News

Car owner in N.J. gets probation, fine for faking theft report
September 18, 2014, Long Valley, NJ -- A Long Valley man was sentenced to two years probation and $824 in fines for lying to a police officer about whether or not his vehicle was stolen on Feb. 3, according to the prosecutors' office. Steven W. Averett, 27, was sentenced by Judge Thomas J. Critchley in Superior Court in Newton on Sept. 15. He was given credit for 25 days served in jail. He pleaded guilty on July 21 to fourth-degree making a false statement to a law enforcement officer, driving while suspended, driving without insurance and driving an unregistered vehicle. Averett was represented by public defender David Nufrio and the ...

Task force in Michigan recommends creation of insurance fraud authority
September 18, 2014, Lansing, MI -- Michigan should create a special authority devoted to targeting auto insurance fraud and require insurers to more frequently send electronic verification of drivers' insurance to the state, a task force recommended Wednesday. The panel, created a year ago by Secretary of State Ruth Johnson to investigate ways to reduce insurance fraud, also said the state insurance department should have expanded powers to penalize people operating as insurance agents without a license. The recommendations were among 17 proposed — some to the Legislature, others proposed as partnerships between state government and the insurance industry, and many to be taken up administratively by Johnson's ...

Yakima man convicted of murder-for-hire
September 17, 2014, Yakima, WA -- As he did for much of his three-week trial for first-degree murder in the death of a Yakima real estate broker, Daniel Blizzard showed no emotion Tuesday when a jury found him guilty. Blizzard was accused of arranging an attack on prominent Yakima real estate broker Vern Holbrook in May 2013. The 79-year-old Holbrook died in January of complications from the injuries suffered in the attack. Prosecutors said Blizzard hired two people to pose as homebuyers to lure Holbrook to a house, where he was brutally beaten and his throat was slashed. After the verdict was announced, Holbrook’s granddaughter, Corie Ratliff, said her ...

Chesapeake couple found guilty of health care fraud
September 17, 2014, Norfolk, VA -- A federal court jury Tuesday found W. Wayne Perry, the owner of a home health care company, and his wife guilty on all 18 counts of health care fraud and related charges for stealing $1.3 million from Medicaid. Angela Perry began weeping at the sound of the first "guilty," and her husband hung his head in his hands. "Obviously, we're disappointed with the result, but we respect the jury's verdict," said Gray Broughton, one of Wayne Perry's attorneys. Andrew Sacks, who represented Perry's wife, said, "I certainly felt there was ample reasonable doubt." Former employees of Perry's now-defunct company, Community Personal Care Inc., which ...

Fraudulent insurance claims running at 500 a day
September 17, 2014, none, none -- Many Britons appear to take the view that honesty is not the best policy when it comes to taking out car insurance. Industry figures showed firms are uncovering almost 3,500 fraudulent applications each week. The Association of British Insurers (ABI) revealed that in 2013, UK insurers detected 180,675 attempted fraudulent applications for motor insurance – equivalent to 495 a day. These cases involve motorists lying about, or knowingly failing to disclose, important information such as previous claims or unspent motoring convictions when asked. This is the first time the association has collected information on the extent of fraudulent car insurance applications, so ...

Investigators torch car as part of workshop on auto arson
September 17, 2014, Greensboro, NC -- Here's something you hope you never see or experience in person: a vehicle fire! The flames and smoke were intense. Thankfully, the car fire is just a demonstration. The fire was intentionally set to help insurance investigators from around the world detect auto insurance fraud. The investigators are members of the International Association Of Special Investigation Units (IASIU). They're in Greensboro for their annual seminar, and spent part of the day learning about burn patterns and techniques to figure out if a fire was intentonally set, or if it was an equipment malfunction. Insurance fraud is big business in North Carolina. In ...

Pair in Tennessee charged with selling Medicaid-paid drugs
September 17, 2014, Weakley County, TN -- Two people are charged in Weakley County with TennCare fraud related to allegedly selling prescription drugs paid for by the state's health care insurance program, according to a news release. The Office of Inspector General today announced the arrest of Oswaldo Rodriguez, 46, and Crystal R. Lecrone, 25, both of Dresden. They were charged separately by a Weakley County grand jury. Rodriguez is accused of using TennCare to obtain Neurontin, a drug used in certain cases for extreme pain management. Lecrone is accused of using TennCare benefits to pay for her prescription of the painkiller hydrocodone. After obtaining the prescriptions, both Rodriguez and Lecrone ...

