News

Lack of trust between insurers and consumers is fueling fraud, insurer says
May 25, 2016, Britain, none -- Up to one third of Britons have committed insurance fraud, a report commissioned by AXA has found. A lack of trust between consumers and insurers and the view that insurance fraud is a victimless crime are encouraging otherwise honest policyholders to exaggerate claims. According to insurers opportunistic fraud is behind the most losses. The study found that more than two million people had made a fraudulent claim, but added the figures understated the true scale of the problem because most people would not admit to breaking the law. The report said the rise in opportunistic fraud was being fuelled by a lack of trust ...

Medical ID theft ring leader in New York sentenced to prison
May 24, 2016, Montefiore, NY -- The head of an identity theft ring that used information stolen from 12,000 Montefiore Medical Center patients pleaded guilty to the scam Monday. Fernando Salazar, 28, the crew’s ringleader, admitted he stole at least $50,000 worth of items from Barneys using stolen financial information of 250 of the patients he allegedly got from an ex-employee of the hospital, who was also charged. Salazar will get 3½ to seven years behind bars in exchange for his plea to grand larceny and unlawful possession of personal information. He expects to get married at Rikers Island in the near future, his attorney told Justice Laura Ward. The ...

Virginia man convicted of hiring hit men to kill wife for life insurance
May 24, 2016, Norfolk, VA -- A jury found a Norfolk man guilty Monday night of hiring three men to murder his wife. The jury convicted Anthony Johnson on all charges against him, including one count of attempted capital murder for hire, one count of conspiracy to commit capital murder for hire and one count of malicious wounding. Johnson’s trial began on May 18. Prosecutors say Johnson hired three men to kill his wife, Elizabeth Shelton, for insurance money. Shelton was about eight months pregnant at the time. According to court documents, Robert Burnette, Tristan Reeder and Joseph Apodaca met Johnson and his wife in 2014. Burnette, Reeder and ...

Insurance agent in California charged with aiding "crash and buy" scheme
May 24, 2016, Freedom, CA -- Donato Ramirez, 38, of Freedom, was arrested by California Department of Insurance detectives on two felony counts of auto insurance fraud after allegedly submitting fraudulent claims on behalf of his clients, resulting in a potential loss of $17,200. "I have zero tolerance for agents or brokers that violate their fiduciary responsibility," said Insurance Commissioner Dave Jones. "Licensed agents are in a position of trust and should be above reproach." Detectives uncovered evidence that after two clients' auto insurance policies lapsed, Ramirez placed new policies after the clients reported their vehicles were vandalized and requested to file claims. Ramirez allegedly misrepresented to the ...

Six men in Connecticut indicted for staging car crashes
May 24, 2016, New London County, CT -- Six men are charged with allegedly staging car accidents in an effort to defraud car insurance companies. A federal grand jury in New Haven returned an indictment charging six men with fraud and conspiracy offenses, according to Deirdre M. Daly, U.S. Attorney for the District of Connecticut, and Patricia M. Ferrick, Special Agent in Charge of the New Haven Division of the FBI, The nine-count indictment was returned on May 18, 2016, and was unsealed Monday, May 24. Charged in the indictment are: Carlins Calixte, 32, of Norwich Frandy Dugue, 39, also known as “Jimmy,” of Norwich Jacques Fleurijeune, 26, also known as “Magic,” of ...

CMS lambasted for failing to curb Medicaid, Medicare fraud and abuse
May 24, 2016, Washington, DC -- Lawmakers grilled a CMS administrator Tuesday as government watchdog groups released more damning reports on the federal agency's efforts at eliminating waste, fraud and abuse in Medicare and Medicaid. Rep. Chris Collins (R-N.Y.) said the CMS is part of his weekly stump speech and “not in a complimentary way.” He said the agency's performance would not be tolerated in the private sector. “If you worked for me, you'd be fired this afternoon,” he told Dr. Shantanu Agrawal, deputy administrator and director of the CMS' Center for Program Integrity. GUEST COMMENTARY Medicare's 'big data' tools to fight and prevent fraud yield over $1.5 billion in ...

