News

Insurance agent in Penn. gets probation for unauthorized sales
August 21, 2017, Altoona, PA -- A former Altoona insurance agent will be on probation for seven years after pleading guilty Friday to an insurance fraud charge. Christopher Drenning, 32, Moon Township, Allegheny County, has also agreed to make restitution to be determined at a forthcoming hearing. Charges filed by the state attorney general’s office indicate that Drenning sold a health insurance plan to a Hollidaysburg company in 2014 even though he had no authorization to do so. When employees with that company tried to use the plan, coverage was denied. Charges indicate that Drenning, at the time of the offense, was working independently with the Teeter Group of ...

Editorial: Healthcare fraud fight paying good dividends in NJ
August 20, 2017, Trenton, NJ -- When politicians as diverse as Donald Trump and Jon Corzine promise tax cuts -- or no new taxes for budgets in dire straits -- they wiggle out of answering the question of how they'll keep the government running by relying on a magic bullet: "Waste, fraud and abuse." Corzine once said that, as governor, he could send pink slips to a third of the state's administrative employees in such area as public relations, without any ill effects. Lt. Gov. Kim Guadagno, in her current gubernatorial campaign, offers "audits" when asked how she'd pay for a $1 billion property tax cut plan. They're all ...

Doctor in Florida gets year in prison for false billing
August 19, 2017, Gainesville, FL -- A Gainesville doctor convicted of 162 counts of health care fraud for false billing and using drugs not approved in the United States was sentenced Friday to effectively serve one year in prison and to pay a fine of more than $1.13 million plus restitution. Ona Colasante, who had practices in Gainesville and Hawthorne, was convicted in May 2016 and sentenced Friday in federal court. Colasante was ordered to serve one year and one day in prison on each count. The terms will run concurrently, said Amy Alexander, a spokeswoman for the U.S. Attorney’s Office, in an email. Also, Colasante will serve three ...

Marines in California recruited to aid $67M healthcare scam
August 19, 2017, San Diego, CA -- Federal authorities say Southern California Marines were recruited for a scheme that bilked the government's military health insurance provider out of $67 million. The San Diego Union-Tribune (http://bit.ly/2v1kixi) says a complaint was filed Thursday in San Diego as part of a civil asset forfeiture case. Authorities are trying to seize the property of a Tennessee couple. Investigators say Marines were recruited at up to $300 a month for a so-called medical study that involved phone consultations with a doctor's office in Cleveland, Tennessee, owned by Jimmy and Ashley Collins. The Marines were prescribed costly compound drugs. A pharmacy in Bountiful, Utah, filled thousands of ...

Journal: Litigation loans a gateway to more scams
August 18, 2017, Washington, DC -- A concerning trend in claims management and civil litigation that will have a major impact on insurance fraud is the emergence of “investments” in personal-injury litigation by third-party lenders. Traditionally, personal-injury attorneys finance suits from their own pocket. That includes costs of taking a personal-injury civil matter to trial. Filing fees, process servers, stenographers and expert fees are a risk borne by the plaintiff’s attorney. Reimbursement is realized only if the suit is successful. Thus, before pursuing a claim/litigation, a personal-injury attorney has an incentive to carefully screen potential clients and their claims. If financing is required, attorneys obtain a loan ...

Cancer providers accused of illegal patient referrals
August 17, 2017, Fort Myers, FL -- Two of the nation’s largest cancer-care providers are accused of engaging in an illegal “gentleman’s agreement” to divide up treatment services in Florida. The allegation against Florida Cancer Specialists & Research Institute and 21st Century Oncology lists multiple claims — gender discrimination, fraudulent Medicare billing and unsafe medical practices — against the companies in a 50-page federal whistleblower lawsuit filed last year that had, until recently, been under seal and out of the public eye. According to the lawsuit, Florida Cancer Specialists and 21st Century Oncology paid “millions of dollars to each other in the form of exclusive patient referrals in order ...

