News

Man in New York accused of faking home burglary
January 29, 2015, Niagara Falls, NY -- A Niagara Falls man was put in jail after he was charged with third degree insurance fraud. Police say Kevin A. Ashby, 40, was charged with the class D felony, along with third degree attempted grand larceny and first degree falsifying business records — class E felonies — after an insurance company contacted the New York State Police. Troopers say the insurance company came to them about a potentially fraudulent claim about a burglary he reported to the Niagara Falls Police Department. Police say in a following investigation, they discovered that Ashby provided false documents to the insurance company, and reported an ...

Cross-state sale of health insurance could spur scams
January 29, 2015, Concord, NH -- Regional pacts better suited to protect consumers from con artists Posted on January 29, 2015 by Howard Goldblatt The idea of allowing consumers to buy health coverage from any insurer in any state has been floated in Congress for several years. It would be an alternative to a consumer’s state or regional exchange. Someone in the Northeast thus could buy coverage from an insurer in the Southwest. It’s a bad idea that persists. Any proposals should be voted down. The idea would open the door for rampant fraud and undermine consumer protections. How would the system be regulated? Let’s say a scammer in State A ...

Worst insurance fraud cases of 2014 profiled by the Coalition
January 28, 2015, Washington, DC -- You Can't Make This Stuff Up: The Worst Cases of Insurance Fraud in 2014 Financial losses due to insurance fraud cost U.S. insurers at least $80 billion a year, according to the Coalition Against Insurance Fraud, an association of industry, government and consumer organizations. The human cost, in terms of suffering and loss of life, is sky high as well. In an effort to dramatize the scope and depth of the problem, the coalition has singled out what it dubs the worst instances of insurance fraud in 2014. While these seven cases may not be the biggest in terms of total dollars ...

Ex-cop in California gets probation for cheating workers comp
January 28, 2015, San Francisco, CA -- One surveillance video showed former California Highway Patrol officer Tony Yao driving a stake into the ground to hold up a banner for a San Francisco 49ers playoff game in January 2012. Others played in Sacramento Superior Court in Yao’s workers’ compensation fraud trial last month showed him carrying shopping bags, helping walk a bike and apparently disassembling a baby carriage. These images contrasted with others in the same time frame of Yao the days he showed up at the doctor’s office to get treatment for the back he said he injured in May 2011 while on the job for the CHP, ...

Dental office in Florida raided by state law enforcement officers
January 28, 2015, Ocala, FL -- Investigators executed a search warrant at a dental office Wednesday as part of a Medicaid fraud investigation. Officials with the Florida Attorney General’s Office, as well as other investigators, were at Churchill Dentistry, 255 SE 17th St., formerly known as Polliwog Dental, for a good part of the day. Capt. John W. Nicks Jr., of the Florida attorney general’s Medicaid Fraud Control Unit, said the investigation is a multi-agency effort that includes the Ocala Police Department, the Florida Department of Health, the FBI and the U.S. Drug Enforcement Administration. He said agents would take whatever material had possible evidentiary value, including such things ...

Contractor in Georgia arrested for workers compensation fraud
January 28, 2015, Macon County, GA -- An investigation conducted by the Georgia State Board of Workers' Compensation's Enforcement Division has led to the arrest of construction contractor Mark Anthony Brannen for Insurance Fraud. Brannen, age 50 was arrested Tuesday, for felony Insurance Fraud and First Degree Forgery in Macon County, for creating and passing a bogus certificate of workers' compensation insurance based on warrants taken by Investigators of the Enforcement Division the previous day. Brannen has been charged with one felony count of providing a fraudulent document to a government agency. Mark Brannen, owner of Brannen Construction Company has been in business for over ten years primarily ...

