News

Alleged arsonist in Maine thinks insurer should still pay his fire claim
August 25, 2016, Belfast, ME -- A Belfast man accused of burning down Goose River Grocery more than two years ago is suing his insurance company because it refuses to pay out on a policy he obtained a few months preceding the fire. Kyle J. Skinner, through his attorney, Patrick J. Mellor, filed a lawsuit last month against Hanover Insurance Group, alleging the company has failed to cover damage to Goose River Grocery as a result of the fire. The fire caused $198,037.20 in damage to the building, which is sited at 77 Swan Lake Ave., and $46,174.89 in inventory losses, according to court documents. The fire was ...

Man in Connecticut pleads guilty to staging 50 car crashes
August 25, 2016, Norwich, CT -- A Norwich man pleaded guilty Thursday to wire fraud in an insurance fraud scheme case, according to the United States Attorney District of Connecticut. Pierre Jeudy, 56, admitted to staging as many as 50 car crashes in Eastern Connecticut in an effort to collect illicit insurance payments, according to a press release. The incidents in question often occurred in isolated areas away from witnesses, according to the press release. Payments in the scheme ranged from $10,000 to $50,000, the press release said. Jeudy, a Haitian national, faces up to 20 years in prison, the press release said. He is scheduled for sentencing on ...

Legislation introduced in California to crackdown on comp fraud
August 25, 2016, Sacramento, CA -- Every time a cheater takes a dollar, an honest person loses one. When dishonest doctors or lawyers cheat the workers compensation system, honest businesses pay and honest injured workers lose out. A few months ago, the Center for Investigative Journalism exposed billions of dollars of fraud in California’s workers’ compensation. It wasn’t nickel-and-dime stuff. Instead, it was widespread, systematic fraud. According to the center’s reporters, prosecutors are investigating the $24 billion workers’ compensation system in California, “pursuing charges against more than 80 medical professionals who’ve handled more than 100,000 injured-worker cases.” These medical providers have been charged with or already convicted of health ...

Man in North Carolina charged with filing false auto claim
August 25, 2016, Hoke County, NC -- A Hoke County man is accused of filing a bogus insurance claim, according to the N.C. Department of Insurance. Travis Lee Richmond, 43, of the 100 block of Westminster Lane in Raeford, is charged with one count of insurance fraud, the agency reported in a news release. Richmond allegedly presented a false claim to Geico Insurance Co. for damages that had occurred in 2012. Richmond was arrested Tuesday. Bail was set at $3,000. ...

Ex-prison guard in Washington accused to working 3 jobs while collecting comp
August 25, 2016, Monroe, WA -- A former corrections officer stands accused of holding three security jobs while claiming his on-the-job injury was so serious he couldn't work. A Washington State Department of Labor & Industries (L&I) investigation caught John J. Gruden, 43, on video jogging on a treadmill and sidewalk, and driving to work at the Phoenix Police Department. All of this occurred while he was receiving workers' compensation disability payments totaling more than $100,000 over five years. Gruden, who was injured while working as a corrections officer at Monroe Correctional Complex, has been charged with felony first-degree theft based on his work activity. Gruden is now believed ...

Fraud referral results in arrest and restitution in hail damage lawsuit
August 25, 2016, Abilene, TX -- An insurance fraud referral filed by the international litigation firm Zelle LLP on behalf of its insurance company client, Strata Underwriting Managers, has resulted in the felony criminal prosecution of a building owner for insurance fraud and payment of restitution to the insurance company. In June 2015, Zelle was defending a hail lawsuit brought by Amarprem, LLC (doing business as Whitten Inn Expo) against Strata. The lawsuit involved alleged hail damage to a hotel in Abilene. Shortly after the lawsuit was filed, Zelle discovered that a roofing contractor invoice submitted by the owner of Amarprem, Ashok Patel, in support of the underlying ...

