July 13, 2018, Columbus, OH -- Six current and one former Ohioan who owe more than $269,000 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) were convicted in June on charges related to workers’ compensation fraud.
Those convicted included six employers and one injured worker who was working in Colorado while collecting disability benefits from BWC. Three employers account for the bulk of the restitution owed.
“If these employers had just played by the rules and reached out to us for help when they were struggling, we could have had a better outcome for all involved,” said Jim Wernecke, director of BWC’s special investigations department. “Instead,
July 13, 2018, Harlingen, TX -- Texas Mutual Insurance Co. recently announced that Marcos Ricoy of Harlingen, Texas and Enrique Colon of Deer Park, Texas, pleaded no contest to a felony charge of engaging in organized criminal activity involving workers’ compensation healthcare fraud.
The convictions are in connection to alleged fraud committed by Expert Medical Evaluators International Inc.
Texas Mutual investigated EME, an entity that determined impairment ratings and performed functional capacity evaluations on injured employees in Texas.
Texas Mutual alleged that EME used unlicensed providers to perform services and overbilled Texas Mutual. The investigation led to several indictments by a Travis County grand jury on June 28.
July 13, 2018, Oklahoma City, OK -- SOUTHWEST ORTHOPAEDIC SPECIALISTS, PLLC; ANTHONY CRUSE, D.O.; R.J. LANGERMAN, JR., D.O.; DANIEL J. JONES, M.D.; MEHDI ADHAM, M.D.; DEREK WEST, D.O.; BRIAN LEVINGS, D.O.; SHANE HUME, D.O.; BRAD REDDICK, D.O.; and KRISTOPHER AVANT, D.O., have agreed to pay $670,000 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid, and Tricare, announced Robert J. Troester, Acting United States Attorney for the Western District of Oklahoma, and Mike Hunter, Oklahoma Attorney General.
Defendants Cruse, Langerman, Jones, Adham, West, Levings, Hume, Reddick, and Avant are physicians who practiced medicine at and held ownership in Southwest Orthopaedic. The
July 13, 2018, Chicago, IL -- A Chicago federal judge has agreed to drop a suburban hospital from a lawsuit brought by a doctor who claimed the hospital had submitted phony claims to Medicare, reversing his prior ruling, and saying he now sees the hospital’s alleged involvement in the alleged scheme was minimal at best and Advocate should have been dropped from the case.
The July 3 decision was laid down by U.S. District Judge John Blakey against Dr. Luay Ailabouni. The doctor had lodged a suit in 2013, amended in 2017, on behalf of the federal and Illinois state governments against several physicians and medical groups,
July 13, 2018, Nashville, TN -- The personal health information of thousands of of HIV and AIDS patients in central Tennessee was left available for any employee of a regional health agency to access upon for a nine-month period, Nashville health officials acknowledged this week.
The data breach, which was reported by the Tennesseean newspaper, exposed patients being treated by the Nashville Metro Public Health — which covers Nashville and 12 surrounding counties — including names, addresses and dates of birth, along with much more intimate details like HIV statuses, sexual orientations, gender identities and drug-use histories.
The database, which contains information from the Centers for Disease Control
July 13, 2018, Washington, DC -- The cost of a data breach for healthcare organizations continues to rise, from $380 per record last year to $408 per record this year, as the healthcare industry also continues to incur the highest cost for data breaches compared to any other industry, according to a new study from IBM Security and the Ponemon Institute.
The global average cost of a data breach is up 6.4 percent over the previous year to $3.86 million, according to the 2018 Cost of a Data Breach study. The average cost for each lost or stolen record containing sensitive and confidential information, globally and across
July 13, 2018, York, -- The 16-day jury trial for a wife accused of shooting her husband in 2016 has been continued until next year.
The case against Lynn Fogarty, 34, was originally scheduled for a jury trial this month — which would have started Monday — but has been continued until Jan. 22, online court records show.
York-Poquoson Commonwealth’s Attorney Benjamin Hahn said Andrew Sacks, Fogarty’s defense attorney, asked for the continuance to have additional time to prepare for the trial. Prosecutors did not object to Sacks’ request.
“The reason for the requested continuance was to enable the defense to have additional time to adequately and effectively
July 13, 2018, Philadelphia, PA -- A Philadelphia woman admitted Thursday that she tried to get a fraudulent prescription for oxycodone filled at a West Reading pharmacy in November 2016.
Gabrielle Jaslow was later connected to and charged in the bust of a prescription drug ring that passed more than 100 fake prescriptions in Berks, Bucks and Lancaster counties and Philadelphia.
Jaslow, 39, pleaded guilty before Judge M. Theresa Johnson to attempting to acquire, obtain or possess a controlled substance through misrepresentation, fraud or forgery and possession of a controlled substance.
Johnson sentenced Jaslow to a time-served penalty of 134 days to 23 months in Berks County Prison followed
July 13, 2018, Cedar Falls, IA -- Two Northeast Iowa nurses have been arrested for allegedly taking painkillers from patients.