Two men in N.J. charged with torching boat for $100K in insurance $
September 17, 2014, Ocean County, NJ -- Two southern New Jersey men stand accused of roles in a marina fire that severely damaged the facility and several boats. Ocean County prosecutors say Bruce Roslin and Jonathan Dockery, both of Little Egg Harbor Township, face charges in an 18-count indictment. Prosecutors say the 44-year-old Roslin paid the 32-year-old Dockery to set fire to his 26-foot boat, which was docked at the Tuckerton Marine Service Center. The boat was destroyed in the September 2009 fire, and Roslin received more than $100,000 in insurance money. Roslin and Dockery are both charged with arson for hire, conspiracy to commit aggravated arson and other counts. ...

Drug diversion charges levied against doctor in West Virginia
September 17, 2014, Martinsburg, WV -- A Martinsburg doctor already facing a disciplinary hearing by a state medical board has been indicted on federal charges that she illegally prescribed prescription painkillers, a prosecutor said Wednesday. A grand jury in U.S. District Court in Martinsburg indicted Dr. Tressie Montene Duffy on 100 felony counts of aiding and abetting the distribution of four controlled substances from April 2010 to February 2012, U.S. Attorney William J. Ihlenfeld said. Duffy, 44, is CEO and owner West Virginia Weight and Wellness Inc. Office assistant Amanda Clark and AIT Laboratories employee Tracie Colbert, both of Martinsburg, were indicted on similar charges. The indictment accuses Duffy ...

Insurer exec in Maryland charged in $100-million premium scam
September 17, 2014, Reisterstown, MD -- The owner of a Maryland-based insurer faces fraud charges for inflating the ratings of his company to win business, according to an indictment which seeks to recover more than $100 million in premiums his clients paid. Jeffrey Cohen, 39, of Reisterstown, Maryland, deceived ratings firm A.M. Best Co. as well as regulators in Delaware and Washington with false financial documents that purported to show his company, Indemnity Insurance Corp. RRG, in stronger health than it was, according to a 12-count indictment handed up yesterday in federal court in Baltimore. Cohen used the fraudulent ratings from January 2008 through fall 2013 to woo ...

Hospital employee in Pennsylvania files whistleblower suit, alleging false billing
September 16, 2014, Philadelphia, PA -- A former Abington Memorial employee has filed a lawsuit in federal court for being fired after pointing out what she claims was Medicare and Medicaid “insurance fraud” by the hospital. Joanne Cleighton, of Roslyn, a 26-year employee of the AMH, alleges in the lawsuit that the hospital submitted false claims for reimbursement by changing orders for blood work. Cleighton came across the alleged fraud in May 2013 when she was manager of patient access, in charge of 40 employees whose work included entering patient insurance and billing information, according to the complaint filed in the U.S. District Court for the Eastern District ...

Woman in Illinois admits to participating in staged auto crash ring
September 16, 2014, Valparaiso, IL -- A Valparaiso woman will plead guilty to her role in an automobile insurance fraud ring that was run out of Michigan City, according to plea agreement. According to the agreement, filed last week in the U.S. District Court in Hammond, Roberta Butler, 31, will plead guilty to one count of conspiracy to commit mail fraud, a charge that comes with up to five years in prison. Butler admits in the deal that she started taking part in the conspiracy in December 2005. She and others would stage car crashes and then report them to police departments in Northwest Indiana and the Chicago ...

Work comp insurer suing former NFL player for lying about football injury
September 16, 2014, Tampa, FL -- Former Tampa Bay Buccaneer Brad Culpepper is being sued by a California insurance company that asserts he fabricated ailments and injuries while leading an active life as a mixed martial arts practitioner. Nearly four years ago, Culpepper filed for workers' compensation for injuries he suffered playing in the NFL. Doctors who examined him concluded that he was 89 percent disabled, and the insurance company, Fairmont Premier, gave him a $175,000 settlement. But what began as a claim similar to those made by other NFL players as well is now headed to court. In a lawsuit filed in Orange County, Calif., in July, attorneys ...

