investigation conducted by the Department of Financial Services' Division of Insurance Fraud discovered that between July 2009 and March 2014 Ferreri stole more than $750,000 from one client's life insurance premium payments and an additional $427,000 from another client. Ferreri then persuaded both clients to write their insurance premium checks payable to his company instead of ...