In separate cases, federal grand jury returned indictments charging Lacey Staveley and James Allen Moorehead with prescription drug fraud and making false health-care statements.
Staveley, of Evansdale, had been working Cedar Falls Health Care Center in November 2016 when she allegedly took hydrocodone-acetaminophen tablets intended for two nursing home patients and then falsely indicated on medical records that the medicine had been administered.
July 13, 2018, Baton Rouge, LA -- In the past few weeks our area has had several instances of prescription fraud. According to arrest reports West Monroe Police charged a Baton Rouge man on two counts of attempt to obtain prescription by fraud. Pharmacists stepped in and notified police when the man tried on two different occasions to fill a prescription for Promethazine with Codeine and Oxycodone.
Metro Narcotics arrested a Monroe man and woman earlier this month for trying to fill a prescription with a stolen prescription pad.
Opioid related deaths are on the rise in the United States. According to the Centers for Disease Control and
July 13, 2018, Dallas, TX -- A Dallas woman with a history of filing 31 insurance claims against a dozen companies got burned when one turned out to be arson.
Genevieve Thompson was sentenced this week to 30 years in prison after Dallas Judge Tracy Holmes found Thompson intentionally set her house on fire to collect insurance money. Thompson pleaded guilty to arson and insurance fraud.
On June 12, 2017, the Dallas Fire Department was called to a house fire on Rock Bluff Drive. An investigation found that the fire had been started on purpose. The Texas Department of Insurance Fraud Unit assisted the Dallas Fire Department on
July 13, 2018, Adair County, KY -- An Adair County man has been found guilty of criminal acts in connection with a fire in Adair County back in 2011 during which an Adair County firefighter suffered a heart attack and later died. According to the U.S. Attorney’s Office for the Western District of Kentucky, a U.S. District Court Jury in Bowling Green found 44 year old Steve Allen “Boo” Pritchard of Columbia guilty of arson and insurance fraud. The five day trial ended Friday, July 13th. It’s being alleged that Pritchard, along with his girlfriend, conceived a plan to set fire to their rental home on June
July 13, 2018, Lewiston, ID -- Two Idaho men have been sentenced for insurance fraud.
Michael T. Wilson, 48, and 39-year-old Jason L. Knabe, both of Lewiston, were sentenced on Wednesday in unrelated cases.
Wilson pleaded guilty to one count of Insurance Fraud in May, according to Idaho Attorney General Lawrence Wasden. Knabe pleaded guilty to one count of Insurance Fraud in April.
Second District Court Judge Jay Gaskill sentenced Wilson to a unified sentence of three years, which was then suspended in favor of three years probation, a news release from Wasden’s office said. Wilson was ordered to serve 40 days in the county jail with 30 days
July 13, 2018, Dayton, OH -- A Dayton man was one of six Ohioans convicted on charges related to workers compensation fraud, the Ohio Bureau of Workers’ Compensation said.
Randall Mount of Ram Restoration at 11125 Yankee Street in Centerville was convicted of not operating with workers’ compensation coverage. Mount pleaded no contest to a second-degree misdemeanor for failure to comply after the Bureau of Workers’ Compensation found he had been operating his business without coverage since 2016. He owes more than $190,000.
The bureau worked with Mount to bring his policy up-to-date, but Mount failed to follow through, according to the Bureau of Workers’ Compensation.
A judge advised
July 13, 2018, Los Angeles, CA -- A former civilian employee of the Los Angeles Police Department pleaded guilty today to one felony count of insurance fraud, the Los Angeles County District Attorney's Office announced.
Gerald Ray Pulley (dob 12/5/66), who worked as a senior clerk typist, will have the charge reduced to a misdemeanor if he pays restitution of $3,491 and does 50 hours of community service as part of the negotiated plea agreement. He is scheduled to return for a sentencing hearing on July 12, 2019, in Department 50 of the Foltz Criminal Justice Center.
Deputy District Attorney Arunas Sodonis of the Healthcare Fraud Division said Pulley
July 13, 2018, Manhattan, NY -- The construction company that oversaw a Financial District work site where a man fell 29-stories to his death pleaded guilty to manslaughter and paid more than $800,000 in restitution to victims of wage theft and to the state for insurance fraud schemes, the Manhattan district attorney announced.
SSC High Rise Inc. pleaded guilty to manslaughter in the second degree Friday for causing the death of construction worker Juan Chonillo, 44, because of equipment that skirted city regulations at 161 Maiden Lane near South Street.
The company was also forced to pay $568,700 in restitution for six years worth of wage theft from
July 13, 2018, Denver, CO -- Vernon Jones dropped his car off at a pop-up hail dent repair tent but says the company never finished the job and forged his signature to get more than $5,000 from his insurance company.
As Jones sits on his couch in his Security-Widefield home, his Dodge Ram Pickup truck is sitting in a parking lot at 1950 S. Academy next to the "AAG Auto Hail Repair" tent.
Jones says the company demanded the unsigned $5,470 insurance check up front to ensure they would get their money. When the repairs were done, Vernon says he was to sign the check and
July 12, 2018, Detroit, MI -- A doctor accused of orchestrating a $112 million health care fraud is a lying bully who hid millions of dollars in offshore bank accounts while threatening to "break the legs" of one associate and entrapping another with exotic dancers, prosecutors said.
