News

Detroit-area doctor pleads guilty to $5.7-million false-billing scam
August 31, 2015, Detroit, MI -- A Detroit-area medical doctor who prescribed unnecessary controlled substances and billed for unperformed office visits and diagnostic testing pleaded guilty today for his role in a $5.7 million health care fraud scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office and Special Agent in Charge Jarod J. Koopman of ...

Dentist in Florida accused of unnecessarily pulling kids' teeth
August 31, 2015, Ridgefield, FL -- An osteopathic physician from Ridgefield who was convicted of health care fraud has agreed to pay the federal government $270,000 to settle similar civil allegations, including charges that he sent bills to Medicare for the treatment of patients he never saw. According to the U.S. Attorney's Office in Connecticut, Dr. David Lester Johnston, 46, who operates Osteopathic Wellness Center, LLC, submitted claims for physician office visits that were not performed at all by him. Instead, the patients only received massages and related services from a massage therapist. In addition, Johnston falsely described the services rendered and falsely stated he himself had rendered ...

Insurance agents urged to take bigger role in combatting comp fraud
August 31, 2015, Washington, DC -- Worker’s compensation fraud is a major issue impacting the insurance industry. Not only is it illegal, but billions of dollars are stolen every year in the U.S. due to fraudulent claims and misreported business information. Although most claims are legitimate, the National Insurance Crime Bureau estimates that 10% or more of all property/casualty insurance claims are fraudulent. To protect their interests as well as the interests of honest policyholders, independent insurance agents need to be aware of the steps to take if they or their clients suspect fraud. Armed with the right information, agents—who are a key conduit between policyholders and ...

Fraudsec whistleblower app evolves from $20.7 million Leighton Contractors fraud
August 31, 2015, Sydney, none -- An Australian technology start-up, founded by the key whistleblower in a $20.7 million insider fraud case at Leighton Contractors, is picking up significant global corporate interest for its whistle-blowing app and could be used to help fight school and workplace bullying. Fraudsec is less than a year old, but has numerous big-name organisations trialling its service, which makes whistleblowing as simple as filling in an online questionnaire, and promises anonymity. The company was founded by Sydney-based French ex-pat Sylvain Mansotte, who realised there was a gap in the market for a reliable and secure whistleblowing solution, when he found himself in the ...

Local woman charged with Medicaid fraud
August 31, 2015, Horsham, PA -- A Horsham woman was one of six people recently arrested in unrelated cases charging them with Medicaid fraud, following an investigation by the Medicaid Fraud Control Section of the Pennsylvania Attorney General’s Office announced Aug. 31. Jeanne Schafle, 60, of the 1300 block of Bryant Court, located in the Ambler section of Horsham Township, was arrested Aug. 19 and charged with four felony counts each of Medicaid fraud and tampering with public records and a felony count of theft by deception, according to a criminal complaint. Schafle received $9,444 from Medicaid for personal care services she allegedly fraudulently reported for providing care ...

Probation officer in California headed to prison for workers comp fraud
August 28, 2015, Orange County, CA -- An Orange County juvenile corrections officer pleaded guilty Friday to insurance fraud and was sentenced to six months behind bars. William Parker, 43, of Corona, pleaded guilty to a count of making a fraudulent statement and five counts of insurance fraud, all felonies. He was also ordered to pay about $41,000 in restitution. Parker started working for the county as a deputy juvenile corrections officer in the Orange County Probation Department in June 2005. He was involved in a car collision in October 2007 while off duty and injured his back, prosecutors said. Parker’s insurance claim in that collision resulted in a settlement, ...

Pill mill operator in Tennessee sentenced to 280 years in prison
August 28, 2015, Chattanooga, TN -- On August 27, 2015, Barbara Lang, a.k.a. “Aunt Bea,” 61, of Rossville, Ga., was sentenced by the Honorable Curtis L. Collier, U.S. District Judge, to serve 280 years in federal prison. After a 25-day trial that spanned almost three months, Lang was convicted of two counts of conspiring to distribute and dispense Schedule II and IV controlled substances, outside the scope of professional practice and not for a legitimate medical purpose; five counts of maintaining a premises for the purpose of distributing controlled substances; and fourteen counts of structuring financial transactions to evade reporting requirements. Lang was charged along with three other ...

