News

Business owner in Georgia charged with arson and insurance fraud
June 25, 2016, Douglasville, GA -- The owner of Town and Country Fabrics and Upholstery, a downtown Douglasville business that burned down in 2014, has been charged with committing first degree arson and insurance fraud. Christopher R. Hedgecock, 32, of Douglasville, was arrested on Thursday, June 23. He appeared before Douglas County Magistrate Court Judge Barbara Caldwell on Friday morning where he was issued a $50,000 bond for the charges. As of late Friday, he remained at the Douglas County jail. Wes Tallon, communications director for Douglas County, said Hedgecock was arrested in connection to the fire of Town and Country Fabrics and Upholstery, which burned down on ...

Pharmacist in Florida sentenced to 24 years in prison for dealing painkillers
June 24, 2016, Orlando, FL -- United States District Judge Paul G. Byron has sentenced Valentine Okonkwo (54, Orlando) to 24 years and 4 months in federal prison for conspiracy to distribute and dispense oxycodone outside the usual course of professional practice and without a legitimate medical purpose and for dispensing and distributing oxycodone outside the usual course of professional practice and without a legitimate medical purpose. A federal jury found him guilty in March 2016. According to evidence presented at trial, Okonkwo, a licensed pharmacist, dispensed more than 500,000 oxycodone pills during the timeframe of the conspiracy and collected over $1.3 million from illegal oxycodone ...

Hospital in Los Angeles to pay $1 million for patient dumping
June 24, 2016, Los Angeles, CA -- Pacifica Hospital of the Valley in Los Angeles has agreed to pay $1 million in civil penalties over allegations that it improperly discharged a homeless patient in direct violation of city law and the hospital's homeless discharge protocols. The civil penalties will be paid to the city attorney's office. The incident in question involves Pacifica Hospital allegedly discharging Kasey Lucious, a patient with a history of mental illness and homelessness, from the Sun Valley hospital following a 30-day stay without contacting relatives who had requested to be notified of her whereabouts. The hospital is accused of sending the patient by taxi to ...

Data analytics aided fed's national sweep of Medicare fraudsters
June 24, 2016, Washington, DC -- Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell this week announced an anti-fraud task force led by the Justice and Health and Human Services Departments executed the largest takedown of health care fraud in U.S. history, charging 301 individuals in 36 Federal districts for health care schemes equaling $900 million. “The diligent use of innovative data analytic systems has contributed or led directly to many of the law enforcement cases presented here today,” said Shantanu Agrawal, the deputy administrator and director of Centers for Medicare and Medicaid Services (CMS) Center for Program ...

Patient in California accused of pocketing $100K in medical reimbursement
June 24, 2016, Diamond Bar, CA -- A Diamond Bar man faces more than 50 felony charges for allegedly billing Anthem Blue Cross for dental work and medical treatment he never received and pocketing more than $100,000 before the insurance company noticed, authorities said. Thomas Anthony Perez, 51, was charged June 3 with 53 felony counts of filing phony insurance claims for $362,268.82, according to court records. He was paid $101,575.82 before Anthem officials discovered the alleged scheme, Orange County District Attorney investigator Elaine Noce said in court papers to justify a request for bail equaling the expense of the claims. Perez sustained facial injuries in a kitchen accident ...

Laborer in Massachusetts charged with working while collecting comp
June 24, 2016, Milford Man, MA -- A Milford man has been indicted on larceny and workers’ compensation fraud charges in connection with allegedly collecting more than $18,000 in disability benefits while he continued to work, Attorney General Maura Healey announced today. Kenneth Doyle, age 42, of Milford, was indicted this week by a Worcester Grand Jury on charges of Workers’ Compensation Fraud and Larceny over $250. He will be arraigned in Worcester Superior Court at a later date. The AG’s Office began investigating this matter after it was referred by the Insurance Fraud Bureau (IFB) in August 2015. “The Insurance Fraud Bureau vigorously pursues these ‘working while ...