Insurance fraud arrests made in Lee County
August 25, 2016, Lee County, GA -- An investigation conducted by the Georgia State Board of Workers' Compensation's Enforcement Division has led to the arrest of a Leesburg Insurance Agent and the agent's boyfriend. According to the Enforcement Division's Director Stan Bexley, 44-year-old Malinda Alison Pedigo was arrested Tuesday afternoon and booked into the Lee County Jail. Pedigo is the owner of Lee Affordable Insurance Agency in the 1400 block of U.S. Highway 19 South in Leesburg and is charged with three counts of felony insurance fraud and one count of felony conspiracy to commit a crime. Pedigo's boyfriend, Christopher Joel Dowdy was arrested Wednesday morning following a brief stand-off ...

Feds: South Beach woman and her boyfriend busted running prescription pill ring
August 25, 2016, South Beach, NY -- A South Beach woman and her boyfriend were busted last month for running a prescription drug ring that included filling fake prescriptions to obtain pills, like Xanax and Oxycodone, to sell to their clientele, authorities allege. Starting in January 2015, Carolyn Richardson, of Lamport Boulevard, and her significant other, Doraymus Robinson, allegedly used phony prescription pads to obtain methadone, Xanax and Oxycodone from numerous pharmacies in New Jersey. They paid for them with cash or Medicaid cards and recruited others to write prescriptions, according to the federal criminal complaint filed in Brooklyn Federal Court. After the duo's accomplice was arrested, the person ...

Vietnamese woman has hand, leg severed to reap $157K in disability money
August 24, 2016, Hanoi, none -- A Vietnamese woman hired a man she knew to cut off part of her hand and leg and staged a train accident last May in a botched attempt to fraudulently claim around US$157,000 worth of insurance, investigators said on Tuesday. According to police in Bac Tu Liem District in Hanoi, in the early hours of the morning of May 5, Doan Van D., whose first name was withheld, came to the police station to report a train accident in which a woman, identified only as L.T.N., had lost her left hand and left foot. N., 30, was rushed to the September 18th ...

Pain doc in New York pleads guilty to illegally prescribing painkillers
August 24, 2016, Long Island, NY -- Noel Blackman, a medical doctor and the former Health Minister of Guyana, who operated from “pain management” clinics in Elmhurst in Queens County, Franklin Square in Nassau County, and Cypress Hills in Brooklyn, today pleaded guilty to conspiring to illegally distribute oxycodone, a highly addictive prescription pain medication. The guilty plea was entered before United States District Judge Joanna Seybert at the U.S. Courthouse in Central Islip. When sentenced, Blackman faces a maximum sentence of 20 years’ imprisonment and a $1 million fine. In announcing the guilty plea, United States Attorney Robert L. Capers expressed his grateful appreciation ...

Trio in Oklahoma charged with auto, workers comp and agent fraud
August 24, 2016, Oklahoma City, OK -- Attorney General Scott Pruitt on Wednesday announced criminal charges against three individuals: Robert Brandon Page, 40, of Muskogee, is charged with one felony count of workers’ compensation fraud. While working at Superior Linen Service, Inc., Page made a workers’ compensation claim after a cart he was pulling up a steep ramp rolled off a platform and injured his shoulder when he tried to stop it. Page was allegedly too hurt to work, and in a deposition, claimed he was also too injured to participate in his go kart racing hobby. However, evidence allegedly shows that Page was still participating in go ...

Woman in North Carolina accused of claiming for previous auto damage
August 24, 2016, Durham, NC -- Insurance Commissioner Wayne Goodwin today announced the arrest of Trudy Brunner-Sharpe, 69, of 5901 Craig Road, Lot 86, Durham; she is charged with two counts of insurance fraud and one count each of obtaining property by false pretense and attempting to obtain property by false pretense. Department of Insurance criminal investigators accuse Brunner-Sharpe of presenting fraudulent information to Nationwide Mutual Insurance Company on Dec. 19, 2015 and received $735.25 in payment, and May 27, 2016 which was denied. Investigators allege Brunner-Sharpe twice reported new vehicle damage when the damages were from previous settled claims. Brunner-Sharpe was arrested on Aug. 17 in Orange ...