Insurance agent in Kansas gets year in jail for health application fraud
August 28, 2015, Olathe, KS -- A cooperative investigation by federal and state law enforcement officials into Brian Curtis Henton of Olathe, Kansas, has resulted in a 12 month federal prison sentence and an order to pay $23,300.15 in restitution for fabricating and submitting Medicare Supplement insurance policy applications to Equitable and Cigna insurance companies between April 2013 and October of 2013. “There is no room in the insurance business for fraudsters like Mr. Henton,” Iowa Insurance Commissioner Nick Gerhart said. “The Iowa Insurance Division will continue to work hard to protect Iowans from insurance and securities fraud.” “Every instance of fraud increases the cost of insurance ...

Dallas attorney charged with bilking governments of $22M in false medical billings
August 28, 2015, Dallas, TX -- A Dallas attorney and his wife and his sister have been charged with bilking the government out of more than $22 million by billing the federal worker’s compensation program for bogus medical equipment, the U.S. attorney’s office said. The attorney, Tshombe Anderson, 52, was arrested Friday. His wife, Brenda Anderson, 45, and his sister, Lydia Bankhead, 61, were arrested on Wednesday and remain in federal custody. They are accused of forming several alleged businesses to provide medical equipment to rehab patients that either wasn’t needed or wasn’t requested. The government reimbursed them based on false billings, officials said. Tshombe Anderson worked as an attorney ...

Optometrist Jeffrey Sponseller and Eye Care One Settle False Claims Act Case for $275,000
August 28, 2015, Augusta, GA -- Jeffrey Sponseller, O.D. of Augusta, Sponseller Eye Care One, P.C., and S&H Eye Care, LLC, currently doing business as “Eye Care One,” have agreed to pay the United States a total of $275,000.00 to settle allegations that they violated the False Claims Act by submitting or causing the submission of false claims to federal and state healthcare programs for services that were either inadequately performed or not performed at all. The civil settlement resolves allegations that were originally part of a joint criminal and civil investigation of Sponseller’s submission of bogus claims to Medicare, Medicaid, and the Railroad Retirement Medicare Program ...

Town employee in Connecticut accused of submitting 273 bogus health claims
August 27, 2015, New Haven, CT -- A town employee accused of submitting 273 fraudulent health insurance claims totaling more than $28,000 is scheduled to appear in court next month. James Cei, 49, of 53 Parker Street, was charged with health insurance fraud, a Class B felony. He has not entered a plea. According to Cei’s arrest warrant, an Anthem Special Investigations Unit representative filed a fraud complaint against him with the Wallingford Police Department on April 29. The investigator reported Cei had submitted 273 fraudulent claims between May 23, 2013 and April 28, 2015. The town of Wallingford is the “victim” in the case, the investigator told police, ...

NYPD cop busted for torching his 2010 Acura in New Jersey
August 27, 2015, Jersey City, NJ -- A 28-year-old New York City police officer was suspended on the spot today in court when he appeared on charges that he torched his vehicle for insurance money. Niculae Madalin of Woodside, N.Y., made his first court appearance on the charge of arson in Central Judicial Processing court where he was represented by attorney Brian Neary. He is charged with starting a fire or causing an explosion at 15th and Coles streets in Jersey City on Aug. 3, 2014, "with the purpose of collecting insurance for the destruction or damage of such property under circumstances which recklessly place any person in danger ...

Agent in Miami charged with stealing premium, having no license
August 27, 2015, Miami, FL -- The Florida Division of Insurance Fraud today announced the arrest of Tania Michel, 41, for failing to notify the Department of Financial Services of a federal fraud conviction, continuing to working in the insurance industry after having her license expired, and knowingly misappropriated premium funds while working at an insurance agency. For a period of nine months, Michel worked at a North Miami Beach insurance agency with an expired professional license and with an unreported federal felony conviction. By failing to reapply for her license, she was able to further conceal the felony fraud conviction that would cause her to become ...

