News

Witness stunned by tests allegedly ordered by Florida doc
April 20, 2017, Clearwater, FL -- A Clearwater retinal specialist who is defending Dr. Salomon Melgen performed a miniscule number of tests and procedures on his own patients compared to the tens of thousands of tests ordered by the Palm Beach County ophthamologist who is accused of bilking Medicare out of as much as $105 million. While Dr. Dana Deupree on Tuesday continued to insist that Melgen’s methods were justified, he was surprised to learn how rarely he had ordered similar tests for his own Medicare patients. For instance, while both treated about 2,300 patients from 2008 to 2013, Melgen billed Medicare 52,673 times for a particular test. ...

Dallas firm allegedly bills for unneeded hearing aids
April 20, 2017, Dallas, TX -- An indictment returned by a federal grand jury in Dallas this week charges Terry Lynn Anderson, 66, and Rocky Freeland Anderson, 36, of Dallas, with offenses related to their participation in an insurance fraud scheme, announced John Parker, U.S. Attorney for the Northern District of Texas. Each defendant is charged with one count of conspiracy to commit health care fraud, ten counts of health care fraud and aiding and abetting and four counts of aggravated identity theft and aiding and abetting. Both defendants will make their initial appearances today before Magistrate Judge David L. Horan. The indictment alleges that Terry Anderson was ...

Billing firm allegedly leads $40-million comp scheme in California
April 20, 2017, Costa Mesa, CA -- Insurance Commissioner Dave Jones and Orange County District Attorney (OCDA) Tony Rackauckas announced a shutdown of a $40 million fraudulent medical billing and kickback operation with the filing of charges against more than two dozen doctors, pharmacists and business owners. Tanya Moreland King, 37, and her husband Christopher King, 38, both of Beverly Hills, own medical billing and medical management companies Monarch Medical Group, Inc., King Medical Management, Inc. and One Source Laboratoires, Inc. The defendants are accused of masterminding a complex insurance fraud scheme of recruiting doctors and pharmacists to prescribe unnecessary treatment for workers' compensation insurance patients. Irvine ...

North Carolina driver accused of false towing receipt
April 20, 2017, Edgecombe County, NC -- Insurance Commissioner Mike Causey today announced the arrest of Robert Anthony Davis, 53, of 916 Bradley Ave., Tarboro; he is charged with one count of insurance fraud. Department of Insurance criminal investigators accuse Davis of providing fraudulent towing receipts to obtain $335.00 from GEICO Insurance Company. Investigators allege the receipts were from Davis’ personal receipt book and the towing companies listed were fictitious. Davis was arrested on March 28 in Edgecombe County and released under a promise to appear in court. "According to the FBI, insurance fraud costs the average family between $400 and $700 per year in the form of increased premiums,” ...

Woman allegedly makes false claim for burned rug in Washington
April 20, 2017, Renton, WA -- Theresa Smith, 39, from Renton was charged with filing false claims by the Insurance Commissioner Mike Kreidler and the Criminal Investigations Unit. Smith was charged with one count of filling a false insurance claim. According to a media release, during the investigation it appears Smith filed a renter’s insurance claim in July 2015 for $9,000 for damage to two area rugs. She claimed a light bulb in her apartment exploded causing the rugs to catch on fire, the release stated. Smith provided a handwritten receipt for the two rugs, claiming she purchased them from a friend for $4,500 each. It was reported that State ...

Idahoans make same vehicle-damage claim with 2 insurers
April 20, 2017, Meridian, ID -- Attorney General Lawrence Wasden has announced the successful prosecution of two Idahoans accused of insurance fraud. On Tuesday, April 18, Fourth District Judge Jonathan Medema sentenced 28-year-old Razia Temori of Meridian after she pleaded guilty to Insurance Fraud on February 21. Judge Medema sentenced Temori to 30 days in the Ada County Jail, followed by four years of felony probation. She was also ordered to notify her employer of her conviction. The defendant received a withheld judgment subject to completing the terms of her sentence. An investigation revealed that in May 2013, Temori filed a claim with insurance provider Progressive for damage to ...