Prosecutors, court records and social-media posts portray Dr. Frank Patino as a conniving crook with lies as big as his biceps, an alligator-wrestling, steroid-buying, frequently shirtless fraudster who spent ill-gotten gains on mixed martial arts fighters and a vanity diet program.
More than $2 million remains missing amid a hunt for money stretching from Metro Detroit to the Cayman Islands.
July 12, 2018, Dedham, MA -- A previously deported Dominican National was arrested on federal healthcare fraud, welfare fraud, aggravated identity theft, misuse of a social security number and illegal reentry charges.
Carlos José Portes-Ortiz, a.k.a. Juan Carlos Mendieta Vega, a.k.a. Anthony Clausell Rivera, a.k.a. Jose Jimenez Agosto, a.k.a. Willian Acevedo Gil, a.k.a. Allison Gabriel, 37, of Pawtucket, has been ordered detained on a federal criminal complaint charging him with healthcare fraud, welfare (SNAP) fraud, misuse of social security numbers, aggravated identity theft and illegal reentry.
The case is being prosecuted by Assistant U.S. Attorneys Ly T. Chin Terrence P. Donnelly.
According to court documents, it is alleged
July 12, 2018, Baton Rouge, LA -- West Monroe police arrested a Baton Rouge man on two counts of attempt to obtain prescription by fraud on Saturday after a local pharmacy notified authorities of a suspect trying to fill a fake prescription.
The pharmacy showed officers the fake prescription for Promethazine with Codeine submitted by Andre Macarthur Whaley, 27, of 2767 Barlett St., Baton Rouge. Whaley also had tried to fill another prescription for Oxycodone 40mg, according to the pharmacy. At the time, the pharmacy had not yet detected the prescription as fake so it returned it to Whaley, according to the July 7 arrest report.
Whaley returned to
July 12, 2018, Fayetteville, NC -- North Carolina Insurance Commissioner Mike Causey today announced the arrest of Miguel Rodriguez, 46, of 7665 Southbend Drive, Fayetteville. Rodriguez was charged with felony insurance fraud, felony obtaining property by false pretense, and two counts of felony identity theft.
Special agents from the Department of Insurance’s Criminal Investigations Division accuse Rodriguez of falsely representing himself under the name of Nelson Lopez when filing auto accident claims. Rodriguez received two electronic checks totaling $10,931 from Farm Bureau Mutual Insurance Co., according to arrest warrants.
One identity theft offense occurred on July 5, 2014, while the remaining offenses occurred between March 23, 2017, and
July 12, 2018, Philadelphia, PA -- A former head of a Philadelphia nonprofit mental health clinic was sentenced to 82 months in prison for perpetrating a multiyear fraud scheme through which she stole over $2 million from the clinic that she headed, announced Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division and U.S. Attorney William M. McSwain for the Eastern District of Pennsylvania.
On June 23, 2017, a jury found Renee Tartaglione, 62, of Philadelphia, Pennsylvania, guilty of 53 counts of conspiracy, fraud, theft and tax crimes. Today, U.S. District Court Judge Joel H. Slomsky sentenced Tartaglione to serve 82 months
July 12, 2018, Bethel, AK -- The owner of Bethel’s Tundra Suites hotel has been charged with Medicaid fraud.
When Medicaid recipients fly to Bethel for medical appointments, they pay for their food, hotel rooms and cab rides with vouchers in lieu of payment. Local companies then use those vouchers to bill Medicaid for reimbursements. Tundra Suites’ owner, Chin S. Kim, age 58, is accused of billing the government for Medicaid recipients who never actually stayed at his hotel. Alaska’s Office of Special Prosecutions has also charged Tundra Suites employee Mi Ae Young, age 56, in the alleged scheme.
According to charging documents filed with the court last
July 12, 2018, Lincoln, GA -- A Lincoln doctor accused of obtaining prescription drugs by fraud pleaded not guilty at his initial appearance on the indictment Wednesday in U.S. District Court in Omaha.
Dr. Jeffrey Fraser is released on bond.
In a June 20 indictment, he is accused of using patients and employees to obtain hydrocodone and oxycodone for his personal use between March 2014 and January 2018.
Fraser, 61, also is accused of being addicted to hydrocodone and oxycodone and in possession of a Smith and Wesson .38 Special revolver.
If convicted, Fraser could get up to 14 years in federal prison and be fined up to $500,000.
July 12, 2018, Maui, HI -- A 60-day jail term was ordered for a man who said he was trying to protect his teenage son when he filed a false insurance claim after the youth got into an accident.
Patrick Kaleo Henriques 42, was placed on four years’ probation as part of his sentence Tuesday.
Special Deputy Attorney General Colleen Chun said that after the collision in 2016, Henriques applied for insurance coverage for his truck that the 14-year-old boy was driving and asked the other party to lie about the date of the accident.
“Finally, the victim came clean because he didn’t want to be accused of fraud