Cancer doc in Michigan pleads guilty to lying about diagnosis
September 16, 2014, Oakland Township, MI -- Former patients of Oakland Township cancer specialist Farid Fata said there are still many unanswered questions after the doctor pleaded guilty to 16 federal charges against him. “I was told every single month that I was terminal. I rushed to take trips and try to make memories for my grandkids, gave things away, watched my husband go into depression ... and everything was a lie,” said Clarkston resident Patty Hester, 60, a former patient. “How does that happen? I want to know the plan of action for the people — I want to know the whole story.” Fata, the owner of the Rochester-area ...

Aledo woman guilty of insurance fraud
September 16, 2014, Aledo, IL -- A former Aledo Walmart pharmacy employee has pleaded guilty to a Class A misdemeanor of insurance fraud. Laura Diehl of Aledo was placed on 24 months conditional discharge Monday in Mercer County Circuit Court. In exchange for her guilty plea, felony controlled substance and forgery charges were dismissed. Mercer County State’s Attorney Greg McHugh said she also has agreed to testify against two co-defendants in the case — Robert Osborn of Rock Island and Paul DeWilde of Silvis. The two are awaiting trial this fall. A fourth defendant, Tara Speck of Monmouth, was placed on 24 months probation, ordered to complete 30 hours ...

Here's how to fight Medicare scams
September 16, 2014, Washington, DC -- Charles Clarkson has some advice for senior citizens. He wants seniors to check and review their Medicare statement. You need to do that if you want to make sure you're not getting ripped off. "Protect their Medicare number at all times from people they don't know or can't trust," said Clarkson, project director at Senior Medicare Patrol of New Jersey. Senior Medicare Patrol battles Medicare fraud through raising awareness and offering help to seniors. "Our job is twofold; to educate seniors about fraud, waste and abuse in Medicare so they will not become victims," Clarkson said. "We also help seniors review any cases ...

Ambulance Company Manager Pleads Guilty to $5.5 Million Medicare Fraud Conspiracy
September 16, 2014, Los Angeles, CA -- The general manager of a Southern California ambulance company pleaded guilty yesterday in Los Angeles to conspiracy to commit Medicare fraud, conspiracy to obstruct a Medicare audit, and making materially false statements to law enforcement officers. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Acting U.S. Attorney Stephanie Yonekura of the Central District of California, Special Agent in Charge Glenn R. Ferry of the Los Angeles Region of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Director in Charge Bill Lewis of the FBI’s Los Angeles Field Office made the ...

Jim Anderson: Progressive Insurance Adopts BAE’s Anti-Fraud Tool to Evaluate Claims
September 16, 2014, Washington, DC -- Progressive Insurance has adopted BAE Systems‘ anti-fraud technology in an effort to identify potentially fraudulent activities in personal auto insurance claims. The insurance company will incorporate the BAE Systems Applied Intelligence-built NetReveal insurance counter-fraud tool for internal systems and operations, BAE Systems said Monday. “Our NetReveal solution will help Progressive with evaluating the risk of claims throughout the lifecycle, reducing fraud leakage on a pre-payment versus post-payment basis,” said Jim Anderson, president of the Americas at BAE Systems Applied Intelligence. Progressive Insurance will use NetReveal’s network analytics and case management system in an effort to detect potential fraud earlier in the claims lifecycle. “The ...

Four fraud fighters honored at annual seminar of IASIU
September 15, 2014, Greensboro, NC -- imageThe International Association of Special Investigation Units (IASIU) honored four of its members for outstanding work in combating fraud and furthering the mission of the association. Honored were: • Investigator of the Year: Phillip Battin, an investigator for Nationwide Insurance, who played a lead role in busting a staged auto crash ring in Las Vegas. The ring caused crashes with tractor trailers and filed numerous claims involving 98 claimants. • Analyst of the Year: Mike Haug from Farmers Insurance, whose data mining skills uncovered multiple accident claims from a Texas man who claimed the expensive equipment he was ...

