News

Clinic head, wife charged with defrauding Tennessee's health program
May 22, 2015, Parsons, TN -- Authorities say the CEO of a Parsons clinic and his wife have been charged with insurance fraud related to a state health care coverage program for children. The Tennessee Bureau of Investigation says James and Kimberly Inman turned themselves in Tuesday after being indicted by a grand jury in Decatur County. They were later released on their recognizance. TBI says Kimberly Inman worked as a nurse practitioner at the Family Clinic, where her husband was CEO. According to the TBI, agents learned the Inmans submitted an application using false income amounts to obtain insurance for their children through the Tennessee CoverKids program, for ...

Drug diversion ring in Florida accused of defrauding Medicare and Medicaid
May 21, 2015, Miami, FL -- The scheme: A ring composed of a doctor, a man whose identity remains hidden and three others paid older folks to order expensive pharmaceutical drugs through Medicare and Medicaid. Then those drugs were repackaged and sold to pharmacies in Florida, Georgia, New York and Puerto Rico. Those pharmacists, police said, had no idea they were often buying stolen and outdated psychopathic and AIDS drugs that could cause harm to their users. “It’s a case that impacts us in the pockets and also puts a lot of our citizens in danger,” said Miami-Dade Deputy Police Director Juan Perez. Tuesday morning, a task force made ...

Man in Washington charged with faking auto break-in
May 21, 2015, Clark County, WA -- Gary Lee Havens, 63, pleaded guilty in Clark County Superior Court on May 14 to felony attempted theft in connection with an auto insurance claim. Havens was sentenced to pay $800 in court costs. Havens was charged with attempted first-degree theft and perjury in September 2014 after an investigation by Insurance Commissioner Mike Kreidler’s Special Investigations Unit (SIU). The investigation revealed that Havens filed a claim with PEMCO Insurance that his vehicle was broken into at the SeaTac Marriott Hotel in March 2011 while he was attending a conference. He claimed 106 items totaling $45,277 were stolen from his vehicle and ...

Hospital administrator in Houston sentenced to 40 years for $116M scam
May 21, 2015, Houston, TX -- The former assistant administrator of Riverside General Hospital was sentenced today to 40 years in prison for his role in a $116 million Medicare fraud scheme. To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division and U.S. Attorney Kenneth Magidson of the Southern District of Texas made the announcement. Mohammad Khan, 65, of Houston, the assistant administrator who oversaw many of the partial hospitalization programs (PHPs) at Riverside General Hospital, pleaded guilty in February 2012 to conspiracy to commit health care fraud, ...

Two Osceola County women arrested for Medicaid fraud
May 21, 2015, Osceola County, FL -- Attorney General Pam Bondi’s Medicaid Fraud Control Unit, the Osceola County Sheriff’s Office and the Osceola County Probation and Parole Services today arrested two Osceola County women for allegedly billing the Medicaid program for more than $94,000 in fraudulent services. According to the investigation, Lynda Gonsalves-Barnes and Jessica Allen, fraudulently billed the Medicaid program for mental health targeted case management services that were never provided. Barnes, owner of Omega Alpha Nu Ministries, allegedly used recipients’ personal identification to fraudulently submit claims without the recipients’ knowledge. Some recipients never even heard of Omega Alpha Nu Ministries prior to the investigation. The investigation ...

Owner Of Parsippany-Based Diagnostic Testing Facility
May 21, 2015, Morris County, NJ -- A Morris County, New Jersey, man was sentenced today to 12 months in prison for his role in a scheme to bill for diagnostic testing services he did not render and to enable a cardiologist to evade the Medicare program’s pre-payment review of his claims, U.S. Attorney Paul J. Fishman announced. Vijay Patel, 57, of Parsippany, New Jersey, previously pleaded guilty before U.S. District Judge Esther Salas to an information charging him with one count of health care fraud. Judge Salas imposed the sentence today in Newark federal court. According to documents filed in this case and statements made in court: From 2009 ...

