News

Dentist in Pennsylvania says he was fired for reporting fraud
July 27, 2016, Philadelphia, PA -- A dentist who was fired by Penn Dental Medicine is suing the University of Pennsylvania, alleging he was wrongfully terminated in retaliation for reporting that a fellow dentist was providing unnecessary treatment to make more money. In its legal response, Penn claims it fired Steven S. Pesis because he reviewed patients' records without permission, in violation of university policies and the federal law that protects the confidentiality of patients' medical information. Pesis' lawsuit is also against Peter B. Kauderwood, executive director of administration for Penn's School of Dental Medicine. The suit, filed in March in Philadelphia Common Pleas Court, asks for a ...

4 face arson, insurance fraud charges after vehicle is burned in Somerset County
July 27, 2016, Somerset, PA -- State police in Somerset said four people are facing felony charges, including arson to commit insurance fraud, after burning a vehicle that had been reported stolen in Somerset County. Chance Smith, Jeremy Scarlett, Jessica Nicklow and Kimberly Bowers have all been arraigned and released on $50,000 unsecured bail. Scarlett and Nicklow are from Somerset, Smith is from Stoystown and Bowers is from Connellsville. According to a criminal complaint, Bowers and Nicklow reported to police on April 7 that Bowers’ 2007 Subaru Forester had been stolen. Bowers said her son, Cody, had mechanical problems while driving home from work and pulled off the road ...

'Injured' worker in Massachusetts caught working while collecting comp
July 27, 2016, Milford, MA -- A Milford roofer was released without bail at his Worcester Superior Court arraignment Wednesday on charges of collecting more than $18,000 in workers’ compensation while he continued to work. Kenneth Doyle, 42, of Milford, was released on personal recognizance after pleading not guilty to charges of workers’ compensation fraud and larceny over $250. There was no bail argument, as Assistant Attorney General Anuj Kheterpal made no case to hold Doyle on bail. Doyle was indicted by a Worcester Superior Court grand jury last month. Milford lawyer Warren Heller represented him in court Wednesday. Heller requested a next date of Oct. 14 after receiving ...

Manager of eye clinic in Oregon pleads guilty to false billing
July 27, 2016, Gresham, OR -- The manager of a Gresham ophthalmology clinic has pleaded guilty to health care and Internal Revenue Service fraud schemes in which he collected more than $2.5 million over seven years, federal prosecutors said Wednesday. Anthony Curtis Neal, 40, told a federal judge Tuesday that he and his now-deceased father, Dr. Dean Neal, defrauded Medicaid and other health care plans and conspired to defraud the IRS while working at Eye Care Services Inc. Neal and his father, who was the clinic's primary doctor, managed the clinic. To increase their income, Neal's father gave patients medically unnecessary tests and Neal submitted the ...

Skin doc in New York to pay $300K to settle false billing charges
July 27, 2016, Long Island, NY -- United States Attorney Robert L. Capers and Scott J. Lampert, Special Agent-in-Charge, Health and Human Services, Office of Inspector General (HHS-OIG), New York Region, today announced that the United States has entered into a civil settlement agreement with Deremedx Dermatology, P.C. d/b/a Dermatique and Dr. Barry A. Solomon to resolve a case brought under the federal False Claims Act. Solomon is the owner of, and sole practitioner at, Dermatique. The agreement resolves an investigation involving allegations that, in contravention of Medicare and Medicaid regulations, Solomon engaged in a host of fraudulent billing practices and submitted false claims to ...

Chiro owner, cohorts to pay $3.5M to New Jersey for faking PIP claims
July 27, 2016, Perth Amboy, NJ -- The state Department of Banking and Insurance has recovered $3.5 million in fines, penalties and attorneys’ fees in an insurance fraud case against Gregorio Lajara of Perth Amboy and various other individuals, health care practitioners and facilities, New Jersey Department of Banking and Insurance Commissioner Richard J. Badolato said in a statement Wednesday. The individuals allegedly were involved in a broad scheme to defraud Allstate and other insurance companies of personal injury protection (PIP) benefits through a widespread personal injury mill, the statement said. In a companion case connected to the same operation, Allstate Insurance recovered more than $20 million in ...