Virginia man tried to use wife's life insurance to hire hitman, police say
August 23, 2016, Virginia Beach, VA -- A sailor will appear in court Wednesday after federal agents said he planned to have his wife killed, offering a cut of life insurance money and prescription medication as payment. 13News Now obtained federal court documents that outline the case against Chadwick Stanley Ghesquiere. Special Agent Edward Winkelspecht with the Bureau of Alcohol, Tobacco, and Firearms (ATF) said a confidential source (CS) met with ATF and NCIS special agents July 28 to "provide information" about Ghesquiere's "criminal activity." The source told agents that Ghesquiere and his wife were going through a divorce and a custody dispute involving their child. "He's always talking about the ...

Woman in North Carolina charged with staging three car crashes
August 23, 2016, New Hanover County, NC -- A fifth woman has been arrested in connection to a scheme to get insurance money by staging vehicle accidents last year. Teresa Halsey Pollock, 44, has been charged with insurance fraud, attempting to obtain property by false pretense, two felony counts of conspiracy and a misdemeanor conspiracy charge. Pollock was arrested in Irwin County in Georgia before being transferred to the New Hanover County Detention Center. Her bond was set at $50,000. Five women are accused of providing false statements to law enforcement and insurance companies to receive insurance money in three separate accidents. ...

Landlord in New York pleads guilty to torching rental house
August 23, 2016, Monroe County, NY -- A Webster man pleaded guilty in Monroe County Court on Monday to a 2012 fire in a rental property in Rochester. Andrzej Gierczak, 64, pleaded guilty to attempted second-degree arson, a felony, in front of Judge Christopher Ciaccio following the 2012 fire, said Lt. Dana Cieslinski of the Rochester Fire Department. The plea, which followed two failed trials, involved an Alford plea agreement, a proceeding that allows a defendant to plead guilty without admitting the underlying allegations. Gierczak's lawyer Jeffrey Wicks said the Monroe County District Attorney's Office had such strong evidence that would have likely led to a conviction, but Gierczak ...

Patient brokers from Florida, Arizona trolling New York's treatment clinics
August 23, 2016, Staten Island, NY -- At drug treatment centers on Staten Island, the calls disturb the daily routine. The solicitations interrupt meals, counseling sessions and support groups. Sometimes, staff members say, the callers make explicit offers: thousands of dollars to refer a person with a heroin or pain-pill addiction and good insurance. Other offers are more subtle — a recurring donation or a contract. The callers are recruiters working for treatment centers as far away as Arizona, California or Florida, or as close as Long Island or upstate New York, all angling to fill their beds with patients from Staten Island. “They are opportunistic people or organizations who ...

Foot doctor in Pa. billed insurers $5M for procedures not performed
August 23, 2016, Havertown, PA -- Stephen A. Monaco, D.P.M., 59, of Broomall PA pleaded guilty to health care fraud today for perpetrating a $5 million scheme to defraud Medicare, Medicaid and four private victim insurance companies, announced United States Attorney Zane David Memeger. In a hearing before United States District Court Judge Juan Sanchez, Monaco admitted that he had committed the fraud using his practice, A Foot Above Podiatry, Inc. (“A Foot Above”), located in Havertown PA. Between January 2008 and October 31, 2014, Monaco submitted fraudulent claims to Medicare, Medicaid and four private victim insurance companies for podiatric procedures that were not provided, ...

Health fraud prevention company ID Experts raises $27.5 million
August 23, 2016, Washington, DC -- ID Experts, a developer of software for managing cyber risks and preventing data breaches for the healthcare industry and other vertical markets, has raised $27.5 million in new funding. The company will use the funds to repurchase ID Experts stock from some undisclosed shareholders, further develop its software-as-a-service security products and target new business opportunities, primarily in healthcare, the company says. Software as a service refers to applications that are hosted by a vendor and accessed by clients via the web, as opposed to the clients hosting the software in their own data centers. The latest round of funding came from healthcare ...

Family wins lead paint judgment for poisoned son — but will they ever get the money?
August 23, 2016, Baltimore, MD -- Chauncey Liles Jr. was poisoned by lead paint by the time he was 2 years old. Now 18, he says he's struggled ever since. He has trouble concentrating. Academic concepts came quickly to other students, he says, but he always had a hard time keeping up. The lead paint chips in the rental property where Liles lived cost him valuable IQ points, his lawyer argued in a successful lawsuit against the landlord. "I feel like I'm different and it's not fair," Liles says. Now Liles, of West Baltimore, faces another challenge. The $1.3 million a jury awarded his family last week is in ...