Pair in Los Angeles accused of filing $1.3M in false cellphone theft claims
May 20, 2015, Los Angeles, CA -- Officials Wednesday announced two cell phone store owners have been charged for their involvement in an insurance fraud scheme that amounted to over $1 million. According to the Los Angeles County District Attorney’s Office, Jason Young Kwon, 31, of Santa Fe Springs, and David Kisuk Chang, 31, of Burbank were each charged with 22 counts of insurance fraud, 18 counts of identity theft, and one count of grand theft. Authorities explained Kwon and Chang were business partners who owned separate cell phone stores. They are accused of billing more than $1.3 million from an insurance company after filing false insurance claims for ...

Insurance agent in Ohio gets 90 days in jail for stealing premiums
May 20, 2015, McConnelsville, OH -- Lieutenant Governor Mary Taylor has announced that former McConnelsville insurance agent James Brent Whitehouse was sentenced in the Morgan County Court of Common Pleas to 90 days in jail with work-release conditions, five years of community control, 200 hours of community service, and ordered to pay $838.09 in restitution to former clients. Whitehouse, 49, had been indicted on March 26, 2014, on six felony charges. The charges included a third-degree felony, a fourth-degree felony and four felonies of the fifth-degree. If he had been convicted, at trial, on all six felony charges, Whitehouse could have been sentenced to a maximum of ...

Mail-order pharmacy to pay $7.9M to feds to settle kickback charges
May 20, 2015, St. Louis, MO -- Medco Health Solutions Inc., a wholly-owned subsidiary of the pharmacy benefit manager Express Scripts Holding Company, of Missouri, has agreed to pay the government $7.9 million to settle allegations that it engaged in a kickback scheme in violation of the False Claims Act, the Justice Department announced today. Medco provides pharmacy benefit management services to clients who receive subsidies under the Medicare Retiree Drug Subsidy program. “We will continue to pursue pharmacy benefit managers that enter into kickback arrangements with pharmaceutical manufacturers,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division. “Hidden financial ...

Public adjuster, 30 others in Florida charged with staging home damage
May 20, 2015, Miami, FL -- A massive insurance fraud sweep has resulted in the arrests of 31 people, most notably a public adjuster already charged in another fraud case, the Miami-Dade State Attorney's Office announced Wednesday. "Operation Flames and Flood Two" looked closely at the kingpin role of public adjuster Jorge Fausto Espinosa, who is already facing charges in a similar fraud case from last year, dubbed "Operation Flames and Flood One," authorities said. "In this fraud, public adjuster Jorge Fausto Espinosa would be hired by policy holders to seriously damage the insured homes for one purpose only: to collect ill-gotten gains from insurance companies," State Attorney ...

Social media posts put brakes on man’s chronic fatigue fraud
May 20, 2015, Cyprus, none -- An insurance cheat who claimed that illness had stopped him working was caught out by his social media posts detailing his hobby of modifying fast cars and driving them on the roads and racetracks of Cyprus. Christopher Parkin, 41, a steelwork draftsman, claimed that he was unable to work between August 2007 and September 2012 because he was suffering from Myalgic Encephalopathy which causes chronic fatigue. He claimed he was living with his parents in Yorkshire, England. But Mr. Parkin’s social media posts revealed that he was able to continue his hobby of modifying and racing Noble Supercars. And many of those social ...

140 charged in Arkansas as part of national prescription drug initiative
May 20, 2015, Little Rock, AR -- Christopher R. Thyer, United States Attorney for the Eastern District of Arkansas, and David Downing, Assistant Special Agent in Charge of the Little Rock District Office of the Drug Enforcement Administration (DEA), were joined today by DEA New Orleans Division Special Agent in Charge Keith Brown in announcing the charging and arrests of multiple individuals in several federal indictments presented as part of a DEA national initiative. In January 2014, as part of the national effort, the DEA New Orleans Field Division—which includes the DEA Little Rock office—launched an aggressive campaign that targeted the largest sources of illegally diverted pharmaceuticals in ...

Ohio man who killed his son for life insurance sentenced to life in prison
May 19, 2015, Lucas County, OH -- For a man who had his son killed, then killed a young man he considered his son, two life sentences without the possibility of parole was the only fitting punishment, a Lucas County judge said Monday. “The facts and circumstances are just bizarre in all forms of the word,” Common Pleas Judge Gary Cook told Michael Taylor, Jr. “The court was given multiple sentencing options to consider, but as indicated, this is the only real sentencing option the court has based on the facts and circumstances.” Taylor, 41, of 263 E. Hudson St. was found guilty Thursday of two counts of aggravated ...