Five farmers in Ohio plead guilty to filing claims for crops not planted
January 27, 2015, Meigs County, OH -- Five Meigs County men who were charged in May of 2014 with crop insurance fraud have plead guilty in federal court and agreed to forfeit $410,000, and a 2012 John Deere tractor. They remain on bond pending sentencing, which could carry a maximum of five years in prison, three years of supervised release and fines for each of up to $250,000. The defendants entered guilty pleas Jan. 16 in the U.S. Attorney’s Office, Southern District of Ohio, for “conspiracy to defraud the United States.” Their names Pleading guilty were Christopher T. Wolfe, 43; Terry J. McNickle, 51; Mark D. Wolfe, 41; and Joey ...

Former owner of dental clinic in Indiana sentenced for Medicaid fraud
January 27, 2015, Indianapolis, IN -- Former owner of Anderson Dental Clinic, Sally Metzner, pleaded guilty and was sentenced four years in prison and four years on probation for corrupt business practices and Medicaid fraud at her clinic. According to 24-hour News 8’s partners at The Herald Bulletin, Metzner pleaded guilty to corrupt business influence, Medicaid fraud and two counts of forgery, all Class C felonies, and practicing dentistry without a license, a Class D felony. Dan Whitehead, her lawyer, said she is currently serving a two-year term in a federal prison in Kentucky for two counts of tax evasion in April 2014. Whitehead said Metzner will start her ...

Nine in Miami charged with staging automobile crashes for profit
January 27, 2015, Miami, FL -- Chief Financial Officer Jeff Atwater today announced nine arrests for personal injury protection (PIP) fraud in Miami. Charged in eight separate cases involving seven staged accidents, these individuals were arrested and charged for their involvement in the filing of more than $242,000 in fraudulent billings submitted to 11 insurance carriers. “While their injuries may have been fake, PIP fraud is real and it is not a victimless crime,” said CFO Atwater. “When insurance carriers absorb such high-dollar losses to fraud, we all pay in the form of higher insurance premiums. I’m thankful to our dedicated investigative team for shutting down ...

DJ in Pennsylvania charged with falsely reporting equipment stolen
January 27, 2015, Marple, PA -- A local disc jockey who allegedly filed a false insurance claim after lying to police about his car being stolen waived a preliminary hearing on fraud and related offenses. Christopher M. Orlando, 25, of the 2600 block of Highland Avenue in Marple, appeared Jan. 22 for the proceeding before Magisterial District Judge David H. Lang. According to charging documents, Orlando contacted the West Chester Police Department on Sept. 25, 2012, to report that someone had broken into his car while he attended a class at West Chester University. A local disc jockey who allegedly filed a false insurance claim after lying to police ...

Florida CEO pushing insurers to share PIP reform savings with consumers
January 27, 2015, Orlando, FL -- Florida’s chief financial officer made it sound like maybe the state’s insurance commissioner wasn’t going anywhere soon — and on one issue, delivered what he called “fair warning” to insurers. Car insurers are saving money from a 2012 law he backed that slashed the Personal Injury Protection benefits they have to pay, CFO Jeff Atwater said Tuesday at the Florida Chamber Insurance Summit. It’s time to pass along savings to customers this year, he said. “The wait is over,” Atwater said. “The consumer has grown tired.” Atwater, a North Palm Beach banker, took a moment to recognize Florida Insurance Commissioner Kevin ...

Insurance agent theft of premium spurs alert to consumers in Mississippi
January 26, 2015, Jackson, -- Commissioner of Insurance Mike Chaney and the Mississippi Insurance Department are alerting consumers that there may be issues with policies purchased through the Mid-Delta Insurance Agency in Indianola, Mississippi and its representative, Randal Ray Henson. Earlier today Mr. Henson was arrested by the Sunflower County Sheriff’s Department and charged with false pretense. The charges are related to Mr. Henson’s failure to forward insurance premium payments on to insurance carriers. The investigation was a joint operation between the Sunflower County Sheriff’s Department, Sheriff James Haywood and the Mississippi Insurance Department. Randal Ray Henson surrendered his insurance producer’s license to the Mississippi Insurance Department ...

