News

Hospice center in Michigan paid notorious cancer doc kickbacks for referrals
December 30, 2016, Oakland County, MI -- A Hospice provider has agreed to pay $200,000 over allegations it paid disgraced doctor Farid Fata for patient referrals. U.S. Attorney Barbara L. McQuade's office reports Vitas Health Corporation Midwest paid the settlement to resolve False Claims Act and the Anti-Kickback Statute violations. As for Fata, he is serving a 45-year prison sentence for putting hundreds of patients through needless chemotherapy and cancer treatment in southeastern Michigan. He must also pay nearly $18 million in restitution. The former Oakland County oncologist, falsely told patients they had cancer and ordered severely harmful chemotherapy while billing insurance companies for the unnecessary and, ...

Medical director for Baltimore pill mill jailed for dealing painkillers
December 08, 2016, Baltimore, MD -- Chief U.S. District Judge Catherine C. Blake sentenced Daniel Alexander, age 53, of Pikesville, Maryland today to 18 months in prison, followed by three years of supervised release, for conspiring to distribute oxycodone and alprazolam. Chief Judge Blake also ordered Alexander to forfeit $30,000. The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Assistant Special Agent in Charge Don A. Hibbert of the Drug Enforcement Administration, Baltimore District Office; Special Agent in Charge Thomas Jankowski of the Internal Revenue Service - Criminal Investigation, Washington, D.C. Field Office; Chief James W. Johnson of the Baltimore ...

Former mayor in Ohio gets prison for false burglary claim
December 08, 2016, Jefferson County, OH -- The former mayor of an eastern Ohio village has been sentenced to seven months in corrections facilities after being convicted of charges including insurance fraud and theft in office. Ex-Smithfield Mayor Patricia Freeland was reprimanded at her sentencing hearing Monday in Jefferson County, with the judge stating that the 74-year-old became a criminal immediately upon taking office. Prosecutors say Freeland forged a document that was then submitted as a fraudulent insurance claim tied to a break-in at the village’s wastewater building in July 2009. The insurance company made a partial payment for pumps that were never installed following the incident. The cash was ...

Seven Puerto Ricans charged with Social Security disability fraud
December 08, 2016, San Juan, PR -- On December 6, 2016, a Federal Grand Jury in the District of Puerto Rico returned five separate Indictments charging seven individuals with fraud against the Social Security Administration (SSA) disability insurance benefits in Puerto Rico, announced United States Attorney for the District of Puerto Rico, Rosa Emilia Rodríguez Vélez. The SSA is responsible for the implementation of the Disability Insurance Benefits Program. The SSA provides monetary benefits to workers with severe, long-term disabilities, who have worked in SSA covered employment for a required length of time. Spouses and dependent children of disabled workers may also be eligible to receive benefits. Pursuant to ...

Postal worker in New York must pay back $430K for faking injury
December 08, 2016, Delmar, NY -- A former U.S. Postal Service worker from Delmar who fraudulently collected nearly $430,000 in disability benefits while telling "tall tales" about her 1987 back injury was sentenced to a year and 10 months in federal prison Wednesday. Carol-Lisa Gutman, 66, must repay the $429,677 she ripped off from the U.S. Department of Labor Office of Workers Compensation Programs. In June, a federal jury convicted Gutman of all eight counts she faced, which included wire fraud, federal employees' compensation fraud and theft of government money. Gutman claimed she hurt her back while lifting a sack of mail on July 13, 1987. She became eligible ...

Logger in New York indicted for workers compensation fraud
December 07, 2016, Auburn, NY -- An Auburn man has been indicted and arraigned on charges that he stole more than $75,000 in workers' compensation benefits and failed to provide workers' compensation insurance for two employees at his logging company. A grand jury in Cayuga County indicted David Sigl, 55, of Wall St., Auburn, on second-degree grand larceny, second-degree insurance fraud and first-degree offering a false instrument for filing. In addition to the felony charges, he also was indicted for the workers' compensation crime of failure to secure compensation, a misdemeanor. Sigl, who was arraigned in Cayuga County Court, was released on $2,500 cash or $5,000 bond ...