Houston home-health owner handed 40 years in jail
August 17, 2017, Houston, TX -- The owner of a string of Houston home health care clinics was sentenced to 40 years in federal prison Thursday for a brazen scheme involving more than $17 million in fraudulent Medicaid and Medicare billing. "I'm not here to pass the buck," Godwin Oriakhi, who ran the five clinics, told U.S. District Judge Sim Lake before sentencing. "I never set out in any way to defraud the government." Defense lawyer Sean Ryan Buckley said prior to sentencing that Oriakhi did not live an opulent life but got caught up trying to pay expenses for his business. "Like so many Medicare cases we see ...

New Jersey pain doc insists fraud charges are false
August 17, 2017, Jersey City, NJ -- The state Attorney General's Office has charged a Jersey City physician with three counts of health care claims fraud, officials said. While providing professional services between May 22 and July 17, Dr. Subramaniam Khanthan, 75, of Kearny, submitted fraudulent claims for reimbursement to an insurance company, the criminal complaint says. Reached this afternoon, Khanthan said "All the charges are false. They will be dropped." The claims, for physical therapy, contained false, fictitious, fraudulent or misleading statement regarding the treatment or assessment of each patient, the complaint says. An online medical website lists his specialties as pain management and anesthesiology. Khanthan, whose specialties are listed ...

Swindlers steal $28 million using phony scripts in New Jersey
August 17, 2017, Camden, NJ -- A pharmaceutical representative from Linwood said he knowingly defrauded a health care benefits program of $28 million using phony prescriptions through a network of recruiters, doctors and public employees. Matthew Tedesco, 42, pleaded guilty Thursday to health care fraud charges before U.S. District Judge Robert B. Kugler for leading a conspiracy that netted him $11 million in profit in little more than a year. In a plea deal with prosecutors, Tedesco and Robert Bessey, 43, of Philadelphia, described a massive prescription fraud scheme that involved recruiting public employees — teachers, firefighters, municipal police officers and a state trooper — to obtain prescriptions ...

Windshield replacement cons drive up Florida auto premiums
August 17, 2017, Tampa Bay, FL -- According to the Florida's insurance commissioner, windshield replacement schemes are driving up the price of auto insurance throughout the state. The issue is most rampant in the Tampa Bay area. It involves drivers with cracked windshields signing over their insurance benefits to repair contractors, some of which then pursue payments from insurance companies at inflated prices. Known in the industry as "assignment of benefits," insurers say the practice has become riddled with fraud and abuse, often at no fault of the actual policyholder. Under Florida law, windshield replacement claims cost nothing out of pocket for insured drivers, making it a lucrative opportunity for those ...

More charges filed against alleged Minnesota staged crashers
August 17, 2017, Minneapolis, MN -- More charges have been filed against several chiropractors accused of being involved with parallel fraud schemes that allegedly swindled insurance companies out of more than $20 million, the Minnesota Department of Commerce announced Thursday. A total of 26 people, including seven chiropractors, now face federal charges. Minnesota Commerce Commissioner Mike Rothman said in the news release that four defendants in the case, all Twin Cities chiropractors, face additional charges of mail fraud and wire fraud. They are Adam J. Burke of Minneapolis, Preston E. Forthun of Bloomington, Huy Ngoc Nguyen of Brooklyn Park and Angela A. Schulz of Chaska. In March, chiropractor Timothy ...

Florida pair headed to prison for staging crashes in Michigan
August 17, 2017, Grand Rapids, MI -- Two Florida men are headed to prison for their role in an elaborate scheme to rip off insurance companies with no-fault policies by staging car crashes in West Michigan. Belkis Soca-Fernandez was sentenced Thursday to 11 years, three months in prison, according to federal officials. David Sosa-Baladron was sentenced to 10 years in prison. They will also have to pay $675,066.96 in restitution to the companies they defrauded. In March, the 47-year-old Soca-Fernandez and 42-year-old Sosa-Baladron — both of Tampa — were convicted in federal court of health care fraud and conspiracy to commit mail fraud in a scheme U.S. District Judge ...