Feds indict x-ray lab owner in Maryland for $7.5M billing scam
September 15, 2014, Owings Mills, MD -- The owner of an Owings Mills medical firm is accused of defrauding Medicare and Medicaid of more than $7.5 million in a federal indictment unsealed Monday. Federal prosecutors say Alpha Diagnostics owner Rafael Chikvashvili, 67, of Baltimore created false examination reports, submitted insurance claims for medical procedures that were never performed by licensed physicians, and overbilled Medicare and Medicaid, among other fraudulent acts. The X-ray company's offices in Owings Mills and Harrisburg, Pa., were raided last October by the FBI. Chikvashvili directed his employees, who were not doctors, to interpret X-rays, medical tests, ultrasounds and cardiological exams, rather than paying licensed physicians to ...

Law firm manager in Texas gets 14 years for $3M auto injury scheme
September 15, 2014, Bryan , TX -- A former law office manager from Bryan was sentenced to 14 years in federal prison Monday after he was convicted of trying to cheat automobile insurance companies out of $3 million. According to the U.S. Attorney's Office, 41-year-old Earlie Dickerson worked at Houston-based Sanjoh & Associates, and he and four other people engaged in a conspiracy to defraud auto insurance companies from 2007-2009. Prosecutors say Dickerson recruited people involved in auto accidents to be represented by the Sanjoh law firm. They say he then sent those people to specific clinics where his associate, 46-year-old Chase Lindsey, was the only chiropractor. ...

Twin sisters in Mass. charged with stealing IDs to file false health claims
September 15, 2014, Boston, MA -- Twin sisters who formerly lived in Burlington have been indicted and arrested in connection with allegations that they billed public agencies for unlicensed psychological services, often using stolen identities to conceal the fraud, Attorney General Martha Coakley announced today. Nita Guzman, through her company New England Psychological Consultants, Inc., allegedly billed Medicaid, Medicare, and Lawrence Public Schools more than $550,000 for unlicensed mental health services. Her twin sister, Nina Tischer, through her company PsychSupport, Inc., billed a division of UMass Medical School more than $30,000 for unlicensed psychological examinations. Neither sister is a licensed psychologist, a legal requirement for practicing psychology in ...

Indictment: Toms River man lied about Sandy roof repairs
September 12, 2014, Toms River, NJ -- A Toms River man was indicted Thursday on a charge of attempting to defraud his homeowner’s insurance company of nearly $80,000 by claiming he had made Sandy-related repairs to his roof when he hadn’t, according to state prosecutors. Louis Ciardi, 55, was charged with second-degree insurance fraud and second-degree theft by deception in a state grand jury indictment, according to acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor. Second-degree crimes carry a maximum sentence of 10 years in prison and a $150,000 fine. The charges stem from a homeowner’s insurance claim filed for partial roof repairs ...

Contractor in Georgia charged with workers comp premium fraud
September 11, 2014, Savannah, GA -- The owner of a Savannah-area paint and contracting business was arrested Wednesday by state authorities, who charged him with insurance fraud and accuse him of defrauding insurance companies of about $50,000 in workers’ compensation premiums. Cesar A. Martinez, owner of Martinez Painting Pros, was charged with insurance fraud and forgery in Effingham and Chatham counties, said Stan Bexley, director of the Enforcement Division of the state board of Workers’ Compensation. Martinez, 40, was taken to the Effingham County jail. Martinez, whom Bexley described as a Rincon and Savannah business owner, operates Martinez Painting Pros, a paint and contracting business that provides residential ...

Former insurance broker found guilty of failing to forward $2.5m of premiums to insurers
September 11, 2014, Auckland, none -- Grant Herbert, the former owner and director of failed insurance broking firm Herbert Insurance Group, has been found guilty on 24 of 26 charges he was facing following a Serious Fraud Office investigation. Auckland District Court has been told that between 2005 and March 2011, Herbert failed to forward about $2.5 million of client premiums to insurers, diverting the money to meet his company's operating expenses. Some clients were left uninsured as a result. Herbert, 62, was remanded on bail on Thursday and will be sentenced on October 16 after being found guilty of 17 Crimes Act charges and seven Secret Commissions Act ...