Pair in Florida charged with diverting drugs paid for by Medicaid
December 07, 2016, Miami, FL -- Attorney General Pam Bondi, the Florida Department of Law Enforcement and the Miami-Dade Police Department today announced the arrest of two South Florida residents in connection to a multimillion dollar drug diversion scheme fueled by Medicaid fraud. Amneris Lopez, 38, allegedly used her corporation, World Med, Inc., to traffic more than $3 million of diverted pharmaceuticals between 2011 and 2013. Ramon Hernandez, 32, allegedly laundered money derived from these black market sales of contraband prescription drugs on behalf of Lopez. According to the investigation, Lopez used her Florida-based corporation to sell pharmaceuticals to a company based in Georgia, where World ...

Hospital in Florida to pay feds $12M for billing for unneeded testing
December 07, 2016, Miami, FL -- South Miami Hospital, a not-for-profit regional hospital located in South Miami, Florida has agreed to pay the United States approximately $12 million to settle allegations that it violated the False Claims Act by submitting false claims to federal healthcare programs for medically unnecessary electrophysiology studies and other procedures allegedly performed by John R. Dylewski, M.D., at South Miami Hospital. Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region, John F. Khin, Special Agent in Charge, Defense ...

9 fraudsters inducted into 2016 Insurance Fraud Hall of Shame
December 07, 2016, Washington, DC -- Who says the elections are over? The insurance world's commanders in thief also take office after balloting for the Insurance Fraud Hall of Shame. The action swirls around jail houses instead of White Houses, insurance policies instead of defense policy and prison terms more than terms of office. The electorate that matters most is a judge and jury. The no-class of 2016 profiles America's most-brazen convicted insurance criminals of the past year. They were dishonored by a poll of one: the Coalition Against Insurance Fraud. Some shamers are stone-cold criminals and even murderers; others are circus-caliber bunglers. All are elected public servants, in ...

Woman in Florida illegally collected benefits from three dead husbands
December 07, 2016, Orlando, FL -- An Orlando, Florida, woman is accused of using her three dead husbands to illegally cash in on more than $320,000 in government benefits. Investigators said she collected Veterans Affairs, Medicare and Social Security benefits for each of the men even though she remarried. Cynthia Brunat, 74, was arrested on suspicion of what investigators said was an organized fraud scheme involving federal benefits. When asked about the allegations, Brunat said she had no idea about the charges. “The benefits were directly linked to several for the husbands she was married to,” said Capt. Evangelina Brooks, of the Division of Insurance Fraud. Investigators said Brunat has been ...

Congress passes law to fund opioid drug prevention programs
December 07, 2016, Washington, DC -- The Senate passed an extensive medical funding bill Wednesday, sending it to the desk of President Barack Obama, who says he'll happily sign it. It was a rare demonstration of unity in a Congress badly split by politics and usually determined to thwart any initiatives coming out the White House. But the $6.3 billion legislation easily passed the Senate in a vote of 94-5. The measure pays for some of Obama's pet projects, including the Cancer Moonshot that Vice President Joe Biden leads. "This bill will make a big difference, and I look forward to signing it as soon as it reaches my ...

Insurance agent in New York accused of submitting fake disability applications
December 07, 2016, Milton, NY -- A Milton insurance agent was indicted by an Ulster County grand jury on multiple felony charges, the Ulster County District Attorney’s Office said Wednesday. On Tuesday, Robert Bari, 37, was indicted for the felonies insurance fraud, grand larceny, criminal possession of a forged instrument and falsifying business records, according to a press release. On June 24, Bari was arrested by state police at Highland at the state police barracks, 212 state Route 299, in Lloyd and was charged with insurance fraud involving more than $3,000 and with insurance fraud involving more than $50,000, both felonies, and with tax fraud, a misdemeanor. The jury ...

Couple in California plead guilty in crash-and-buy scam with motorcycle
December 07, 2016, Sacramento, CA -- Grandon David DeMasters and his wife, Sandra Jean DeMasters, pled guilty to felony insurance fraud. On July 16, 2015, the defendants’ 21-year-old son, Grandon Dylan DeMasters, left a bar near Isleton on a Harley Davidson motorcycle owned by the defendants. He rode at a high rate of speed, passing motorist Wing Joe. Moments later, Grandon Dylan DeMasters crashed the motorcycle on the side of the road and left it on the roadway. As Mr. Joe came around a bend, he hit the motorcycle. The Harley then burst into flames, totaling both vehicles. On July 17, ...