Blog: Cost of air-ambulance transport flies high
August 16, 2017, Washington, DC -- Billing practices of air-ambulance services is a “hot topic” among many insurance groups. The question involves the large and often unexpected charges airborne transports can impose on insurers and consumers. Patients may need air transport when they’re physically and mentally unable to give consent, or to understand the cost impact or options. No one questions the value of emergency air transport in times of great medical need. Yet issues abound about how the services are billed and paid for. An air ambulance may sit unused for hours or even days, but expenses are constantly being incurred. Often four crews of pilots and medical ...

Rehab exec: Florida health insurers must pay for outcomes
August 16, 2017, Palm Beach, FL -- Widespread incidents of fraud have given the South Florida addiction treatment industry a black eye. Law enforcement has been cracking down — with strong support from the treatment industry’s legitimate providers. Andrew Burki is CEO of Life of Purpose, an addiction treatment center on the Florida Atlantic University Campus in Boca Raton. He’s been working with the Palm Beach County Sober Home Task Force to increase oversight and close loopholes exploited by unscrupulous operators. Burki spoke with WLRN’s Peter Haden about steps that could clean the abuse. BURKI: If you built cars and 90 percent of them broke down, you would ...

Unlicensed Texas chiro bills under names of licensed colleagues
August 16, 2017, Bushland, TX -- Thomas Roy Clark, 52, of Bushland pleaded guilty Wednesday to one count of health care fraud stemming from a scheme to defraud insurance companies through the submission of improper billing. The announcement was made Wednesday by U.S. Attorney John Parker of the Northern District of Texas. Clark, who remains on bond, faces a maximum statutory penalty of 10 years in federal prison, a $250,000 fine, and may be ordered to pay restitution. Sentencing is scheduled for Nov. 29, 2017, before U.S. District Judge Sidney A. Fitzwater. According to documents filed in the case, from July 1, 2012 through July 31, 2015, Clark ...

Chicago foot doc’s con stamped out with 7-year sentence
August 16, 2017, Chicago, IL -- A Chicago podiatrist has been sentenced to more than seven years in prison and ordered to pay nearly $7 million in restitution following his conviction for health care fraud. Yev Gray was sentenced Tuesday in federal court in St. Louis. The 49-year-old doctor pleaded guilty in May to two felony charges. Gray owned Chicago-based Aggeus Healthcare, which provided podiatry services at long-term care facilities in Missouri and 15 other states. Federal prosecutors say the company inserted diseases and symptoms that patients did not have into their medical records. Gray also pressured Aggeus podiatrists to provide unneeded services, causing Medicare to pay millions of ...

Home-health owner in Texas tries to cheat Medicare out of $20M
August 16, 2017, Pearland, TX -- A registered nurse and home health company owner has been convicted of conspiracy and multiple counts of healthcare fraud in a $20 million dollar scheme to defraud Medicare, the Department of Justice announced. Evelyn Mokwuah of Pearland, Texas was convicted on one count of conspiracy to commit health care fraud and four counts of healthcare fraud for her role in a scheme connected to her two companies Beechwood Home Health and Criseven Health Management Corporation. Citing evidence from her trial, the scheme ran from 2008 to 2016. Mokwuah, along with co-conspirators, participated in a scheme to defraud Medicare of approximately ...

Immigrant Florida workers charged — even with legit injuries
August 16, 2017, Pensacola, FL -- At age 31, Nixon Arias cut a profile similar to many unauthorized immigrants in the United States. A native of Honduras, he had been in the country for more than a decade and had worked off and on for a landscaping company for nine years. The money he earned went to building a future for his family in Pensacola, Fla. His Facebook page was filled with photos of fishing and other moments with his three boys, ages 3, 7 and 8. But in November 2013, that life began to unravel. The previous year, Arias had been mowing the median of Highway 59 ...

Construction worker claims injury, does logging in New York
August 16, 2017, Cayuga County, NY -- A Central New York man pleaded guilty Wednesday to several charges that he stole money from the workers' compensation system by claiming he was disabled when he wasn't, the state inspector general announced Wednesday. David C. Sigl, 54, of Wall Street, Auburn, received more than $83,000 after he said he was fully disabled from a previous injury, but continued to work for his logging business, according to state Inspector General Catherine Leahy Scott. Sigl began collecting the benefits in 2013 after he was injured while working as a heavy equipment operator for a Syracuse construction and engineering firm, officials said. He continued ...