Coldwater chiropractor pleads guilty to health care fraud
May 24, 2016, Coldwater, MI -- A Coldwater chiropractor is scheduled to be sentenced on August 1, 2016 after he entered into a plea agreement with the Branch County Prosecutors Office Monday. Branch County Circuit Court officials say 49-year-old Sebastian Wilson entered a guilty plea to a felony charge of health care fraud. In exchange for the guilty plea, prosecutors have agreed to dismiss 22 other health care fraud charges. Wilson was scheduled to go on trial in Branch County Circuit Court on August 2, 2016. The 23 charges covering three cases were filed after Wilson was convicted by a Branch County Circuit Court jury on eight counts of ...

Salinas doctor pleads not guilty to felonies
May 24, 2016, Salinas, CA -- A Salinas doctor charged with 37 felonies related to health insurance fraud and unlawful prescriptions entered a not guilty plea in court on Tuesday. Dr. Steven Mangar, 46, was arrested and booked into Monterey County Jail last week after the charges were filed. During the arraignment on Tuesday, Deputy Attorney General Larry Mercer of the state Department of Justice also requested to file a motion to prohibit Mangar from practicing medicine while the criminal proceeding is pending. However, the judge handling the complaint on Tuesday was filling in for another judge who has been assigned the case and stated that he was not ...

Attorney General Laxalt announces sentencing of Medicaid provider for fraud
May 24, 2016, Las Vegas, NV -- Today, Nevada Attorney General Adam Paul Laxalt announced that Advanced Counseling Group, LLC, doing business as Advanced Behavioral Care (ABC) and based in Las Vegas, was sentenced for Medicaid fraud. The fraud was committed between April and July 2014. “Medicaid provider businesses need to be held accountable for taking advantage of the Medicaid system,” said Laxalt. “Prosecution of these crimes helps deter fraud and keep these fraudulent businesses from operating in Nevada.” Eighth Judicial District Court Judge Jennifer Togliatti sentenced ABC on a gross misdemeanor charge of intentional failure to maintain adequate records and placed it on probation for three years. As ...

Bristol woman, 2 others charged with health care fraud
May 24, 2016, Bristol, CT -- Deirdre M. Daly, United States Attorney for the District of Connecticut, Phillip Coyne, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General, and Chief State’s Attorney Kevin T. Kane today announced that a federal grand jury in New Haven has returned an indictment charging RONNETTE BROWN, 43, of Bristol, with 23 counts of health care fraud and one count of conspiracy to commit health care fraud. Brown was arrested yesterday. She appeared before U.S. Magistrate Judge Donna F. Martinez in Hartford, entered a plea of not guilty to the charges in the ...

Ambulance company owner and brother arrested in $6 million health care fraud conspiracy
May 24, 2016, Houston, TX -- A 20-count federal indictment has been unsealed following the arrest of the owner of KMD Healthcare Services Inc., and his brother on charges they engaged in a conspiracy involving fraudulent Medicare and Medicaid billing for ambulance services, announced U.S. Attorney Kenneth Magidson. Authorities arrested Melvin Davies, 28, and his brother Kevin Davies, 27, both of Houston today. They are expected to make their initial appearances before U.S. Magistrate Judge Frances H. Stacy tomorrow at 10:00 am. The indictment alleges the defendants billed Medicare and Medicaid for ambulance services that were not medically necessary and not provided, as well as ambulance transport miles ...

2 doctors & healthcare worker charged w/Medicaid fraud
May 24, 2016, Springfield, IL -- Two doctors and one healthcare worker face charges of Medicaid fraud. The Illinois State Police Medicaid Fraud Control Bureau (ISP MFCB) made the arrests after a three-year investigation. Those arrested are Dr. Hector Flores-Arroyo, 56, of Chicago, Dr. Mohan Rao, 82, of Lemont and Susana Araujo, 61, of Cicero. In October, 2013, an anonymous letter was received indicating possible illegal Medicaid billing and someone practicing without a medical license. Investigators say Dr. Flores-Arroyo and Araujo were treating Medicaid recipients at the Blue Island Medical Group and billing Medicaid for services using Dr. Rao's provider number. Officials say Dr. Rao "knowingly conspired." All three were indicted ...

