News

Comp claimant in Ohio caught working side job as a teacher
February 26, 2015, South Euclid, OH -- A South Euclid (Cuyahoga County) woman was sentenced Feb. 10 in Franklin County Court of Common Pleas for working while receiving workers’ compensation benefits. Brecia Whitten pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony. “BWC uses various techniques to detect whether someone receiving workers’ compensation benefits is receiving wages when they are prohibited from working,” said BWC Administrator/CEO Steve Buehrer. “In this case, a data exchange alerted our investigators that Whitten may be working and committing fraud.” BWC investigators found that Whitten did in fact receive wages for working as a substitute teacher and as a mailroom coordinator ...

Pharmacy owner in West Virginia pleads guilty to false billing
February 26, 2015, Charleston, WV -- A Charleston pharmacy owner faces up to five years in prison after pleading guilty to making a false statement in a health care matter. Paula Butterfield also pleaded guilty on behalf of her business, Trivillian's Pharmacy, to health care fraud and misbranding drugs. U.S. Attorney Booth Goodwin says the pharmacy faces a fine, up to 10 years of probation and restitution. Butterfield entered the pleas Wednesday in U.S. District Court in Charleston. She and the pharmacy are scheduled to be sentenced May 28. Goodwin says Butterfield admitted that the pharmacy dispensed compounded drugs and generic drugs and billed Medicare and Medicaid for brand name ...

Trio charged with operating unlicensed clinic in Florida PIP scam
February 25, 2015, Orlando, FL -- Three Central Florida arrests were made by the Florida Division of Insurance Fraud for the operation of an unlicensed clinic in Orlando that was used as part of a personal injury protection (PIP) fraud scheme, according to the Florida Department of Financial Services. Dr. Lherisson Domond, a Coconut Creek resident, fronted ownership of the clinic, Unity Pain and Injury Center, from February to December 2012, but the clinic was operated by several non-licensed individuals who offered to pay Domond $1,500 a month for use of his name. An investigation conducted by the Florida’s Department of Financial Services’ Division of Insurance Fraud revealed ...

Gov. gets $650,000 in civil Medicare fraud case against doctor and 2 businesses
February 25, 2015, Lafayette, LA -- LAFAYETTE, Louisiana — The U.S. attorney in Lafayette says a $650,000 civil settlement has been reached with a convicted doctor who is serving a prison sentence for performing unnecessary medical procedures. The Tuesday news release from U.S. Attorney Stephanie Finley says Acadiana Cardiology LLC and Acadiana Cardiovascular Center also are involved in the settlement. Finley's office said the settlement was reached after the federal government intervened in a lawsuit a cardiologist filed against Mehmood Patel (meh-MOOD' pah-TELL) and the cardiology businesses. The suit was filed under the federal False Claims Act, which allows people who have witnessed fraud to file suit on ...

Trio in New York charged with faking theft of Ford Mustang
February 25, 2015, Hicksville, NY -- LONG ISLAND, NY – Nassau County Police and the Nassau County Major Case Bureau has arrested three men for Insurance Fraud on Tuesday, February 24, 2015 at 2:20 P.M. in Hicksville. According to detectives, on February 15, 2015 Anthony D. Trapani, 24, of Hicksville reported to the Nassau County Police that his 2007 Ford Mustang had been stolen from the Hicksville Long Island Railroad station. An investigation revealed he conspired with Michael Schmeltzer, 24, of Hicksville who arranged to have the car taken from Trapani’s residence by William Lange, 44, of Amityville. Schmeltzer then drove Trapani to the train station to make ...

Agent in Georgia gets probation, fine for $39K premium theft
February 25, 2015, Royston, GA -- A former local insurance agent has been sentenced in Franklin County Superior Court for insurance fraud. James Travis Williams, 35, pleaded guilty Feb. 12 to Violation of Racketeer Influenced and Corrupt Organizations Act and received 20 years probation and a $20,000 fine. District attorney Parks White said Williams received a reduced sentence after paying back what he stole from his victims, plus interest, a total of roughly $39,000. Williams collected premium payments on a variety of insurance products and never forwarded those premiums to the appropriate insurance companies for coverage. His victims included Madison County residents. Williams created Tri County Insurers in Royston ...