“I do insurance fraud for people” auto arsonist brags on video
May 19, 2015, Las Vegas, NV -- Damien Dean Moses proudly admits on a law enforcement surveillance video: “I do insurance fraud for people.” But court documents show that’s no longer the case after the North Las Vegas man was caught in the act, part of a complex undercover sting that started with a fire. North Las Vegas police responded to a vehicle fire Aug. 9, 2014, at the home of Guerrero Sanchez, the registered owner of the car, according to Michael Kovac, deputy attorney general for Nevada. Kovac says Sanchez claimed it was stolen but when police pressed him, he came clean. “He stated someone at work, ...

Pharmacist in Pennsylvania convicted of selling pain pills over Internet
May 19, 2015, Manhattan, NY -- Preet Bharara, United States Attorney for the Southern District of New York, announced today that LENA LASHER, a licensed pharmacist, was found guilty in federal court of misbranding and fraud offenses arising from an Internet pharmacy scheme. LASHER was convicted on Friday, May 15, in Manhattan federal court after a two-week trial before U.S. District Judge Naomi Reice Buchwald. According to the Indictment, and Superseding Indictment, public filings, and evidence presented at trial: From 2008 through late November 2012, LASHER, along with others, engaged in a scheme to dispense prescription drugs, including addictive pain medications, to customers who ordered them online, without ...

Woman in Louisiana charged with faking theft of diamond ring
May 19, 2015, Shreveport, LA -- Troopers with the Louisiana State Police Insurance Fraud and Auto Theft Unit arrested a Shreveport woman for allegedly filing false public records. On May 6, the department received a complaint filed with the Louisiana Department of Insurance by the United Services Automobile Association (USAA) Special Investigations Unit. The referral alleged that 37-year-old Lawaneka Lee filed a fraudulent insurance claim against her USAA renter's policy following an alleged theft of a diamond anniversary ring from her Shreveport residence in February 2013. Prior to the claim, authorities say Lee made two additional claims involving the same piece of jewelry. USAA reportedly paid Lee about ...

Federal judge tosses suit against NJ fraud bureau and insurers
May 19, 2015, Trenton, NJ -- A federal judge threw out a lawsuit by a doctor against the New Jersey Office of Insurance Prosecution and several insurance companies. The lawsuit alleged the state was “outsourcing” its criminal investigations to insurers. The doctor, Harshad Patel, owns a diagnostic-imaging firm that has been under investigation by insurers. Fraud fighters followed the case closely fearing that a successful lawsuit could have placed funding of state insurance fraud efforts into serious question. New Jersey, like most states, receives funding for its fraud bureau through assessments on insurers. Funding though does not play a role in which cases the state decides to ...

Woman in Florida accused of reinstating policy after auto crash
May 18, 2015, Escambia County, FL -- A Century woman has been charged with allegedly trying to rip off her automobile insurance company. Trisha Michelle Milstead, 43, was charged one felony count of insurance fraud by the Florida Department of Financial Services Insurance Fraud Division. She remains in the Escambia County Jail Monday with bond set at $10,000. According to Assistant State Attorney Greg Marcille, Milstead was involved in a vehicle accident on September 8 of last year, but at that time her vehicle policy had lapsed for non-payment. She allegedly reinstated the policy on September 9, signing a statement that there had been no damage to her ...

Brookfield Physician Sentenced to Prison for Illegally Distributing Prescription Narcotics
May 18, 2015, Brookfield, WI -- United States Attorney James L. Santelle, announced that on May 6, 2015, Jerry Yee (age: 82) a former Brookfield physician was sentenced in federal court to one year and a day in prison for illegally distributing prescription narcotics. Yee who was a doctor of osteopathic medicine, previously pleaded guilty to two counts of illegally attempting to distribute controlled substances by issuing prescriptions for narcotics outside of his professional practice and without a legitimate medical purpose. As a physician, Yee was authorized to issue prescriptions for narcotics but only for legitimate medical purposes. Yee, however, issued prescriptions in the names of ...