Police in Maine warning about life insurance telemarketing scam
January 26, 2015, Rockland, ME -- Rockland police have been alerted by a leading insurance company about a new scam that is targeting victims who have recently lost a family member. According to Bruce Boucher, Rockland Police Chief, during the last eight months this insurance company has received many complaints from people who have been called by individuals falsely representing employees of insurance companies. These "employees" inform the targeted victims that their recently deceased family member had a life insurance policy which lapsed for non-payment of premiums.The victims are told that if they immediately pay the overdue premium then the policy would be reinstated and life insurance ...

Hospital executive in Florida convicted in $67M billing scam
January 26, 2015, Hollywood, FL -- A hospital executive in Hollywood was ordered to turn himself in February 26, after he was sentenced for his role in a scheme that resulted in more than $67 million in fraudulent Medicare claims. Christopher Gabel, 62, was the former chief operating officer of the Hollywood Pavilion psychiatric hospital, 1201 N. 37 Ave. He was sentenced to six years in prison. He also must pay more than $39.3 million in restitution. Medicare paid $40 million of $67 million claimed. Pavilion employees submitted claims to Medicare for treatment that was not provided from April 2003 to September 2012, authorities said. Gabel confessed to ...

Home-health agency owner sentenced to prison for $30M fraud
January 26, 2015, Miami, FL -- The owner and operator of a Miami home health care agency was sentenced today to 106 months in prison for his participation in a $30 million Medicare fraud scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement. Ramon Regueira, 66, of Miami, pleaded guilty to one count of ...

Man in South Carolina charged with double dipping on home damage claim
January 26, 2015, Moore, SC -- A Moore man has been charged with insurance fraud, forgery and filing a false insurance claim by the State Law Enforcement Division. Vincent G Millines, 48, of 607 Heathrow Court, was arrested Monday by Spartanburg County sheriff’s deputies, according to arrest warrants. The warrants state that on Jan. 19, 2011, Millines provided false information regarding an insurance claim to Travelers Insurance Company that resulted in a payment of $2,857. Millines presented Travelers Insurance with a claim for payment on damage to his house after being previously paid for the same claim in 2010, according to the warrants. Millines was released from the Spartanburg County ...

Medicare launching pilot program to curb home-health fraud
January 26, 2015, Washington, CT -- The CMS is developing a pilot program to determine just how many Medicare fraud cases are taking place in home health agencies. A contractor search is underway to help implement the initiative. Medicare fraud experts praised the endeavor. “Home health is a small part of the Medicare program, but the long-standing allegations of fraud tarnish the sense of integrity of the entire program,” said Vernon Smith, managing principal at Health Management Associates. “My father used to say, 'If you have to swallow a frog, swallow the big one first.' In home health, the big frog is definitely in South Florida.” Medicare ...

High roller accused of $20M fraud in Penn. was big political contributor
January 25, 2015, Bucks County, PA -- For Bucks County Republicans and power brokers, the parties at Claire Risoldi's extravagant mansion near New Hope were unforgettable affairs. Risoldi would book bands. Occasionally she brought in performers to impersonate celebrities including Frank Sinatra or Cher. The Mummers made at least one appearance. She even held her own wedding in front of a crowd that had paid for tickets to a fund-raiser for Rep. Mike Fitzpatrick. "Claire's larger than life," said District Attorney David Heckler, a Republican who had at least one soiree thrown in his honor at Risoldi's estate, a 10-acre property known as Clairemont. "No expense was spared." Occasionally, guests ...

Ex-Dodgers pitcher charged with buying policy on his ATV after crash
January 24, 2015, San Luis, CA -- Former Major League Baseball player Ted Lilly has been charged in California with three felonies related to insurance fraud. The San Luis Obispo Tribune reported Friday that the charges stem from allegedly false insurance claims related to Lilly's damaged recreational vehicle. An investigation by the state Department of Insurance finds the RV sustained damage in a collision and Lilly sought an estimate from a body shop on March 19, 2014. The estimate was $4,600. The agency says Lilly then bought insurance from Progressive on March 24 and claimed the damage on March 28. Lilly's lawyer, James Murphy, didn't return a call for comment. The 39-year-old ...

