News

PI firm in Philly focuses on social media to catch cheaters
September 27, 2016, Philadelphia, PA -- Spying is pretty creepy. But cheating spouses and people who file false insurance claims have made poking around others' business a necessary profession for a long time. Which brings us to Scott Catron, a private investigator for more than 20 years. His work has exposed him to dogs and wild animals during camouflage surveillance on public land. He has endured eight hours on a deep-sea fishing excursion to catch an insurance claimant evidently fit enough to work on the boat. Then there were the six days he hid in a hatchback, waiting to capture visual evidence that a supposedly wheelchair-bound person could walk. But ...

Florida court limits life insurers' actions on underwriting fraud
September 26, 2016, Tallahassee, FL -- On September 22, 2016, the Florida Supreme Court issued an eagerly-awaited opinion in Wells Fargo Bank, N.A. v. Pruco Life Insurance Co. The Court held that Florida's two-year contestability statute applies to bar an insurer's challenge to a life insurance policy on the basis that it was procured through an alleged STOLI transaction, as long as the policy nominally benefitted persons with an insurable interest in the life of the insured. The decision answered questions of Florida insurance law presented in two federal district court cases that were consolidated on appeal before the U.S. Court of Appeals for ...

Contractor in Florida charged with defrauding New Jersey storm victims
September 26, 2016, Pinellas County, NJ -- The official name of the charge is "Theft by Failure to Make Required Disposition." The unofficial name is "scam." Sometimes, contractors or other service providers rob Peter to pay Paul. Or buy a Mercedes. Or a speedboat. Or go to Rome. Or Aspen. Whatever. The victim's money is gone, and so is the thief. In the case of Hurricane Sandy victims, this "theft" was especially egregious because the people allegedly scammed had already lost so much. Last March, I wrote about several New Jersey people who trusted a contractor named Richard Woodard to make them whole again after Sandy had turned their lives upside ...

How to avoid towing scams
September 26, 2016, Washington, DC -- Every driver knows the frustration of having their car break down. A dead car battery, overheating radiator, accident, or any number of causes can force you to have to contact a towing company. While the best case scenario would be to prevent an emergency from happening, it is important to always be prepared for unavoidable emergencies. The best way to be prepared for an emergency that may require you to call for a tow truck is to know how to avoid towing scams. Every community has laws about towing. For example, many areas make it illegal for towing companies to drive ...

Are More State Data Breach Notification Laws Recognizing PHI?
September 26, 2016, Washington, DC -- Several states have made adjustments to their data breach notification laws in the past year, but there are still some that do not account for medical information. Federal regulations, such as HIPAA and the HITECH Rule, garner the majority of attention when it comes to the data breach notification process. However, state laws also exist, and tend to vary. Covered entities and business associates must ensure they adhere to their state’s requirements for data breaches, along with the federal regulations. As technology continues to evolve, and medical information becomes more highly sought after on the black market, more states are adjusting their data ...

A.G. Schneiderman announces $173K settlement with Wny transportation provider to resolve allegations of falsely billing medicaid
September 26, 2016, Buffalo, NY -- Attorney General Eric T. Schneiderman announced today that his office has entered into a settlement agreement with First Call, Inc., to resolve allegations that it billed Medicaid for transportation services provided by unqualified drivers and without required documentation. “When providers bill and receive Medicaid payment by submitting claims reflecting services performed by unqualified providers and without required documentation, New York tax dollars are spent on services which are ineligible for such payment,” said Attorney General Schneiderman. “My office will continue working to investigate and address fraud alleged by whistleblowers in order to preserve the integrity of the Medicaid program and ...

Police seek woman in Fentanyl prescription fraud investigation
September 25, 2016, Mississauga, none -- Peel Regional Police are asking for the public’s help in identifying a woman wanted in connection with a Fentanyl prescription fraud investigation. Police say in May and July of this year, fraudulent prescriptions for Fentanyl were faxed to three separate Mississauga pharmacies. The suspect attempted to pick up the prescriptions from two of the pharmacies, but was refused. She attempted to obtain a third prescription over the phone from another pharmacy but was also refused. The suspect is described as a black female, approximately 25 years of age, 5-foot-8, 135 pounds with a slim build and straight black hair with blonde highlights. The ...