Former owner of restaurant in Ohio pleads no contest to arson and fraud
May 18, 2015, Boardman, OH -- One of four suspects in the October 2013 burning of the Spice of India restaurant in Boardman entered a plea Monday. The restaurant’s former owner, Rajendra Ingle, pleaded no contest to one count of arson and one count of insurance fraud. In February 2014, investigators indicted four people including Ingle. At that time, a grand jury charged that Sonia Bhatia, 24, described as Ingle’s niece, hired Christopher Reynolds, 20, and Jessie Winphrie, 22, to burn the restaurant. Mahoning County Assistant Prosecutor Nick Brevetta said Monday that Ingle paid Reynolds and Winphrie $500 each to burn the place down and that Bhatia let them ...

Pair arrested in California for faking pedestrian-car crash
May 18, 2015, Los Angeles, CA -- Tony Bimbo aka Anthony Riste, 45, and Brandy Riste, 22, both of Los Angeles, were arrested on two felony counts of insurance fraud after they allegedly conspired with Bobby Vlado, 40, to defraud Alliance United Insurance Company out of nearly $18,000. Investigators are still searching for Vlado. In October 2013, Bobby Vlado reported to his insurer that he accidentally struck a pedestrian, Brandy Riste, at a busy intersection in Los Angeles because he was distracted while using his mobile phone. Riste visited the emergency room twice following the accident incurring over $11,000 in medical bills. Her father, Tony Bimbo, negotiated a ...

Man in San Diego accused of torching his car for insurance cash
May 18, 2015, San Diego, CA -- Richard Peters, 36, of Lakeside, pleaded guilty to one felony count of insurance fraud. He was arrested last week by the San Diego Urban Auto Insurance Fraud Task Force on suspicion that he set fire to his vehicle in order to defraud Progressive Insurance out of nearly $32,000. In October 2013, just one month after he financed a Ford Fusion for $32,000, Peters reported his car stolen and it was found later that night by the San Diego Police Department burning in San Ysidro near the Mexico border. Peters claimed to have an alibi during the time his car was stolen, telling ...

Roofer in Oklahoma charged with defrauding hail storm victims
May 18, 2015, Muskogee, OK -- Attorney General Scott Pruitt announced Monday charges filed in Muskogee County against an Oklahoma roofing contractor. The Attorney General’s Public Protection Unit received numerous complaints against Justin Ryan Clark regarding his business, Clark Roofing and Contracting. An investigation found that Clark, 30, allegedly embezzled thousands of dollars from innocent Oklahomans in Muskogee and Caddo counties. Between April 2014 and December 2014, Clark told several customers he would complete services including repairing hail damage to roofs and siding as well as replacing roofs. The customers paid Clark a combined $26,867.19 for services that were never provided. In one instance, Clark subcontracted a roofing ...

Physician in Massachusetts charged with drug diversion and Medicaid fraud
May 18, 2015, Boston, MA -- Delivering on her promise to tackle the opioid and heroin epidemic from all angles, Attorney General Maura Healey announced today that a Hyannis physician has been indicted for illegally prescribing opioids and defrauding the state’s Medicaid program (MassHealth). Dr. Mohammad Nassery, 63, a doctor who practiced at Ariana Pediatric Neurology in Hyannis, was indicted Friday by a grand jury in Barnstable Superior Court on charges of Illegal Prescribing (11 counts), Medicaid False Claims (9 counts), and Larceny over $250 (1 count). He will be arraigned at a later date. As a result of these charges, Nassery has entered into an agreement ...

Bogus McDonalds' hot-coffee claim yields probation for woman in California
May 18, 2015, Victorville, CA -- A 38-year-old Victorville woman accused of fraudulently claiming hot McDonald's coffee spilled and burned her hand at a drive-thru has been sentenced to five years probation, court records show. Selena Edwards pleaded no contest last month to two counts of felony insurance fraud in a deal with prosecutors. An additional 12 related charges she had faced were dismissed Friday as part of the plea bargain. Edwards was arrested Jan. 28, 2013, some time after filing an injury claim against McDonald's, which she said was responsible for alleged second-degree burns to her right hand. She claimed that when she was handed a cup of ...