Two arrested for defrauding Medicaid out of more than $360,000
June 24, 2016, Panama City, FL -- Attorney General Pam Bondi’s Medicaid Fraud Control Unit and the Bay County Sheriff’s Office arrested two Panama City mental health counselors for allegedly defrauding the Florida Medicaid program out of more than $360,000. The investigation revealed that Laurie Lynne Kidd, 54, who has a doctorate in psychology, hired Courtney Ann Hill, 27, to provide individual and group therapy to assisted living facilities. Hill is an unlicensed and unqualified employee and allegedly submitted false reports claiming that Hill provided therapy to the residents, when, in fact the defendant did not. Kidd billed Medicaid for the services never rendered as if Kidd herself ...

Southampton Town councilman sentenced to 24 months in prison for conspiring to illegally distribute Oxycodone
June 24, 2016, Southampton Town, NY -- Earlier today in Central Islip, NY, Bradley Bender, former Southampton Town Councilman, was sentenced to 24 months’ imprisonment, three years supervised release and $5,000 forfeiture, following his guilty plea on November 24, 2015, to conspiring to illegally distribute oxycodone. The sentencing proceedings were held before U.S. District Judge Arthur D. Spatt. The sentence was announced by Robert L. Capers, United States Attorney for the Eastern District of New York. In announcing the sentence, United States Attorney Robert L. Capers stated, “Today’s sentence is a reminder to all those entrusted to represent the interests of the public that they will be ...

Six in New York charged in auto 'crash and buy' scheme
June 23, 2016, Albany, NY -- Attorney General Eric T. Schneiderman announced today the arrests of six individuals for allegedly purchasing automobile insurance policies after their vehicles had already sustained damage or been stolen, and then falsifying the dates of the incidents in claims submitted to their insurance carriers. The defendants were arrested yesterday and today on felony complaints filed in Queens, Kings, Nassau and Suffolk Counties. The charges are the result of “Operation Crash & Buy,” a pro-active investigation initiated by the Attorney General’s Auto Insurance Fraud Unit (“AIFU”) in conjunction with the New York State Department of Financial Service’s Criminal Investigations Unit, Insurance Frauds Bureau ...

Three plead guilty to various fraud charges in Washington
June 23, 2016, Kitsap County, WA -- Three people pleaded guilty in connection with insurance fraud cases after investigations by Insurance Commissioner Mike Kreidler’s Special Investigations Unit (SIU). Joshua Zabel, 28, pleaded guilty in Kitsap County Superior Court to one count of first-degree attempted theft, a felony. Zabel was sentenced to 24 hours of community service, a $1,000 fine and $800 in various court fees. According to the investigation, Zabel rear-ended a Honda Accord in March 2014. At the time, Zabel filed a Joshua Zabelclaim with his insurance company, Progressive Insurance, for severe damage to the front of his 2005 Ford Mustang. Progressive denied the claim because he had ...

Los Angeles jury convicts man of murder for $250K in life insurance
June 23, 2016, Los Angeles, CA -- A 31-year-old man was convicted Thursday of killing his brother’s ex-boyfriend in Sun Valley in what authorities said was a plot to collect on a $2.5 million life insurance payout. A Los Angeles Superior Court jury deliberated about seven hours before finding Hachik “Kriss” Maskovian guilty of first-degree murder and attempted kidnapping for the April 24, 2013, killing of Joshua West, the 33-year-old man with whom his brother, Hovanes, had been involved in a long-term romantic relationship. Jurors found true the special circumstance allegations of murder for financial gain, murder while lying in wait and murder during an attempted kidnapping, but rejected ...

Pinellas County doc arrested and charged with multiple offenses related to writing prescriptions for compounded medications
June 23, 2016, Pinellas County, FL -- United States Attorney A. Lee Bentley, III announces the unsealing of an indictment charging Dr. Anthony Baldizzi (52, Tierra Verde) with one count of conspiracy to defraud the United States, twenty-one counts of health care fraud, one count of money laundering, one count of making a false statement, and one count of receiving illegal kickbacks. The health care fraud and money laundering counts each carry a maximum penalty of 10 years in federal prison. The remaining counts each carry a maximum penalty of five years. The indictment also notifies Baldizzi that the United States is seeking a ...