Indiana couple charged with setting home arson fire
August 16, 2017, Clinton County, IN -- Two people face charges in Clinton County after one of two house fires on Aug. 3 was determined to be arson. Police said Jennifer Matthews is accused of arson and insurance fraud. Joshua Smith is accused of conspiracy to commit arson. The charges stem from a house fire on State Road 39. It was called in on Aug. 3 just after 2 a.m. It was the second house fire to be called into Frankfort in just a few minutes. The first was a home on Clinton Street that was engulfed when firefighters arrived. That case is still under investigation. Frankfort had to call in ...

East Tennessee pill mill allegedly pumps 22M opiates onto streets
August 15, 2017, Knox County, TN -- An ongoing probe of what authorities say was East Tennessee’s largest pill-mill operation has revealed a nearly $3 million Medicare kickback scheme involving two national drug-testing companies, court records show. A federal grand jury has served up a beefed-up indictment in the case of Sylvia Hofstetter, a 53-year-old grandmother accused in a pill-mill operation that put 12 million prescriptions for opiates into the hands of addicts and $22 million into the pockets of its overseers. The latest indictment, filed in U.S. District Court, adds to the defense table two men accused of not only having ownership in the pain clinics Hofstetter allegedly ...

Doc smuggles cancer drugs, bills for FDA-approved meds
August 15, 2017, Palm Harbor, FL -- A Florida doctor has been sentenced to nearly six years in prison for smuggling misbranded and unapproved cancer drugs into America, some of which were likely counterfeit, and administering them to patients. Diana Anda Norbergs, MD, (61) was initially convicted last November by a jury for receipt and delivery of misbranded drugs, smuggling goods into the US, healthcare fraud and mail fraud. The court heard that the owner of East Lake Oncology, in Palm Harbor, Florida, had been ordering cheap drugs – such as MabThera, Ribomustin and Zometa – from unlicensed overseas distributors, including from the UK and Canada, since 2009. The drugs ...

Ortho doc charged with billing for exams while traveling overseas
August 15, 2017, Clinton, NY -- State officials say an orthopedic surgeon from Clinton “systematically submitted false bills” over the course of more than two years to defraud the state of New York out of thousands of dollars in workers’ compensation claims. Dr. Gregory Shankman, 69, was arrested Tuesday and charged with felony first-degree scheme to defraud, two counts of felony third-degree grand larceny and two felony counts of the workers’ compensation crime of fraudulent practices, along with misdemeanor petit larceny, according to a news release from state Inspector General Catherine Leahy Scott and Oneida County District Attorney Scott McNamara. A search warrant also was executed at Shankman’s ...

California suspends 5 providers for suspected comp cons
August 15, 2017, Lompoc, CA -- California’s Division of Workers’ Compensation has suspended five more medical providers from participating in the state’s workers’ comp system, bringing the total number of suspended providers to 32. DWC Acting Administrative Director George Parisotto issued suspension orders against the following providers: Leovigildo Sayat, a physical therapist in Lompoc who in October 2015 pled guilty in U.S. District Court for the Central District of California as a co-conspirator in a $15 million scheme to defraud Medicare by billing for physical therapy services never provided. Alexander Kiev Martinez, a durable medical equipment provider in El Centro, who in April 2016 pled guilty in San Diego ...

Correctional officer allegedly alters injury documents in Georgia
August 15, 2017, Irwin County, GA -- A former Irwin County Detention Center correctional officer has been indicted for insurance fraud. Pamela Frazier was arrested in May 2016 after an investigation by the Georgia State Board of Workers’ Compensation’s Enforcement division. Frazier was then indicted on Monday on charges of felony insurance fraud, forgery in the first degree, false and misleading statements to obtain workers’ compensation benefits and violation of oath of office. The Enforcement Division’s investigation alleges that Pamela Frazier filed a workers’ compensation claim in December of 2015 and that during the course of Frazier’s injury claim, she altered medical documents relating to the injury and she then ...