Medical mill operator in New York sentenced to prison for $30M scam
August 27, 2015, Bronx, NY -- A man was convicted of running fraudulent Bronx Medicaid mills that bilked the government out of $30 million and give HIV patients watered down meds. Preet Bharara, the United States Attorney for the Southern District of New York, announced that Oscar Huachillo, the former owner and operator of multiple HIV/AIDS clinics in New York City, was sentenced in Manhattan federal court to 87 months in prison for orchestrating a scheme to defraud Medicare out of more than $31 million; he was also sentenced to 60 months in prison, to be served concurrently, for evading more than $3.4 million in federal income ...

Ex-probation officer in Calif. charged a second time with disability fraud
August 27, 2015, Los Angeles, CA -- A former Los Angeles County probation officer who lives in Long Beach was arrested Wednesday, suspected of forging documents to illegally collect disability insurance benefits while serving probation for a previous insurance fraud conviction Robyn Palmer, 29, was arrested while serving five years’ probation following her conviction on 14 felony counts of insurance fraud, forgery, wire fraud, and grand theft in May 2014, according to information provided by the state Department of Insurance. This time, she’s facing six felony counts of insurance fraud. PRIOR TROUBLE Authorities say Palmer illegally collected disability benefits from Allstate Insurance, was sentenced to five years’ probation and ordered to ...

Rocky Point Woman Pleads Guilty to $4M Fraud
August 27, 2015, Rocky Point, NY -- A Rocky Point woman was among four people who have admitted to committing a $4-million health care fraud scheme over a two and ½ year span. Sophia Lin, 34, and three Queens residents pleaded guilty Thursday to conspiring to commit health care fraud at Brooklyn federal court. Also pleading guilty to that charge were 55-year-old Jeffrey Suh of Bay Side, 42-year-old Kang Young Chung of Woodside and 40-year-old Emily Shim of Flushing. “The fraud scheme that Mr. Suh and his employees engaged in was motivated by nothing more than greed,” said Scott Lampert, Special Agent-in-Charge of the U.S. Department of Health and ...

Des Plaines couple charged with paying kickbacks to defraud Medicare
August 27, 2015, Des Plaines, IL -- A Des Plaines wife and husband face federal charges of paying kickbacks to employees and a marketer in exchange for referrals of Medicare patients to the couple's Chicago home health care company, prosecutors said Thursday. Estrellita Duquilla, 58, is charged with five counts of paying kickbacks to induce referrals of Medicare beneficiaries, while her husband Miguel Duquilla, 60, is charged with two counts of the same crime. Both also face charges of conspiracy to pay and receive health care kickbacks, conspiracy to commit health care fraud, and 10 counts of Medicare fraud. The owners couldn't immediately be reached for comment. It was the second ...

A-Rod faces $100M fraud lawsuit filed by ex-brother-in-law
August 27, 2015, Albany, NY -- As the Yankees find themselves embroiled in a battle for a postseason berth, Alex Rodriguez looks to be headed for a battle of his own, inside a courtroom. The polarizing slugger, whose resurgence from a drug suspension has helped the Yankees regain relevancy in the AL East, is being sued for $100 million by Constantine Scurtis, Rodriguez's ex-brother-in-law and a former business partner, according to the New York Daily News. In an amended lawsuit filed Wednesday in a Miami-Dade County court, Scurtis alleged Rodriguez used their real estate business, Newport Property Ventures Ltd., to commit insurance and mortgage fraud following Hurricane Ike ...

Attorney General Patrick Morrisey Alerts Consumers To Watch Out For Solicitations From Out-Of-State Pharmacies
August 27, 2015, Charleston, WV -- Attorney General Patrick Morrisey today alerted consumers to be on the lookout for out-of-state pharmacies sending unsolicited order forms, medical supplies or medications to insurance customers without their consent. The Office’s Consumer Protection Division has received several reports of local consumers receiving what appear to be order forms for medical supplies and prescriptions from out-of-state pharmacies. Consumers and medical providers are also receiving supplies and prescriptions from these pharmacies, even though they have not placed orders from these companies. Many of these reports are from residents who are diabetic and frequently fill prescriptions for diabetes medications and testing supplies. The ...