Law office worker in New Jersey says boss is serial over-biller
May 23, 2016, Sussex County, NJ -- A candidate for the Republican nomination for Sussex County freeholder -- who has criticized the legal costs of an investigation into what went wrong with Sussex County's multimillion dollar solar initiative -- is being sued by the former office manager of his law firm for firing her after she questioned him about alleged inflated and fraudulent legal bills to the firm's clients. David Gray, a Byram councilman and an attorney, is accused in the complaint of violating the state's whisteblower law by retaliating against Juliette Bresnahan -- described as a single mother of three children -- and later demanding she sign ...

Doctor in Illinois admits to billing Medicare for treating dead people
May 23, 2016, Belvidere, IL -- A suspended physician pleaded guilty to two counts of healthcare fraud in federal court Friday, in a scheme that involved billing Medicare for services provided to deceased patients, according to the Department of Justice. In the written plea agreement, Charles S. DeHaan, MD, of Belvidere, Ill., admitted he billed Medicare at the highest reimbursement levels for routine, noncomplex visits with patients even though he knew the services didn't qualify for the top reimbursement rate. Dr. DeHaan, who primarily billed Medicare for in-home patient visits, billed Medicare at the highest reimbursement levels for patients who were deceased on the date of the ...

Woman in St. Louis charged with defrauding Medicaid of $350K
May 23, 2016, St. Louis, MO -- Corrine Dale, a Medicaid counselor has been charged with several felonies stemming from Medicaid fraud. One of several red flags that tipped off authorities was Dale’s salary. The average Medicaid counselor makes about $40,000 a year. In 2015, Dale brought in more than $350,000 from Medicaid billings. Dale, 51, is even listed on the Health Grades website as having a specialty in counseling. “Corrine Dale is not a doctor at all despite that she is making herself out to St. Louisans that she is a doctor,” said Chris Koster Missouri Attorney General. In a five page indictment, Dale is accused of billing ...

Eight in Ohio convicted of workers comp fraud last month
May 23, 2016, Columbus, OH -- Eight individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in April 2016. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID). “Investigating and putting an end to fraud helps protect the benefits of injured workers and keep employers’ premiums down,” said BWC Administrator/CEO Sarah Morrison. “That’s why BWC is so proactive in pursuing all employers, medical providers, workers and others who are committing fraud.” Cases that resulted in guilty pleas or convictions during April include: Mitchell Jones of Akron (Summit County) – Ordered to pay $1,824.73 in restitution after ...

Pair in Oklahoma charged with working side jobs while collecting comp $
May 23, 2016, Oklahoma City, OK -- Attorney General Scott Pruitt on Monday announced workers’ compensation fraud charges against William “Billy” Nichols of Oklahoma County and Johnathon H. Glover of Pontotoc County. William “Billy” Nichols, 44, started U.S. Weed Control while he was still employed by another company. Nichols allegedly accessed the other company’s records to generate fraudulent workers’ compensation insurance certificates using the other company’s information. In addition, Nichols allegedly charged and received payment for two weed spraying services that never occurred, one in the amount of $3,000 and the other in the amount of $7350. Nichols is charged with two counts of workers’ compensation fraud ...

Ex-insurance agent in Colorado charged with selling fake policies
May 20, 2016, Grand Junction, CO -- A Grand Junction man who in 2015 surrendered his state insurance selling license for issuing false insurance policies and pocketing the money has been arrested and accused of committing similar crimes — for the second time this year. James Joel Ahlin, 55, might face 40 new charges including 16 new counts of insurance fraud after being arrested Thursday. He is being held at the Mesa County Jail in lieu of a $100,000 cash bond upheld by Mesa County Court Judge Gretchen Larson on Friday. Prosecutors in February charged Ahlin with felony counts of forgery, insurance fraud, criminal impersonation and misdemeanor theft on ...

Insurer claims rep in California gets prison for $275K claims scam
May 20, 2016, Santa Clarita, CA -- Elizabeth Louise Brown, 48, was sentenced to four years in state prison for two counts of insurance fraud, said Ricardo Santiago, a spokesperson for the Los Angeles County District Attorney’s Office. Brown was one of nine people arrested on April 7 in connection with the case, while 10 others were sought by state police. She was charged with multiple felonies, including insurance fraud and conspiracy for allegedly embezzling more than $276,000 from her employer, Explorer Insurance. A team of California Department of Insurance police officers raided a residence on the 26800 block of Madigan Drive in Santa Clarita in the early morning ...