Doctor in Arkansas gets 2 years in prison for billing scam
July 26, 2016, Little Rock, AR -- A Little Rock doctor must serve two years in prison and pay more than $700,000 in restitution to insurers and patients after turning a blind eye to regulations that forbid billing massage therapy services as actual "physical therapy," a judge decided Monday. Dr. Robert Barrow, 62, who from 2003 through 2014 operated a west Little Rock clinic called Your Doctor's Office with his wife, Dr. Angela Barrow, pleaded guilty Oct. 13 to a charge of health care fraud conspiracy. He acknowledged then that he had been "deliberately ignorant" to the fact that his office used a billing code for physical therapy ...

New study says claim rejection spurs people to commit fraud
July 26, 2016, Washington, DC -- A new study revealed that the pain an individual feel when being rejected could lead the person to commit fraud. The study, published in the journal Frontiers in Psychology, suggests that people who are rejected by their insurance companies, regardless of the fairness of the rejection, were more likely to submit false insurance claims in their next tryFor the study, the researchers recruited 156 American MTurks workers. The participants were told that the study is about English language proficiency. To make the cover story of an English language proficiency test more plausible, the researchers divided the test into two parts: grammar ...

Cop's girlfriend in Iowa accused of helping him torch his home
July 26, 2016, Jones County, IA -- The girlfriend of a convicted former Jones County Sheriff’s deputy and volunteer firefighter has been charged in federal court for participating with him in a scheme to defraud an insurance company involving arson. Beth Galloway, 41, of Olin, on Monday was charged with one count of mail fraud in U.S. District Court. She is accused of participating with James Plower, 51, of Olin, who admitted to burning down his house in Martelle in 2013 in order to collect $150,000 in insurance money. He was convicted of mail fraud and use of fire to commit a felony last year and is serving ...

Chicago-area home-health head sentenced to 6 years in prison
July 26, 2016, Chicago, IL -- The head of a Schaumburg home health care company was sentenced Tuesday to six years in prison for fraudulently billing Medicare for unnecessary services, officials said. Diana Jocelyn Gumila, 47, of Streamwood, was found guilty by a jury in April on 21 counts of health care fraud and three counts of making false statements in a health care matter. As the manager of Suburban Home Physicians, which did business as Doctor at Home, Gumila directed employees to perform in-home visits with patients who were physically capable of leaving their residences and not in need of in-home treatment, federal prosecutors said in a ...

Eight people in Louisiana charged with staging auto crashes
July 26, 2016, Jeff Davis Parish, LA -- Louisiana State Police on Tuesday arrested seven of eight people suspected in an insurance fraud ring in Jeff Davis Parish. Mobile users, click HERE to see mugshots of those arrested. The allegations are that a group of family and friends staged three separate crashes over a five-month period, as well as a “jump in” crash several months later, said Sgt. James Anderson, Louisiana State Police Troop D spokesman. None of these crashes involved anyone from outside of the criminal group. The group included children in some of the staged crashes. Anderson said that a “jump in” crash occurs when an individual or individuals ...

Poll: nearly half of Utahns have been affected by prescription drug abuse epidemic
July 26, 2016, Salt Lake, UT -- Almost half of all Utahns know someone addicted to prescription drugs or have had a family member addicted or suffered from an overdose, a new UtahPolicy poll finds. Prescription drug addiction and overdoses have come out of the shadows in recent years, with Utah political leaders trying to find ways to help with what seems to be a growing problem. And our new Dan Jones & Associates poll finds there is a good reason for public concern – so many Utahns have been or are being touched directly with the addiction problems. ...

Former Centra nurse pleads no contest to prescription drug fraud
July 26, 2016, Lynchburg, VA -- A former nurse at Lynchburg General Hospital was found guilty of replacing a painkiller with saline over a two-month period. And, even after she was terminated, prosecutors say, her attempt to get more of the narcotic didn't end there. Autumn Burks Ferguson plead no contest to prescription drug fraud in Lynchburg on Tuesday. Prosecutors say she accessed "Acudose" machines, which hold prescription drugs for patients, 36 times between October and November of 2015. Ferguson reportedly used a syringe to drain vials of dilaudid, replacing the loss with a saline solution. It follows a lengthy investigation involving the Department of Health Professions and Virginia State ...