Senior LIC officer gyps over 300 clients of 54 lakh
September 25, 2016, Kalyan, none -- A criminal offence has been lodged against a senior woman officer of Life Insurance Corporation, or LIC, for allegedly cheating 338 policy holders of Rs 54 lakhby hacking into the computer system of LIC's Kalyan branch. The police said that the accused, Shaileja Oval who has been suspended, is on the run. An administrative officer at branch 934 in Kalyan (west). Oval's job was to clear settlement dues of policy which were due for maturity. During the course of her job, she came across several such policies which had matured over the past few years but the holders had not claimed the ...

Weight-lifting cop in California gets jail time for faking injury
September 24, 2016, Santa Barbara, CA -- A Santa Barbara police officer has been charged with four counts of felony workers' compensation fraud. The Santa Barbara County District Attorney's Office says Jacob Finerty, 28, claimed to have injured his lower back during an on-duty traffic accident and said he was unable to perform his duties. However, the District Attorney says he was seen lifting weights and even performing in strength and wrestling competitions. Photos and videos from those competitions were posted on social media. Finerty was sentenced to 120 days in jail, five years of probation and has to pay $115,669 in restitution to the City of Santa Barbara. "The ...

Three men in Georgia accused of torching car for insurance money
September 23, 2016, Douglas County, GA -- Three arrests were made in the past week in a vehicular arson that took place on June 12. According to Douglas County Fire Inv. Dewayne Johnson, those arrested were Henry Carter, 49, Tradon Williams, 41, and Carlton Morrow, 42. ...

Home-health agency in New York accused of "massive fraud"
September 23, 2016, Albany, NY -- The Visiting Nurse Service of New York, one of the largest nonprofit home health care agencies in the United States, likes to highlight a lineage going back to its founder, Lillian Wald, who began nursing the poorest immigrant New Yorkers in their homes in 1893. Whatever its outcome, a federal whistle-blower lawsuit served on the agency on Thursday showcases how far today’s billion-dollar entity has come from its early days, when Ms. Wald’s visiting nurses charged a dime, or nothing at all, for their services. The lawsuit, brought under federal and state False Claims Acts by a senior manager who worked at ...

Nation's top painkiller prescriber charged with drug diversion
September 23, 2016, Huntsville, AL -- Federal prosecutors on Thursday charged a former Huntsville physician, who was the nation’s highest Medicare prescriber of opioid painkillers at the height of his practice, with illegally prescribing controlled substances and with a health care fraud involving $9.5 million in unneeded and unused urine tests, announced U.S. Attorney Joyce White Vance and FBI Special Agent in Charge Roger C. Stanton. In a two-count information filed in U.S. District Court, the U.S. Attorney’s Office charged SHELINDER AGGARWAL, 48, of Huntsville, with one count of distributing a controlled substance outside the scope of professional practice and not for a legitimate medical purpose in ...

Medical clinic owner in California convicted of $1.1M false billing
September 23, 2016, Los Angeles, CA -- A federal jury in Los Angeles convicted the owner of a medical clinic for his role in a health care fraud scheme and for filing false income tax returns. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Eileen M. Decker of the Central District of California, Assistant Director in Charge Deirdre Fike of the FBI’s Los Angeles Field Office, Acting Special Agent in Charge Anthony J. Orlando of Internal Revenue Service Criminal Investigation’s (IRS-CI) Los Angeles Field Office and Special Agent in Charge Scott Rezendes of the Office of Personnel Management Office of Inspector General ...