Pine Ridge man indicted for health care fraud
June 23, 2016, Pine Ridge, SD -- United States Attorney Randolph J. Seiler announced that a Pine Ridge, South Dakota, man has been indicted by a federal grand jury for False Statements Relating to Health Care Matters and Attempt to Obtain Controlled Substance by Fraud. William Wounded, age 20, was indicted on March 22, 2016. Wounded appeared before U.S. Magistrate Judge Daneta Wollmann on June 20, 2016, and pleaded not guilty to the Indictment. The maximum penalty upon conviction is up to 5 years in custody and/or a $250,000 fine, 3 years of supervised release, and $100 to the Federal Crime Victims Fund. Restitution may also be ...

Foot doctor in Pennsylvania charged with submitting $5M in bogus claims
June 22, 2016, Delaware County, PA -- Stephen A. Monaco, D.P.M., 59, of Broomall PA was charged by criminal information, unsealed today, in connection with a $5 million scheme to defraud Medicare, Medicaid and four private victim insurance companies, announced United States Attorney Zane David Memeger. The information alleges that Dr. Monaco committed the fraud through his practice, A Foot Above Podiatry, Inc. (“A Foot Above”), located in Havertown PA. According to the information, between January 2008 and October 31, 2014, Dr. Monaco submitted fraudulent claims to Medicare, Medicaid and four private victim insurance companies for podiatric procedures that were not provided, and podiatric procedures that were ...

Chicago cited as hot spot for home healthcare fraud schemes
June 22, 2016, Chicago, IL -- Chicago's home health care industry has a big fraud problem and a federal study released Wednesday suggests more scrutiny may be warranted. The metropolitan area is one of 27 geographic "hot spots" identified by an analysis of Medicare claims data by the U.S. Department of Health and Human Services' Office of Inspector General. The examination found dozens of home health agencies and physicians in the Chicago area whose recent Medicare claims have characteristics similar to those observed in cases of fraud. Federal authorities are paying close attention to home health because it is playing a growing role in U.S. health care as ...

County employee in Arkansas charged with filing $250K in fake auto claims
June 22, 2016, Pulaski County, AR -- A Pulaski County employee was arrested Tuesday morning on 153 charges of theft and fraud after being accused of pilfering nearly $250,000 from the county's vehicle insurance provider since 2008. Wanda Wyatt, 60, of Bryant was placed under arrest after admitting to investigators that she took part in an insurance-reporting scheme, according to an arrest report. She was being held at the Pulaski County jail Tuesday evening on 73 felony counts of theft and 80 felony counts of computer fraud related to submitting or accessing deposits online. Bail was set at $665,000. Wyatt was a 17-year employee with the county's Public Works ...

Woman in Las Vegas falsely reported theft of damaged car in California
June 22, 2016, Las Vegas, NV -- Nevada Attorney General Adam Paul Laxalt announced that Nancy Ramirez Lozano, also known as Nancy Ramirez Montelongo, 42, of North Las Vegas, pleaded guilty to one count of insurance fraud, a category “D” felony. The fraud was committed between October and November 2013. Lozano initiated a claim under a State Farm insurance policy in which she fraudulently represented that her motor vehicle had been stolen while parked in front of her brother’s residence in Las Vegas. Lozano did so knowing that her motor vehicle had been parked in Stockton, California in a damaged condition on the day of the alleged theft. ...

Nationwide healthcare fraud sweep nets 301 people filing $900M in false claims
June 22, 2016, Washington, DC -- Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its ...

Former nurse sentenced to 82 months for stealing and tampering with patient medications
June 22, 2016, East Greenbush, NY -- Nathan Baum, age 31, of East Greenbush, New York, was sentenced today to serve 82 months in prison after admitting to stealing pain medication intended for hospice patients. The announcement was made by United States Attorney Richard S. Hartunian; Special Agent in Charge Jeffrey G. Hughes of the U.S. Department of Veterans Affairs Office of Inspector General, Northeast Field Office; and Acting Special Agent in Charge Russell J. Hermann of the U.S. Food and Drug Administration Office of Criminal Investigations, New York Field Office. Senior United States District Judge Lawrence E. Kahn also imposed a three-year term of supervised release, ...