Owner of Independence clinic pleads guilty to health care fraud scheme
April 20, 2017, Independence, MO -- Tom Larson, Acting United States Attorney for the Western District of Missouri, announced that the owner of an Independence, Mo., medical clinic pleaded guilty in federal court today to his role in a fraud scheme that involved disability examinations of veterans and to making false statements regarding his role in the physical examinations of commercial truck drivers. David L. Biersmith, 80, of Kansas City, waived his right to a grand jury and pleaded guilty before U.S. District Judge Howard F. Sachs to a federal information that charges him with one count of health care fraud and one count of making false ...

Maryland pain doc wants some fraud charges dropped
April 19, 2017, Frederick, MD -- A Frederick doctor accused of a medical kickback scheme and tax fraud is asking a judge to drop some of the charges against him. Atif Babar Malik, of Germantown, was one of five medical professionals indicted on charges related to financial crimes involving American Spine Center, a pain management practice in Frederick. Joshua Daniel Greenberg, one of Malik’s attorneys, asked U.S. District Judge Marvin J. Garbis on Wednesday to dismiss eight charges of health care fraud that arose from allegations that Malik and his co-defendant Sandeep Sherlekar falsified medical bills as owners of American Spine Center. Sherlekar died by suicide on Sept. 30, ...

Cold callers try to steal medical IDs of Idaho seniors
April 19, 2017, Boise, ID -- The Idaho Senior Medicare Patrol (SMP) program is alerting beneficiaries, their family members, and caretakers of a new Medicare fraud scam. Scam artists, posing as Medicare or other agency employees, are calling people telling them that new cards are being issued and that in order to continue receiving benefits, the agency must “verify” or “update” identifying information. This includes their Medicare number and birth date, and in some cases, even financial accounts. Don’t be fooled! This is a scam to steal personal information, money, and possibly one’s identity. In an effort to help protect health care and financial information as well as federal health ...

Blog: States need more civil penalties to fine fraudsters
April 19, 2017, Washington, DC -- Crafting a model fraud law was one of the Coalition’s first agenda items when we were founded in 1993. It took us two years to complete, and still is the most complete anti-fraud model law on the streets. The larger the fraud the stronger the penalty, our model says. Arson and other potentially life-threatening schemes merit the most-serious felony sentences. We also created a unique law exposing leaders of crash rings and organized fraud schemes to large civil fines that can bankrupt their operations. Our “unlawful insurance act” was ahead of its time — few policymakers grasped the civil penalty’s purpose when ...

Ring allegedly fakes auto-insurance cards in Pennsylvania
April 19, 2017, Harrisburg, PA -- The state attorney general’s office has filed charges against a dozen people accused of taking part in an organized crime ring that rented out thousands of fraudulent license plates. Attorney General Josh Shapiro said the ring obtained the plates in Pennsylvania and charged $400 a month or more to people who then avoided paying more than $1 million in parking fines and highway tolls in New York, Pennsylvania, and neighboring states. Charges were also filed against 14 Pennsylvania businesses. Shapiro said the ring also provided fake insurance cards, rolled back odometer readings on 35 cars it bought and sold, and issued phony letters ...

Atlanta tech firm to chase health care fraud
April 19, 2017, Atlanta, GA -- Health care fraud is estimated to cost the nation at least $68 billion annually — with some estimates at $230 billion or more. Musheer Ahmed wants to lower those fraud figures significantly. Ahmed has started a health information technology company to detect fraud in medical billing practices. He started the firm, named FraudScope, at Georgia Tech in Atlanta. “We have a lot of thought leaders in Atlanta,’’ Ahmed says. “The talent pool at Georgia Tech attracts health care companies.’’ Georgia, in fact, has promoted itself as the leader in health information technology, with more than 225 companies employing about 30,000 people. The sector’s growth is ...

https://www.govtechworks.com/federal-leadership-needed-to-fight-medicaid-fraud-waste-and-abuse/#gs.null
April 19, 2017, Harrisburg, PA -- Data analytics offers unparalleled promise to stop fraud, waste and abuse in state-run Medicaid programs, but the lack of standards and federal leadership is holding states back, experts say. Improper payments account for about 5 cents of every Medicaid dollar, according to federal estimates, or about $29.1 billion of the $547.7 billion program in 2015 alone. Those improper payments fall into three categories: Intentional deception or misrepresentation The overuse or inappropriate use of services and resources Provider practices that are inconsistent with sound fiscal, business or medical practices, such as providing medically uneccessary services, or beneficiary practices resulting in unnecessary Medicaid costs. Spotting all three ...