Man in Minnesota sentenced to five years for torching his home
January 23, 2015, Ellendale, MN -- An Ellendale man convicted last fall of setting fire to his family home to collect on insurance money was sentenced to nearly five years in prison Wednesday. Mark Allan Misgen, 43, received a sentence of 58 months on convictions of first-degree arson and insurance fraud. He was also ordered to pay restitution of more than $20,000. District Judge Joseph Bueltel heard arguments from both sides after the defense requested a lesser sentence of probation. The hearing, which took place at the Steele County Courthouse, lasted nearly two hours. Misgen’s attorney, Richard Swanson, argued that the defendant doesn’t have a history of arson and ...

Psychotherapist in Illinois billed $500M to treat patients long dead
January 23, 2015, Chicago, IL -- In the murky annals of Chicago’s political history, it wasn’t unusual for the dead to vote — sometimes more than once. Now the city’s deceased have pulled off another neat trick, the feds say. They’ve received psychotherapy at the expense of the U.S. taxpayer. According to a federal indictment filed late Thursday, Evanston psychotherapist Jonathan A. Levy, 44, and his employee, Janice Nakao, 59, bilked taxpayers out of $500,000 by filing false Medicare claims, including billing for the treatment of long-dead patients. But Levy’s business pulled other scams, too, the feds say. It billed for treatments it failed to provide to elderly patients who were ...

Adjuster in Washington ordered to pay restitution for claims scam
January 23, 2015, King County, WA -- Former Nationwide Insurance claims associate Fariborz Romeo Rahrovi, 40, was sentenced in King County Superior Court to 12 months of work release and ordered to pay his victim $165,000 in restitution. On Nov. 21, 2014, he pleaded guilty to two counts of theft, criminal conspiracy, and money laundering related to the theft of an accident victim’s $525,000 insurance settlement. Rahrovi worked with Seattle private law attorney Edward Joseph Callow on the scam, the Washington State Insurance Commissioner’s Office said in a statement. Callow was sentenced in August 2014 to 24 months in prison and ordered to pay restitution and attorney’s fees to ...

Talks with Cuba could lead to arrests of more fraud fugitives
January 22, 2015, Havana, none -- Gilberto Martinez was almost penniless when he left Cuba in 2005 to start a new life in the United States. Eight years later he returned a rich man and built a large house in his dusty neighborhood on the outskirts of Havana. Flush with money, he drove an Audi and a Mercedes and started a music career under the artistic name "Gilbertman". But two weeks ago, a swarm of Cuban police descended on his home and arrested him. "It was dramatic. There were dozens of cops, in cars, sirens blaring. They blocked off the street," said one neighbor who asked not to be ...

Doctor in New Jersey pleads guilty to bilking $237K from Medicare and Medicaid
January 21, 2015, Franklin, NJ -- A doctor from Franklin Lakes with offices in Newark, Union City, Paterson and Passaic admitted his role in a three-year scheme to bill Medicare for services that were not provided and services provided by unlicensed and unsupervised providers, U.S. Attorney Paul J. Fishman said. Benjamin Sabido, 62, pleaded guilty in Newark federal court to an information charging him with health care fraud after court documents say he received $237,182 from Medicare and Medicaid based upon fraudulent claims. Sabido did so by instructing his staff to submit bills for physical therapy services that were not provided from at least December 2006 through ...

Woman in Georgia charged with arson and fraud after home fire
January 21, 2015, Flowery Branch, GA -- A Flowery Branch woman was charged Tuesday with first-degree arson and insurance fraud in connection with allegedly setting a fire at her home. Jaclin Michelle Lance, 34, reported a fire to Hall County Fire Services on Dec. 8 at her Daffodil Drive home. The fire burned out by itself, authorities said. At the time of the fire, Lance told investigators she was staying with family over the weekend and discovered a small fire when she returned home. “Investigators continuing their investigation found evidence that indicated the owner deliberately set the fire,” according to a news release from the fire department and the Hall ...