Fraud rings targeting Minnesota, Coalition tells lawmakers
February 25, 2015, Minneapolis, MN -- Combating rapidly spreading organized rings targeting Minnesota auto insurers will require stronger laws that impose intimidating penalties, the Coalition Against Insurance Fraud told a state Senate subcommittee today. “Minnesota is being targeted by out-of-state organized crime rings. They perceive Minnesota is an easy target because it lacks the legal infrastructure to effectively combat the rings,” the Howard Goldblatt, the Coalition’s director of government affairs, said in testimony. The legislature is debating bills limiting ring access to police crash reports, imposing large civil fines on ringleaders, and booting dishonest medical providers from the insurance system. Organized rings are moving to Minnesota and homegrown ...

Five years in prison for Las Vegas pet shop owner for attempted arson
February 25, 2015, Las Vegas, NV -- A 36-year-old former Las Vegas pet shop owner was sentenced to 5 to 14 years in state prison for setting fire to the business where 27 puppies and dogs were rescued last year. Gloria Lee stunned the courtroom when she told Clark County District Court Judge David Barker on Wednesday that she's three months pregnant. Prosecutor Shanon Clowers says Lee will have her baby in prison. Lee pleaded guilty in October to arson, insurance fraud and attempted animal cruelty charges in a plea deal that had 28 other charges against her dismissed. Store security video showed Lee and co-defendant Kirk Bills setting fire in ...

Medicaid director in Delaware apologizes for not instituting anti-fraud program
February 25, 2015, Dover, DE -- The director of Delaware's Medicaid program publicly apologized to lawmakers on Wednesday for delaying a pilot program intended to root out fraud and abuse. "I apologize we did not meet your timeline," Stephen Groff, the Medicaid official, said during a budget hearing on Wednesday. "Please be aware a delay was not my intention," Groff said, adding the office was dealing with "competing priorities." Lawmakers gave public health officials until Oct. 31 last year to hire a contractor to uncover over-utilization, waste and abuse in Medicaid, the state-federal health insurance program for the poor. State taxpayers are expected to pay $734 million for the ...

U.S. Reps. Kevin Brady, Jim McDermott introduce bill to prevent Medicare fraud
February 25, 2015, Olympia, WA -- On Tuesday, Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) of 2015. The bill would prevent fraud in Medicare by making a number of commonsense reforms such as removing Social Security numbers from Medicare cards and eliminating unnecessary paperwork for employers. PIMA incorporates a number of ideas from legislation previously introduced by committee members from both parties. “We have all heard stories and read the news regarding fraud, waste, and abuse in the Medicare program," Brady said. "Seniors are either personally harmed or negatively affected by ...

Elkton man charged with TennCare fraud
February 25, 2015, Elkton, TN -- An Elkton, Kentucky, man was arrested Tuesday after being indicted by the grand jury on insurance fraud charges. Rene Gonzalez, 44, is charged with obtaining TennCare in February 2011 for himself and his children by “fraudulently representing that he and his children lived in Tennessee,” according to the indictment. Between February 2011 and August 2013, Gonzalez obtained medical assistance services and benefits totalling more than $10,000 for himself and his children, the indictment said. The Office of Inspector General investigated the case, and Gonzalez was indicted in November 2014, but served the indictment Tuesday. Gonzalez is charged with five counts of Tenncare fraud and ...

Reports of medical ID thefts jumped 22 percent in 2014
February 24, 2015, NY, NY -- An estimated 2.32 million American adults were victims of medical identity theft as of 2014, up from the 1.84 million estimated in 2013, according to the Medical Identity Fraud Alliance. That’s a nearly 22% jump in this specific kind of fraud. This month, MIFA released its fifth edition of this annual study, conducted by the Ponemon Institute, which highlights the growing threat of medical identity theft. The group defines medical identity theft as someone using a person’s name and other identifying information to fraudulently obtain medical services, receive prescription drugs or pay for medical care. It’s unclear if the crime is occurring ...