Florida man charged with arson, fraud after torching his car
May 20, 2016, Marianna, FL -- The Marianna Police Department, in cooperation with the Florida State Fire Marshall’s Office, would like to announce the arrest of Jerry Lee Upshaw Jr. in reference to a vehicle arson that occurred on May 15, 2016 at H & H Towing on Jackson Street in Marianna. During the joint investigation it was determined that Mr. Upshaw Jr. paid a subject to assist him in burning a 2015 Toyota Avalon that owned by Upshaw and had been towed and was stored on the H & H towing Lot. Investigators determined that Upshaw paid a subject $200.00 to burn his vehicle and that ...

Chiro in New Jersey pleads guilty to taking $250k in kickbacks
May 20, 2016, Morris County, NJ -- Acting Attorney General Robert Lougy announced that a chiropractor from Morris County pleaded guilty today to taking more than $250,000 in illegal kickbacks from doctors and other individuals in return for referring patients to their practices, clinics and medical imaging centers. The guilty plea is the second to be taken by the Attorney General’s Commercial Bribery Task Force, which was formed in January to target commercial bribery in the healthcare industry. The task force includes deputy attorneys general and investigators from the Division of Criminal Justice Financial & Computer Crimes Bureau and the Office of the Insurance Fraud Prosecutor. Dr. Alexander ...

Contractor in Florida accused of $700k workers comp premium scam
May 20, 2016, Naples, FL -- Florida Chief Financial Officer Jeff Atwater today announced the recent arrest of Raimundo Hernandez-Argueta, owner of Naples construction company Complete Framing Professionals (CFP). Following a joint investigation by the Department of Financial Services’ (DFS) Division of Insurance Fraud and Division of Workers’ Compensation, Hernandez was arrested on fraud charges for allegedly misrepresenting information regarding CFP’s employee operations and payroll when applying for a workers’ compensation policy. By doing so, Hernandez avoided at least $700,000 in workers’ compensation premium payments. Workers’ compensation policies protect employees in the event of an on-the-job injury and if proper policies are not in place, injured ...

Gunman in Louisiana convicted of killing Medicaid fraud informant
May 20, 2016, Gentilly , LA -- A federal judge unsealed an indictment Friday naming Stanton “Nan Nan” Guillory in the alleged contract killing of a 60-year-old Gentilly man who had just agreed to plead guilty and cooperate in prosecuting a Medicare fraud scheme when he was gunned down in his car four years ago. Guillory, 22, is better known as the alleged driver in a notorious Central City shooting that left 5-year-old Briana Allen and 33-year-old Shawanna Pierce dead. Three members or associates of the St. Thomas-area “110’ers” gang were convicted early last year and sentenced to life prison terms in the May 29, 2012, shooting melee. Guillory ...

Federal bill would exclude more suspect providers from Medicare
May 19, 2016, Washington, DC -- Individuals affiliated with fraudulent healthcare companies would face tougher government scrutiny under a bill introduced in the House on Tuesday. The “Fighting Medicare Fraud Act of 2016,” introduced by Reps. Lois Frankel (D-FL) and William Keating (D-MA), would give the Department of Health and Human Services greater ability to exclude individuals linked to companies penalized for fraud from participating in federal healthcare programs. That increased ability would close a “loophole” that allows employees to resign before a company receives a penalty and “potentially launch a new Medicare fraud scheme,” the bill's authors said. Current laws only exclude individuals who are still employed ...

Ex-cop in New York convicted in $200k 9/11 disability scam
May 19, 2016, Manhattan, NY -- A retired NYPD officer has been convicted of filing false Social Security Disability Insurance applications and reaping over $200,000 in benefits by falsely claiming to be suffering from mental illness, the Manhattan District Attorney announced yesterday. Kevin Hurley, 56, was among more than 100 people who have been indicted for and pleaded guilty to stealing hundreds of millions of dollars from the federal government by claiming false psychiatric disabilities. Many were former police officers and firefighters, and claimed that their disabilities were the result of the September 11, 2001 attacks. According to the indictment filed by DA Cyrus Vance in 2014, ...