Louisiana Attorney General arrests two for Medicaid fraud
April 19, 2017, Baton Rouge, LA -- Attorney General Jeff Landry today announced the arrests of two women on Medicaid Fraud charges, whose alleged crimes costed the State over $10,000. “My office will not rest in our pursuit of those who rob much needed services from our State’s most vulnerable,” said Attorney General Jeff Landry. “Our award winning fraud detection and prevention unit remains committed to uncovering, investigating, and arresting those who attempt to defraud the system.” Amanda Hollins, 31 of Ruston, was arrested and booked into the East Baton Rouge Parish Prison on four counts of Medicaid Fraud for allegedly submitting timesheets and service logs for services ...

California business owner under-reports employees, payroll
April 19, 2017, Salinas, CA -- Monterey County District Attorney Dean D. Flippo announced today that Chang Tai Lin, age 53, of Salinas, was sentenced by Judge Andrew G. Liu. On March 3, 2017, the defendant pled to two counts of making a material misrepresentation in order to obtain a lower workers' compensation insurance premium and one count of willfully failing to file payroll tax returns with intent to evade tax. The defendant was the owner of the AA Buffet in Salinas. The restitution of $42,778.81 to EIG Services and Sequoia Insurance was paid in full at the time of the plea. In May, 2015, operating on ...

Cincinnati woman steals $328,000 of comp refunds
April 18, 2017, Cincinnati, OH -- A Cincinnati woman pleaded guilty in federal court Monday to taking $328,000 of workers’ compensation refunds from the insurance company where she was employed, according to the Department of Justice. Angelia Zwick, 46, faces up to 23 years in prison for wire fraud and willfully filing a false income tax return. Zwick worked for the Sheakley Group from July 2009 through May 2013. The U.S. Attorneys Office said she devised a scheme to defraud her employer by wiring the stolen funds from her employer’s bank account to a bank account for Amerihealth and Life Solutions, a company owned by Zwick. She also failed ...

Doc bribed $66,000 for blood-test referrals in New Jersey
April 18, 2017, Staten Island, NJ -- An internal medicine doctor practicing in Staten Island, New York, today admitted taking bribes in connection with a long-running and elaborate test referral scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, Acting U.S. Attorney William E. Fitzpatrick announced. Ahmed El Soury, 44, of Monmouth Junction, New Jersey, pleaded guilty to Count One of an indictment charging him with conspiracy to violate the Anti-Kickback Statute, the Federal Travel Act, and the honest services wire fraud statute. El Soury pleaded guilty before U.S. District Judge Stanley R. Chesler in Newark federal court. According to documents ...

Fake claims allegedly made for solar panels in California
April 18, 2017, Antioch, CA -- The former general manager of a golf club and a contractor have been arrested and charged with stealing hundreds of thousands of dollars, which led to the club’s demise. Kevin Robert Fitzgerald, 45, the former general manager of the Roddy Ranch Golf Club in Antioch, and Mark Mattson, 56, a general contractor, turned themselves in to police Tuesday afternoon on charges of grand theft, diverting construction funds, theft from an elder or dependent, attempted grand theft, filing a false police report, and insurance fraud. The two surrendered days after Fitzgerald appeared on a list of Northern California’s most wanted fugitives. They are ...

Louisiana contractor charged with stealing downpayment
April 18, 2017, Baton Rouge, LA -- Court documents say a Zachary based contractor is wanted for a felony count of residential contractor fraud. An arrest warrant was issued Monday for Joseph Blake Sequin, the owner of JBS Construction and Development, for a felony count of residential contractor fraud. According to court documents, the victim, an employee of JBS Construction, hired Seguin to perform restoration on her home after the August flooding. The victim told East Baton Rouge Sheriff’s deputies she paid Seguin $40,000 for restoration work in November. After failing to get invoices for work performed, the woman dismissed Seguin and requested the remaining funds. Seguin said there were ...