Doctor in Illinois headed to prison for illegal distribution of OxyContin
February 24, 2015, Darien, IL -- A suburban physician who pleaded guilty to health care fraud and illegally prescribing controlled substance medications was sentenced Tuesday to 18 months in prison, the U.S. Attorney’s Office said. Bolingbrook resident Sathish Narayanappa Babu, 48, was arrested in February 2014, accused of illegally dispensing oxycodone to an undercover agent and then fraudulently billing Medicare. Babu operated Anik Life Sciences, a home-visiting physician’s office located in Darien. The business was previously located in Arlington Heights. In September, Babu admitted that he illegally prescribed oxycodone and other controlled substances, and fraudulently billed Medicare approximately $500,000, and fraudulently collected approximately $216,000, for services he did not ...

Care provider in Minnesota pleads guilty to $164K Medicaid scam
February 24, 2015, Duluth, MN -- A Duluth woman has pleaded guilty to defrauding Medicaid out of more than $164,000 by falsely billing the state for services through two home health care companies. Lisa Marie Huffman, 43, entered the plea to a felony charge of theft by false representation this week in State District Court. Under the terms of a plea agreement, Huffman is expected to receive a stay of imposition, but she could face jail time as a condition of probation. The Minnesota Attorney General's Medicaid Fraud Control Unit began investigating Huffman and her two businesses, Proactive Caring Accommodating Services (PCA North) and Peace of Mind Health Services, ...

Comp claimant in Florida charged with working construction job
February 24, 2015, Lake City, FL -- LAKE CITY – The Florida Department of Financial Services today announced the arrest of James “Mike” Millard for workers’ compensation fraud. An investigation by the Department’s Division of Insurance Fraud confirmed reports that Willard fraudulently received more than $20,000 in benefits from December 9, 2012, through February 7, 2014, when he filed more than a dozen reports claiming no earned income. It was discovered, however, that Willard was being employed and compensated by a concrete construction company during this time. Millard faces a second degree felony charge that carries a maximum 15 year sentence. His case will be prosecuted by ...

Ex-mayor of New Jersey town pleads guilty to filing false auto claim
February 24, 2015, Roselle, NJ -- UNION COUNTY – A former mayor of Roselle has pleaded guilty to insurance fraud in connection with a motor-vehicle accident more than four years ago. Garrett Smith, 53, pleaded guilty to one count of insurance fraud Tuesday before Union County Superior Court Judge Robert J. Mega, sitting in Elizabeth, according to acting Union County Prosecutor Grace Park. The plea comes the day before Smith’s trial was scheduled to begin following a series of delays. Around 2 a.m. Dec. 25, 2010 Smith left a Roselle bar and struck a parked car with his 2001 Lincoln Town Car on his way home, according to ...

Former Owner of Durable Medical Equipment Company Pleads Guilty in $5 Million Health Care Fraud Scheme
February 24, 2015, Miami, FL -- Washington, DC—(ENEWSPF)—February 24, 2015. A Miami man pleaded guilty today to health care fraud charges in connection with a $5 million scheme to defraud Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Field Office, Special Agent in Charge Mike Fields of HHS-OIG’s Dallas Field Office, Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office, and Special Agent in Charge Perrye K. ...

Former Normal dentist gets probation for fraud
February 24, 2015, Normal, IL -- SPRINGFIELD — A former Normal dentist has been sentenced to three years' probation for insurance fraud. Frank Koe Jr. pleaded guilty in October in federal district court to defrauding dental insurance companies between 2002 and 2012. He was charged with submitting claims and receiving payments for services not performed, or not performed to the extent he described in the claims. Koe, 64, must serve the first six months of his probation in home confinement. He also must pay $60,546.10 to two dental insurance firms. The sentence recommended by Assistant U.S Attorney Patrick Hansen and approved by the court on Monday also bars Koe ...

Raleigh woman sentenced in loan, insurance scam case
February 24, 2015, Raleigh, NC -- A Raleigh woman was sentenced to 60 months in prison after she pleaded guilty to charges stemming from schemes to defraud banks and an insurance company. Teresa Lyn Fletcher, 55, pleaded guilty to two charges of bank fraud and one count mail fraud, authorities said. Fletcher attempted to defraud Bank of North Carolina, TD Bank, and Liberty Mutual Insurance in 2013. In January 2013, authorities said Fletcher provided incorrect information about her wages and assets in order to be approved for a loan from Bank of North Carolina. Once she was approved for the loan, she quickly spent the money and then defaulted due ...