Comp claimant in Ohio caught working two jobs while collecting
September 23, 2016, Columbus, OH -- A Columbus man who worked two jobs while collecting injured workers’ benefits must pay the Ohio Bureau of Workers’ Compensation $6,000 in restitution and investigative costs and serve five years probation, a judge ruled Tuesday in the Franklin County Court of Common Pleas. Dion S. Hopson, 43, pleaded guilty Sept. 20 to workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 180 days in jail, which was suspended in exchange for five years community control. Hopson also was ordered to pay $5,000 in restitution to BWC and $1,000 in investigative costs. He must pay $100 per month to stay in ...

Pharmacy technician from Carlsbad facing federal charge for stealing prescription opioid painkillers
September 23, 2016, Roswell, NM -- The DEA has arrested a pharmacy technician on a federal theft of medical products charge arising out of the theft of more than 20,000 prescription opioid tablets from the pharmacy that previously employed the technician, announced U.S. Attorney Damon P. Martinez and Special Agent in Charge Will R. Glaspy of DEA’s El Paso Division. Amber Otero, 30, of Carlsbad, N.M., was arrested this morning on a criminal complaint charging her with theft of medical products. According to the criminal complaint, the DEA initiated the investigation leading to Otero’s arrest in Aug. 2016, after receiving a report of theft of loss ...

Senior fraud affects millions of Americans every day, especially financial crimes
September 23, 2016, Washington, DC -- There are than 18,500,000 Americans over the age of 75. Another 10,000 turn 65 each day. This trend has led to a dramatic increase in financial crimes targeting the elderly. Many normal aspects of the aging process – memory loss, poor eyesight and reduced ability to think critically – make them susceptible to financial exploitation. More than 90 percent of reported elder abuse is committed by members of a senior’s own family. Most by their adult children, followed by grandchildren, nieces and nephews and others. There are also plenty of strangers willing to take advantage. Seniors often have substantial retirement ...

Office of Justice programs announces grant awards of more than $8.8 million to help reduce prescription drug abuse, misuse, diversion
September 23, 2016, Washington, DC -- The Office of Justice Programs’ Bureau of Justice Assistance (BJA) today announced funding of more than $8.8 million in 20 separate awards to 19 state health and pharmacy boards and departments to better track and share prescription drug information to help reduce drug abuse, misuse, and diversion. The awards, funded under the BJA’s Harold Rogers Prescription Drug Monitoring Program FY 2016 Competitive Grant Program, enable awardees to create, implement, and enhance Prescription Drug Monitoring Programs (PDMPs). PDMPs are state-run databases that collect data about controlled substance prescriptions dispensed by pharmacies and doctors. Authorized users, including prescribers and dispensers, are permitted to ...

Appeals court overturns Indiana death row inmate's conviction
September 23, 2016, Chicago, IN -- A federal appeals court overturned the triple-murder conviction of an Indiana death row inmate on Friday and granted him a new trial due to key evidence that was withheld in earlier trials, the man's attorney and court documents said. The U.S. Court of Appeals for the 7th Circuit in Chicago voted 6-3 to overturn the conviction of Wayne Kubsch for the 1988 murders of his wife Beth Kubsch, her ex-husband Rick Milewski and his son Aaron Milewski. A videotaped police interview with neighbor Amanda Buck, who was then 9, could have helped challenge the prosecution's timeline of events if it had been ...

Attorney General Jeff Landry announces four medicaid fraud arrests
September 23, 2016, East Baton Rouge Parish, LA -- Attorney General Jeff Landry today announced that his Medicaid Fraud Control Unit has arrested four people from South Louisiana on Medicaid fraud charges. “Medicaid Fraud is a problem in Louisiana; and with the Governor’s recent expansion, we unfortunately anticipate even more people stealing from the needy,” said Attorney General Jeff Landry. “Our award-winning fraud detection and prevention unit will continue working hard to uncover, investigate, and arrest criminals who defraud the Medicaid system.” Mary Altemus, 51 of LaPlace, was arrested on 4 counts of Medicaid fraud. Altemus allegedly submitted time sheets and service log for services not rendered. Deloris Crockett, 57 ...