Syracuse area physician to pay civil penalty for violating the controlled substances act
June 22, 2016, Syracuse, NY -- United States Attorney Richard S. Hartunian announced that his office reached a $30,000 civil settlement with Dr. Anthony A. Ascioti, a Fayetteville, New York anesthesiologist. The settlement was in connection with violations of the Controlled Substances Act. Dr. Ascioti’s Drug Enforcement Administration (DEA) number, which enabled him to prescribe controlled substances, has expired and he has not sought to renew it. In 2015, the New York State Police (NYSP) and the New York State Bureau of Narcotic Enforcement (BNE) received information that an individual was receiving significant amounts of Adderall[1] using prescriptions signed by Dr. Ascioti on prescription pads ...

ERISA precludes man's breach of contract and insurance fraud claims
June 22, 2016, Philadelphia, PA -- The U.S. Court of Appeals for the Third Circuit agreed with a trial court that the Employee Retirement Income Security Act of 1974 (ERISA) pre-empted a Philadelphia man’s breach of contract and fraud claims. Judges D. Michael Fisher, Patty Shwartz and Robert E. Cowen, in a per curiam ruling issued June 16, ruled Andre D. Butler’s claims leveled against Liberty Mutual were groundless and affirmed a prior decision from the U.S. District Court for the Eastern District of Pennsylvania in this matter. “On June 8, 2011, Butler allegedly suffered an injury at work as an employee of Home Depot U.S.A., Inc. He ...

Texas medical center wins legal case against Aetna Life Insurance Company
June 22, 2016, North Cypress, TX -- North Cypress Medical Center has been awarded a resounding legal victory in a case against Aetna Life Insurance Company. In a decision issued on June 15, 2016, the United States Senior Judge, Kenneth Hoyt of the Southern District of Texas, found no merit in Aetna's allegations that North Cypress Medical Center had committed common law fraud, healthcare fraud or misrepresentations in over 44,000 claims at issue. The allegations were fully rejected by the Court, and the Court refused to award any of the $225 million in damages sought by Aetna from North Cypress. The Court found that ...

Governor Cuomo signs landmark legislation to combat the heroin and opioid crisis
June 22, 2016, Albany, NY -- Governor Andrew M. Cuomo today signed landmark legislation to combat the heroin and opioid crisis in New York State. The comprehensive package of bills was passed as part of the 2016 Legislative Session and marks a major step forward in the fight to increase access to treatment, expand community prevention strategies, and limit the over-prescription of opioids in New York. The legislation includes several best practices and recommendations identified by the Governor’s Heroin and Opioid Task Force, and builds on the state’s aggressive efforts to break the cycle of heroin and opioid addiction and protect public health and safety. The ...

N.Y. AG announces landmark civil settlement with Long Island nursing home and its owners
June 22, 2016, Long Island, NY -- Attorney General Eric T. Schneiderman today announced a $28 million settlement of a civil lawsuit that claimed the owners of Medford Multicare Center for Living, Inc. (“Medford”) located in Medford, New York looted the corporation and committed fraud and illegality in operating a business. The civil lawsuits claims were based on a history of criminal conduct by employees of the nursing home, staffing and service cuts and diversion of Medicaid funds to themselves and their controlled entities. The assurance of discontinuance provides that the settlement funds, which will be administered by an Independent Financial Monitor, will in part be used ...

Alabama AG strange announce arrests in Medicaid fraud case
June 22, 2016, Dothan, AL -- George L. Beck Jr., U.S. Attorney for the Middle District of Alabama, and Alabama Attorney General Luther Strange announced the arrests of two individuals on charges that they defrauded the Alabama Medicaid Agency by billing for counseling services that were never provided. Catrina R. Copeland, 43, of Dothan, is the owner of The Counseling Place, a Dothan company that contracted with the Medicaid Agency to provide counseling services to at- risk youth. Stephanie Govan, 41, a resident of Glenwood, was employed by Copeland as a therapist. Both were arrested ...