Louisiana contractors allegedly work despite fraud charges
April 18, 2017, Ascension, LA -- Some Louisiana contractors are still open even after employees or company owners have been arrested for fraud. Their customers don't think that's right. Mark and Deb Landry say they're angry because the company they've filed charges against is still up and running. "TWG is still running around, in operation," said Deb Landry. The owner of TWG Contractors, Michael Simmers faces fraud charges in Livingston and Ascension Parishes. He's currently awaiting arraignment in Ascension. The Landry's hired the company in September to repair their flood damaged home in Baton Rouge. The couple says they wrote checks for items that were never purchased and work ...

Georgia couple lights up rental home for insurance
April 18, 2017, Austell, GA -- Two women have pleaded guilty to arson and insurance fraud charges after admitting to setting their Austell home on fire in an attempt to collect insurance money, according to the Cobb District Attorney’s office. The fire took place on Sept. 30, 2015, on Ivy Log Drive in Austell. No one was home when a passerby saw the flames and kicked in the front door to check for anyone inside, said Kim Isaza, spokesperson for the DA’s office. Cobb firefighters discovered evidence of arson in the housee, such as the knobs on the gas stove all being turned on despite the pilot light ...

OH: Workers’ Comp Investigators See Downward Fraud Trend
April 18, 2017, Columbus, OH -- Ohio Bureau of Workers' Compensation (BWC) investigators are seeing a decline in the amount of pill mill cases resulting in workers' compensation fraud, a spokesman for the department said. Tim Larrison, assistant supervisor for the Ohio BWC's special investigations department's health care provider team, said that while workers' compensation fraud in the healthcare field has remained fairly consistent, incidents of pill pushing in relation to fraud has seen a downturn because of new regulations. In 2016, the BWC announced changes in the way they would be handling opioid reimbursements through WC claims — including limiting reimbursement to claims where only best medical ...

North Dakota passes law protecting consumers from massive, unexpected air ambulance bills
April 18, 2017, Bismarck, ND -- Insurance Commissioner Jon Godfread today praised the signing of Senate Bill 2231, regarding the regulation of how insurance companies pay for air ambulance services in North Dakota. The bill also requires hospitals to notify patients in non-emergency situations which air ambulance providers have a contractual agreement with the patient’s health insurance company. Air ambulance has become a more frequently used mode of transport for individuals needing medical care. Often these patients are then faced with unexpected and outrageous bills for the full cost of the flight or the balance left after a partial payment is made by the patient’s insurer, a ...

North Dakota passes law protecting consumers from massive, unexpected air ambulance bills
April 18, 2017, Bismarck, ND -- Insurance Commissioner Jon Godfread today praised the signing of Senate Bill 2231, regarding the regulation of how insurance companies pay for air ambulance services in North Dakota. The bill also requires hospitals to notify patients in non-emergency situations which air ambulance providers have a contractual agreement with the patient’s health insurance company. Air ambulance has become a more frequently used mode of transport for individuals needing medical care. Often these patients are then faced with unexpected and outrageous bills for the full cost of the flight or the balance left after a partial payment is made by the patient’s insurer, a ...

Feds say Pittsburgh doc illegally distributes painkillers
April 18, 2017, Pittsburgh, PA -- Two Pittsburgh residents have been indicted by a federal grand jury on charges of distribution of Oxycodone, a Schedule II controlled substance, and Amphetamine, a Schedule II controlled substance, outside the usual course of professional practice, and health care fraud, Acting United States Attorney Soo C. Song announced today. The 15-count indictment named Brent E. Clark, 55, a family care physician who practices in Pittsburgh, and Carl T. Wilson, age 49, an office employee of Clark, as the defendants. According to the indictment, from February 26, 2015 through March 27, 2017, Clark distributed Oxycodone, a Schedule II controlled substance, on 13 occasions, ...