Nurse accused of stealing Mariners Hospital prescription pad, forging doctor's signature
July 26, 2016, Key Largo, FL -- A nurse at a Florida Keys hospital was arrested Monday after she stole a prescription pad, forged an emergency room doctor's signature and filled the prescriptions at an area pharmacy, according to the Monroe County Sheriff's Office. Heather Born, 30, of Key Largo, faces charges of forgery, possession of a controlled substance without a prescription and petit theft. According to a probable cause report, Born was working as a nurse at Mariners Hospital in Tavernier when she stole two hospital prescriptions, forged Dr. Thomas Morrison's signature, filled the prescriptions at a CVS in Key Largo twice in April and signed the receipt. Deputies ...

Federal jury convicts Houston doctor of dealing painkillers
July 26, 2016, Houston, TX -- A federal jury has returned guilty verdicts on all 19 counts as charged against a Houston doctor for distributing oxycodone and hydrocodone, announced U.S. Atttorney Kenneth Magidson. The jury deliberated for approximately eight hours before convicted Richard Arthur Evans, 71. He now faces up to life in prison. The jury heard testimony for 14 days from 15 witnesses, including other doctors who appeared as expert witnesses. The government presented more than 175 exhibits during the course of the trial. Co-defendant David Devido, 78, of Houston, pleaded guilty on the first day of trial. The two defendants conspired to distribute oxycodone ...

Comp claimant in California headed to jail for faking injury
July 26, 2016, Ventura County, CA -- A former Ventura County Human Services Agency employee was sentenced Tuesday to 109 days in county jail and placed on probation for filing fraudulent workers' compensation claims. A jury in June found Linda Boggess, 59, guilty of four felony counts of workers' compensation insurance fraud. According to prosecutors, Boggess filed the claim in March 2007 and said she was experiencing "paralyzing pain." Boggess received medical treatment and was placed on temporary disability until November 2011, when she was cleared to return to work without restrictions. Prosecutors said the Ventura woman filed new work restrictions approved by another doctor that limited her from ...

Care aide in Missouri billed for providing services to man in prison
July 25, 2016, Camdenton, MO -- Attorney General Chris Koster said Monday that a health care aide from Camdenton, Mo. has pleaded guilty to a felony count of Medicaid fraud. The Attorney General’s Medicaid Fraud Control Unit and Camden County Prosecuting Attorney Michael Gilley jointly prosecuted the case. Koster said his Medicaid Fraud Control Unit led the investigation into Lisa Long, 52, after the case was referred by the Missouri Medicaid Audit and Compliance Unit of the Department of Social Services. The investigation revealed that Long fraudulently billed Medicaid for personal care attendant services in 2013 that were not provided because the recipient was incarcerated. The fraud ...

McMinn County deputies make TennCare fraud arrest
July 25, 2016, McMinn County, TX -- A man on the run from authorities for TennCare Fraud for ten months gets arrested in McMinn County. 22-year-old Tyler C. Knox of Sweetwater was charged last September with four counts of doctor shopping for the painkiller Hydrocodone in McMinn County. Authorities say Knox used the Tennessee state healthcare insurance benefits as payment for the drugs. That just become a Class D felony July 1, 2016. That means it is now punishable by up to four years in prison. You can report suspected fraud by calling 1-800-433-3982 toll-free from anywhere in Tennessee, or follow prompts that read “Report TennCare Fraud.” District Attorney General Stephen Crump is ...

Pain of rejection makes us more likely to commit fraud
July 25, 2016, Washington, DC -- People commit fraud because they are unhappy about being rejected, a new study in Frontiers in Psychology has found. Many of us might not professional criminals, however when an insurance company rejects our claims, we are more likely to inflate the claims. Insurance companies take note: we are more likely to submit false insurance claims if our original submissions are rejected. Regardless of whether that rejection is fair or unfair, or if there is a financial reward at stake, being rejected makes us feel unhappy and we react by behaving dishonestly. In this study, which used a mock insurance claim scenario, people whose ...