Sandy insurance scam demands law enforcement scrutiny
February 23, 2015, Sandy Hook, NJ -- Early Wednesday morning in the Long Island town of Uniondale, a group of investigators from the New York state attorney general's office crashed the office of a structural engineering company and walked out with file cabinets, computers, and whatever wasn't nailed down. The inspectors are looking for what many victims of Superstorm Sandy have sought since they began to rebuild their shattered lives: evidence that proves how heinous flood insurance companies can be, when they conspire to reduce payments after the worst storm in our history. The dodge has gone on long enough. It's been months since Sens. Robert Menendez and Cory ...

Bergen County, New Jersey Doctor Charged with Fraudulently Billing for Office Visits That Were Never Rendered
February 23, 2015, Englewood, NJ -- NEWARK, NJ—A family medicine physician with offices in Cresskill and Little Falls, New Jersey, was arrested this morning and charged with fraudulently billing Medicare, Medicaid and private health care insurance companies hundreds of thousands of dollars for physician office visits that were never rendered, U.S. Attorney Paul J. Fishman announced. Albert Ades, 60, of Englewood, New Jersey, was indicted by a federal grand jury in Newark on Feb. 20, 2015, on one count of health care fraud and 35 counts of making false statements relating to health care matters. The indictment was unsealed today. Ades is scheduled to appear later today ...

Fraud Hotline Tip Leads Investigators To Ohio Man Committing Fraud
February 23, 2015, Columbus, OH -- Columbus, OH (WorkersCompensation.com) - Gregory Barnett, of Huron (Erie County), pleaded guilty Feb. 4 in Franklin County Court of Common Pleas and was sentenced on one count of workers’ compensation fraud, a first-degree misdemeanor. He agreed to repay $1,125 in restitution. BWC received a tip on its fraud hotline that Barnett was working while receiving BWC benefits. Investigators reviewed records and conducted interviews, and confirmed that Barnett returned to work as a self-employed home contractor in 2013 while receiving temporary total disability benefits. Injured workers are not permitted to work while receiving this type of benefit. In addition to restitution, Barnett was ...

Columbus Woman Sentenced For Workers’ Comp Fraud
February 23, 2015, Columbus, OH -- Columbus, OH (WorkersCompensation.com) - Ronickia Keffer, of Columbus (Franklin County), pleaded guilty to and was sentenced Feb. 10 in Franklin County Court of Common Pleas on one count of workers’ compensation fraud, a first-degree misdemeanor. She was ordered to pay $1,104 in restitution and was also fined $1,000. BWC received an allegation that Keffer was working and engaging in physical activities outside of her medical restrictions while receiving disability benefits. Investigators obtained evidence that revealed Keffer performed cleaning and maintenance duties for a business while receiving disability benefits. Keffer must pay the restitution and fine by June 16, or will have to ...

Englewood doctor accused of Medicaid, Medicare fraud
February 23, 2015, Englewood, NJ -- An Englewood doctor with offices in Cresskill and Little Falls is accused of fraudulently billing Medicare, Medicaid and private health insurance companies between 2005 and June 2014. Albert Ades, 60, is charged with one count of health care fraud and 35 counts of making false statements relating to health care matters, according to the U.S. Attorney's Office. He will appear in federal court in Newark later today. Ades owns and operates Albert Ades M.D., P.A., and allegedly billed insurers for face-to-face physician visits when he never saw patients on the dates he billed, according to a news release. To hide his wrongdoing, officials ...

Five dental scams that can put a bite on you
February 23, 2015, N/A, none -- Going to the dentist involves a certain amount of trust. In a way, it's not that different from taking your car to a mechanic: Most of us don't have the expertise to evaluate the diagnosis. While most dentists are ethical, it's a good idea to remember that the degree on the wall isn't a guarantee of honesty. Dental scams sink their teeth into unsuspecting patients every year, says James Quiggle, a spokesman for the Coalition Against Insurance Fraud. "The most frequent dental scams are inflating claims, delivering worthless treatment that patients don't need and billing insurers for phantom treatment that the dentist ...