Protect Against Rising Medical Data Fraud
August 23, 2016, Washington, DC -- Oncology practices should protect themselves from the danger of having their IT systems hacked by having a risk analysis done to identify potential access and compromise points, says Ann Patterson, senior vice president and program director for the Medical Identity Fraud Alliance (MIFA). The alliance was formed three years ago when its originators realized that medical ID fraud was growing rapidly and had the potential to become a huge problem. A study by the Ponemon Institute indicates that the number of US victims of medical ID theft increased 21.7% just from 2013 to 2014, reaching a total of 2.3 million people.1 ...

Fraud charges dropped against contractor in North Carolina
August 22, 2016, Charlotte, NC -- Months after a North Carolina Department of Insurance investigation put a Charlotte man behind bars for 108 counts of insurance fraud, prosecutors have dropped every charge. Eyewitness News reported in June 2014 that a state investigation led to the arrest of Ron Pierce. The Department of Insurance sent out a news release and did interviews to discuss its work. "A Charlotte contractor is in jail, accused of pocketing more than $450,000 in insurance claims," Channel 9 reported at the time. Investigators claimed that Pierce inflated hail damage repair estimates. Police arrested him and put him in jail on a $540,000 bond. "People who fraudulently ...

Couple in New Jersey charged with arson and fraud after diner fire
August 22, 2016, Butler, NJ -- According to Sussex County Prosecutor Francis A. Koch in a press release Friday, the indictment alleges that Tina Diakos purposely started a fire and destroyed Jerzeez Diner at 2 Andrea Drive in order to collect insurance money. The indictment further alleges that her boyfriend, Ozkan Cengiz, 39, conspired with her to do so. No one was injured in the fire that had engulfed the diner when firefighters arrived on scene. Police had received a call at 4:07 a.m. on March 8 that there were flames coming out of the roof, said Vernon Police Lt. Keith Kimbowski at the time of the incident. ...

Comp claimant in Washington caught working while collecting benefits
August 22, 2016, Tacoma, WA -- A Tacoma-area man faces a felony theft charge after he was caught working while receiving more than $81,000 in workers’ compensation disability payments. Bobby R. Johnson, 47, has been charged with first-degree theft after investigators from the Washington State Department of Labor & Industries discovered he was working while receiving disability payments. He was scheduled to be arraigned in Pierce County Superior Court on Aug. 19. The Washington Attorney General’s Office filed the charge based on the investigation by the Washington State Department of Labor & Industries (L&I). “Cheating the workers’ comp system doesn’t pay,” said Elizabeth Smith, assistant director of L&I’s Fraud ...

Convicted and indicted providers in California filed $600M in comp liens
August 22, 2016, Sacramento, CA -- Criminally indicted or convicted providers and physicians filed an estimated $600 million in liens against injured employees' claims for workers' compensation benefits between 2011 and 2015, according to the California Department of Industrial Relations and its Division of Workers' Compensation. The current system presents fertile ground for presenting fraudulent claims, the Department of Industrial Relations said. California is pursuing legislation to prohibit criminal and indicted providers from lining their pockets through liens, DIR Director Christine Baker said in a statement Friday. That legislation would stay the liens of physicians or providers who are criminally charged with workers' compensation fraud, medical billing fraud, ...

Pennsylvania launching database to monitor drug prescriptions
August 22, 2016, Harrisburg, PA -- A new tool in Pennsylvania's effort to curb prescription drug abuse will become available later this week. The state's Department of Health will launch a database Thursday that will track information about prescription drugs distributed to patients. The effort is part of the department's Prescription Drug Monitoring Program to combat the opioid epidemic. According to state health officials, 80 percent of heroin users began using due to abuse of prescription medication. In October 2014, Governor Tom Corbett signed Act 191 into state law that required the monitoring of all controlled substances with the potential for abuse such as oxycodone, fentanyl and amphetamine. The legislation aimed ...