Is Data the Answer to Getting a Handle on Prescription Drug Abuse?
July 25, 2016, Washington, DC -- For years, those on the ground level at addiction treatment facilities saw a problem boiling up among their patients: prescription opioid addiction. As the issue became increasingly commonplace, law enforcement and medical examiners also began to see increasing evidence of the situation in crime statistics and on the morgue slab. But larger governments, despite vast connections into communities, were slower to realize the full gravity of opioid addiction in America without hard data and analytics systems in place. The problem now maintains a full boil, fluctuating between the successes of state and local programs and spikes in prescription drug use. While many ...

Overturned 2011 murder case leads to lawsuit
July 25, 2016, Lincoln County, MO -- Last fall, after spending more than three years in jail, Russell Faria was acquitted in his wife’s murder. Now, Faria is suing Lincoln County Prosecuting Attorney Leah Askey, as well as several of the investigators who worked on the case for false arrest and due process violations. The federal civil suit, filed Tuesday, alleges that Askey, former Sheriff’s Department Sgt. Ryan McCarrick, and current Sheriff’s Department Detectives Michael Merkel and Patrick Harney “fabricated evidence, ignored exonerating evidence and failed to prosecute the other obvious suspect in the murder.” Faria, who now resides in St. Charles, is being represented in the suit by St. ...

Ohio Supreme Court Sides With Workers’ Comp Fraud
July 25, 2016, Columbus, OH -- Ohio has a specific statute that protects injured workers from retaliation after filing a workers’ compensation claim. O.R.C. 4123.90 states: No employer shall discharge, demote, reassign, or take any punitive action against any employee because the employee filed a claim or instituted, pursued or testified in any proceedings under the workers’ compensation act for an injury or occupational disease which occurred in the course of and arising out of his employment with that employer. It would seem that for this statute to protect an employee, the employee’s alleged injury must be an actual workplace injury. Not so fast. In Onderko v. Sierra Lobo, Inc. ...

Three charged in massive medicaid and medicare fraud scheme
July 25, 2016, Miami, FL -- Attorney General Pam Bondi’s Medicaid Fraud Control Unit today announced the arrests of three individuals for operating a $1 billion Medicare and Medicaid fraud scheme involving numerous Miami-based health care providers. Attorney General Bondi’s MFCU, as part of the HEAT Strike Force, assisted in identifying more than $100 million of Medicaid fraud in connection to this scheme. Odette Barcha, 49, Arnaldo Carmouze, 56, and Philip Esformes, 47, all of Miami-Dade County, are charged with conspiracy, obstruction, money laundering and health care fraud. “My Medicaid Fraud Control Unit worked tirelessly to investigate more than $100 million in fraudulent Medicaid charges connected ...

How to cut costs If your doctor isn't part of your health insurance network
July 25, 2016, Washington, DC -- You’ve probably heard the horror stories. You go to a doctor or local hospital and expect that your health insurance will cover your costs. Then you get hit with a huge medical bill, which can leave you on the hook for thousands of dollars. Such surprise medical bills are all too common because it’s not always clear whether a doctor or medical provider is part of your health insurance network. While your insurance company provides a list of doctors and hospitals that are considered "in-network," there are times when the doctor you want—or need—won't be covered by your insurance. This could ...

Psychiatrist in Florida sentenced for aiding disability scams
July 25, 2016, Miami, FL -- Attorney General Pam Bondi, the United States Attorney’s Office for the Southern District of Florida and additional federal partners today announced the sentencing of a Miami-Dade psychiatrist for participating in various schemes to defraud Medicare, Medicaid, the U.S. Social Security Administration, and the U.S. Citizenship and Immigration Services. Fernando Mendez Villamil, 48, of South Miami is sentenced to more than 12 years in prison, followed by three years of supervised release. Villamil previously pleaded guilty to conspiracy to commit health care and wire fraud, conspiracy to defraud the U.S. and make false statements with respect to immigration matters and conspiracy to ...