U.S. Supreme Court upholds Katrina verdict against State Farm
December 06, 2016, Washington, DC -- The Supreme Court on Tuesday handed a victory to two whistleblower sisters by upholding a jury verdict that found State Farm defrauded the U.S. government when the insurance company assessed damage caused by Hurricane Katrina along the Gulf of Mexico coast in 2005. The court ruled 8-0 to reject State Farm’s challenge to a 2015 lower court decision upholding the verdict in a 2006 lawsuit brought by sisters Cori and Kerri Rigsby under the False Claims Act, which lets people sue on behalf of the government over allegations it has been defrauded. The suit accused the Bloomington, Illinois-based company of improperly seeking ...

Woman in Kentucky cashed dead husband's disability checks for 11 years
December 06, 2016, Louisville, KY -- A Louisville woman pleaded guilty this week in United States District Court before Chief Judge Joseph H. McKinley Jr., to several charges involving the fraudulent receipt of Old-Age, Survivors and Disability Insurance (OASDI) benefits by the Social Security Administration (SSA), for an eleven-year period, totaling $268,396 announced United States Attorney John E. Kuhn, Jr. In court, Janice M. Arnow, age 69, admitted that she failed to disclose the death of her husband and continued to receive and spend OASDI payments made by the SSA between October 2003 and October 2014. Further, Arnow admitted to theft of government property. Arnow embezzled, stole, ...

Feds sue owner of lab in New Jersey for filing bogus claims
December 06, 2016, Parsippany, NJ -- The owner of a Parsippany medical-testing company is being sued by the U.S. government for submitting claims to Medicare for testing he never actually performed, U.S. Attorney for New Jersey Paul Fishman said in a statement Tuesday. Vijay Patel, 59, of Parsippany, pleaded guilty in 2014 to health care fraud in connection with his company, Mobile Diagnostic Testing. The civil complaint announced Tuesday alleges Patel violated the False Claims Act. Authorities say Patel worked with a cardiologist who also accepted Medicare patients, but who was required to submit documentation justifying the services being billed to the government health care program. Between ...

Firefighting in New York accused of faking hate crime by torching home
December 06, 2016, Endicott, NY -- An Endicott firefighter is accused of setting an "obstacle course" of gasoline-filled cans inside his home while his wife and two teenagers slept Aug. 10, prosecutors say, then starting a fire. While the house at 410 E. Main St. filled with smoke and as emergency responders rushed to the scene around 2 a.m., 41-year-old firefighter Jason T. Stokes and his family escaped unhurt, according to Broome County District Attorney Steve Cornwell. Gas cans and containers with flammable materials — alleged booby traps for firefighters — were found while searching inside after quickly extinguishing the flames, he said. Coupling the suspicious fire was ...

Insurers beefing up technology to counter growing fraud
December 05, 2016, Washington, DC -- Tools deployed against cyber, auto scammers to help control premiums Technology is a valued ally of insurers in combatting insurance fraud. And for good reason — this crime is growing. These are two findings of the Coalition’s newest study of how insurers use tech to combat billions of dollars in fraud each year. The study is one of the surest barometers of progress in how insurers wield technology against fraudsters. It’s also a window into scams that most concern property-casualty insurers, and how they’re responding. Fraud is climbing, more than 60 percent of insurers say in the study. Cyber-fraud is a newer problem area ...

Woman in Utah charged with fraud after jeep found in ravine
December 05, 2016, South Ogden, UT -- A South Ogden woman has been charged with felony insurance fraud after she reported her Jeep Cherokee stolen and it was found at the bottom of a national forest ravine in Box Elder County. South Ogden police said Kimmi Chute, 47, reported the theft to police and filed an auto insurance claim for the vehicle, saying it had disappeared overnight June 30. But the Jeep was located July 1 via GPS trackers installed by the dealership that had leased it to Chute. Officers later learned Chute had been having financial troubles, the Jeep had transmission problems and she had told others she ...