Preventing opioid prescription medication abuse receives funding
September 23, 2016, St. Paul, MN -- Minnesota’s efforts to reduce the abuse of opioids have received a boost with new funding from the U.S. Department of Health and Human Services (HHS). The Minnesota Department of Human Services (DHS) received a $1.6 million, five-year grant from the federal government through the Substance Abuse and Mental Health Services Administration (SAMHSA). The Minnesota Department of Health also received an HHS grant of about $900,000 over a three-year period as part of the CDC Prescription Drug Overdose: Data-Driven Prevention Initiative. These grants will help address the state’s worrisome rise in the abuse of prescription opioid pain medication. Over the past two decades, ...

Social insurance fraud leads to sentence of four months imprisonment
September 22, 2016, Norway, none -- A man in his 50s in Inner Finnmark District Court was sentenced to prison for four months for having defrauded themselves 375.000 NOK from NAV. The fraud went on for four years, writes Altaposten. – During the period from 6 April 2009 to 2 June 2013 in Kautokeino and / or elsewhere he submitted his electronic notification card to NAV where he stated to have worked all together 74 hours, despite the fact that he actually worked together 2,259 hours, it was said in the indictment. The man pleaded guilty and acknowledged that the reason he gave incorrect information was to deceive and ...

Couple in Oklahoma charged with buying policy after home burglary
September 22, 2016, Oklahoma County, OK -- Attorney General Scott Pruitt on Thursday announced multiple insurance fraud charges filed in Oklahoma County. Alma Garcia, 37, and Jose Luis Garcia, 37, allegedly reported the date of their home burglary to have happened after the date they had purchased insurance, when police reports show the burglary occurred before insurance was purchased. The Garcias each face one count of conspiracy to commit a felony. If convicted Jose Garcia could face up to 10 years in prison and fines of up to $10,000. Alma Garcia could face up to 13 years in prison and a fine of up to $11,000 due to an ...

Chiro in Utah convicted of inflating treatment bills
September 22, 2016, Salt Lake City, UT -- A jury trial for a local chiropractor accused of insurance fraud ended in a no contest plea Wednesday, just hours after testimony began. The Utah Attorney General’s Office filed charges in 1st District Court in January 2015, accusing 47-year-old Jace Ferguson of racketeering, filing fraudulent insurance claims, and communications fraud, all felony offenses. During opening arguments, Attorney Erwin Petilos said Ferguson treated two women injured in the same traffic accident in the spring of 2013. One of those women testified in court that the treatments listed on the bills submitted to Allstate were not consistent with the treatments she actually received. In his own ...

Doctor, chiro in California charged with filing 165 fake claims
September 22, 2016, Corona, CA -- Dr. Edward Albert Balbas, M.D., Chiropractor Jon Brunelle, D.C., and Alejandro Brunelle were recently arrested for insurance fraud. The trio conspired to submit over 165 fraudulent bills to health insurers. The amount pilfered was $380,000 and occurred over a 3-year period. Their ruse involved marking up insurance reimbursement claims for out-of-state lab tests. The test normally cost between $312 and $625. They billed insurers $4,256 for these tests. “Patients should be able to trust that medical professionals are making medical decisions based on patient needs and conducting their practice ethically,” said Insurance Commissioner Dave Jones. “These defendants took extraordinary steps to hide ...

Five people tied to Maryland pain clinic charged in urine testing scam
September 22, 2016, Baltimore, MD -- A federal grand jury indicted five defendants on charges arising from a scheme whereby physicians and administrative personnel associated with a Maryland pain management practice agreed to refer urine specimens to a testing lab for evaluation in return for $1.37 million in kickbacks: Sandeep Sherlekar, age 51, of Germantown, Maryland, Atif Babar Malik, age 46, of Germantown, Muhammad Ahmad Khan, age 43, of Pakistan, Mubtagha Shah Syed, age 49, of Jersey City, New Jersey, and Konstantin Bas, age 40, of Brooklyn, New York. The indictment also charges Sherlekar, Malik and Khan with conspiring to defraud the IRS, and Sherlekar and Malik are further charged with health ...