Florida hospital group offers settlement to end Medicare fraud probe
August 27, 2015, Fort Lauderdale, FL -- A leading public hospital group based in Fort Lauderdale, Florida, will offer a $69.5 million settlement to the Department of Justice to end a four-year-long Medicare fraud investigation that grew out of a whistleblower lawsuit, according to hospital records. The board of the North Broward Hospital District voted unanimously in a public meeting last week to make the offer to resolve allegations that it violated the Stark Law, also known as the physician self-referral law. To read the full story on WestlawNext Practitioner Insights, click here: bit.ly/1NDielk ...

10 years in prison for Michigan pharmacy operator convicted of billing fraud
August 27, 2015, East Grand Rapids, MI -- U.S. Attorney Patrick A. Miles, Jr. announced that Kim Duron Mulder, 56, formerly of East Grand Rapids, was sentenced today to ten years in prison. Mulder, the CEO of Kentwood Pharmacy, pled guilty to a conspiracy to commit health care fraud based on billing Medicare Part D Plans, Medicaid, and private insurance plans for misbranded and adulterated drugs. At a sentencing hearing in Grand Rapids, Chief U.S. District Judge Robert Jonker also ordered that Mulder serve three years of supervised release following his prison term Following the execution of federal search warrants on November 2, 2010 and the execution of an ...

Five charged with PIP auto fraud in Florida
August 26, 2015, Fort Myers, FL -- The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) has made multiple arrests related to a large-scale personal injury protection (PIP) fraud scheme spanning across Central Florida. Five individuals have been arrested for their alleged various roles in the scheme, and arrest warrants have been issued for three additional individuals whose arrests are pending. Three related arrests have been made in the Fort Myers area. DIF partnered with the FBI to conduct investigations into two personal injury clinics, First Medical Rehab of Bradenton (FMRB) and Kirkman Family Chiropractic Care (KFCC) in Orlando, after insurance carriers and former patients raised ...

AG in Indiana says medical ID theft is a "growing threat" in Hoosier state
August 26, 2015, Fort Wayne, IN -- Indiana Attorney General Greg Zoeller said data breaches impacting medical information pose challenging and growing threats to the public. Medical identity theft can be very difficult to detect and correct, costly and potentially dangerous, he said. Zoeller was in Fort Wayne today warning people about the risk of medical identity theft following the recent breach at Fort Wayne-based Medical Informatics Engineering (MIE) and its subsidiary NoMoreClipboard, which compromised medical and financial information of an estimated 1.5 million Hoosiers and 3.9 million people nationwide. The two companies provide electronic medical record services to health-care providers and individuals. Medical identity theft occurs when an ...

Two home repair businesses banned in NC, ordered to pay fines, refunds
August 26, 2015, Wake County, NC -- Two local home repair companies have been ordered to pay more than $700,000 in refunds and penalties after misleading dozens of consumers, Attorney General Roy Cooper said today. “These North Carolina consumers deserve to get their money back,” Cooper said. “Don’t do business with anyone who shows up at your home and asks you to pay upfront for roofing, paving or other repairs.” At the request of Cooper’s Consumer Protection Division, Wake County Superior Court Judge Henry W. Hight, Jr. ordered defendant Brian William Smith of Eagle Roofing and Restoration to pay $148,308.57 in restitution to consumers, and pay up ...

Landlord in Rhode Island sentenced to 6 1/2 years for apartment building arson
August 26, 2015, Providence, RI -- A Providence man has been sentenced to 6 ½ years in prison after he was convicted of orchestrating a scheme to set fire to a multi-family building he owned in an effort to collect more than $725,000 in insurance. The U.S. Attorney's office in Providence says 40-year-old Kormahyah Karmue was sentenced on Wednesday. He was convicted by a jury in May of conspiracy to commit arson and three counts each of wire fraud and mail fraud. He was also sentenced for defrauding the government of $61,250 in unemployment compensation after pleading guilty to theft of government funds. Prosecutors said Karmue was the ringleader ...