Man in Idaho sentenced for buying policy after car is stolen
December 05, 2016, Canyon County, ID -- A judge has sentenced a Canyon County man following a guilty plea to one count of insurance fraud. Scott Gropp, 52, of Nampa was sentenced Nov. 28 by Judge Bradly S. Ford in district court in Canyon County. Gropp pleaded guilty to the charge on Oct. 15. He was a licensed insurance agent when he committed the crime and was initially charged with four counts of fraud. During the sentencing, Ford withheld judgment and placed Gropp on three years’ supervised probation. The terms and conditions of probation include the completion of 50 hours of community service, a $1000 fine, 150 days ...

FBI seeking to seize $5M in life insurance tied to murder in Texas
December 05, 2016, Colleyville, TX -- The FBI is seeking to seize $5 million in life insurance benefits from policies that investigators claim were fraudulently obtained for a woman killed while cleaning a house in Colleyville in 2014. The insurance proceeds have been tied up in legal wranglings since shortly after the Sept. 22, 2014, killing of Anita Fox, 69. Officials say a father and son — members of a nomadic, ethnic clan known as Irish Travellers — plotted to kill Fox in order to collect on a $1 million insurance policy that the father had invested in along with other family members. The father, Gerard “Big Joe” Gorman, ...

Why Analyzing Unstructured Data Benefits Every Claims Manager
December 05, 2016, Washington, DC -- If you’re just catching on to the fact that big data is shaking up the insurance industry in a big way, you’re a bit behind the curve. Across all industries, almost 90 percent of large companies say big data is going to revolutionize business operations, according to a report from Accenture. It’s predicted that this revolution will be on a scale comparable with how the internet changed the way we work starting in the 1990s. Remember the way it was before the days of email, Google and filing claims online? Understandably, companies are scrambling to identify the new realities big data will ...

Columbia County resident Arrested for Medicaid Fraud and Grand Theft
December 05, 2016, Columbia County, FL -- Attorney General Pam Bondi’s Medicaid Fraud Control Unit, with the assistance of the Columbia County Sheriff’s Office, today announced the arrest of a Columbia County resident for Medicaid fraud and grand theft. Lorrene L. Morrow-Miller, a certified nursing assistant, 42, allegedly submitted daily service logs and timesheets to her previous employer, Kelly’s Helping Hands, Inc., for services not provided. Kelly’s Helping Hands, a Levy County home and community-based services Medicaid provider, relied on the daily service logs Morrow-Miller submitted to submit claims of more than $1,900 to the Florida Medicaid program. Additionally, Morrow-Miller received more than $1,000 in salary from Kelly’s ...

Home health fraud paid for couple’s $900,000 dream house
December 05, 2016, Columbus, OH -- The owners of a home health care agency in Columbus, Ohio, admitted last week to defrauding Medicaid and building a $932,000 house with the funds, The Columbus Dispatch reported. Muna Alnoubani, 49, and her 51-year-old husband, Riyad Altallaa, pleaded guilty on Dec. 1 in Columbus federal court to conspiring to defraud Medicaid. Altallaa also pleaded guilty to money laundering and using the money to pay for the couples’ home. Between October 2011 and March 2015, Alnoubani and Altallaa’s home health care agency, Columbus Home Health Care Services, allegedly submitted bills to Medicaid for services that were never provided. The agency also falsified ...

Ohio fraud conviction stains carpet cleaner's record
December 05, 2016, Chillicothe, OH -- A Florida man who had been collecting injured workers’ benefits from Ohio since 2011 pleaded guilty to workers’ compensation fraud Monday after investigators with the Ohio Bureau of Workers’ Compensation found him working as a carpet cleaner in Florida. Jarrod B. Lewis, 40, of Palm Bay, Florida, must pay $5,300 in restitution to BWC and serve five years probation in lieu of a 12-month prison sentence for committing the fifth-degree felony, a Franklin County Common Pleas Court judge ruled Nov. 28. Lewis, formerly of Chillicothe, Ohio, was working as a youth specialist for the Ohio Department of Youth Services when he was ...