News

Court in New Jersey overturns auto fraud conviction of ex-police chief
August 01, 2015, Bergen County, NJ -- In a stunning reversal of fortune for former Hackensack Police Chief Ken Zisa, an appeals court on Friday overturned his conviction on misconduct and fraud charges in a decision that was harshly critical of prosecutors and has the potential to reopen deep fissures in the city. The judges said the prosecution improperly focused on Zisa’s politically connected family during his 2012 trial as they threw out jury verdicts on official misconduct and insurance fraud charges, which were related to accusations that the chief covered up an alleged drunken-driving incident involving his former girlfriend. The fraud charge was dismissed outright, but the judges ...

Bait shop owner in Ohio caught on video working while collecting comp $
July 31, 2015, Cleveland, OH -- A Cleveland (Cuyahoga County) man was sentenced July 21 in the Franklin County Court of Common Pleas on one count of workers’ compensation fraud, a first-degree misdemeanor. Anthony A. Avancini pleaded guilty to the charge on the same day. “A doctor’s note tipped off one of our claims service specialists, who reported potential fraud,” said BWC Administrator/CEO Steve Buehrer. “Our Special Investigations Department will not waiver in its efforts to seek justice in cases where claimants, employers and medical providers commit workers’ compensation fraud.” SID received an allegation from a claims service specialist supervisor that a doctor’s note stated Avancini “owns a ...

Owner of hospice service in Oklahoma sentenced to three years in prison
July 31, 2015, Prairie View, OK -- The owner of Prairie View Hospice in Oklahoma will pay $2.5 million in restitution and serve three years in prison starting August 28, after a jury convicted her of Medicare fraud, according to the Department of Justice in the Western District of Oklahoma. From 2010 to 2013, Paula Kluding, 39, concealed the true medical condition of Prairie View Hospice's patients in order to "pass" a Medicare audit and to fraudulently obtain money from Medicare, according to evidence presented at trial. Nursing notes were falsified to make it appear that patients were in worse health than they actually were to justify the patient's ...

Man in North Dakota admits to filing fake comp claim to get painkillers
July 31, 2015, West Fargo, ND -- A West Fargo man is wanted on fraud charges after prosecutors allege he filed fake workers' compensation claims against the state's Workforce Safety and Insurance agency. Court documents filed Wednesday with the charges in Cass County District Court allege James Wesley Johnson, 45, filed the first of nine false workers' compensation claims for injuries to his lower back, right shoulder and left leg in December 2013. A senior WSI claims adjuster told investigators Johnson filed his work injury claim after he was supposedly working with a forklift at Mac's Hardware in Fargo and sought treatment at Sanford Medical Center's emergency room and ...

Chiro in Hawaii fined for submitting 67 fraudulent medical claims
July 31, 2015, Maui, HI -- The state Department of Labor and Industrial Relations has ruled that a Maui chiropractor defrauded the County of Maui dozens of times, in what may be one of the greatest number of fraud counts found against a health care provider in county history, according to county officials. In a press release issued by the Office of Maui Mayor Alan Arakawa, county officials say the administrative ruling states that “Dr. James Hattaway of Maui Family Chiropractic committed 69 counts of fraud, including concealing a material fact, presenting multiple claims for the same injury and 67 fraudulent claims for payment of a health ...

Irish Travellers suspected in murdered Texas woman’s life insurance scam
July 30, 2015, Colleyville, TX -- Anita Fox was found stabbed to death in the Colleyville home which she was hired to clean in September 2014. Fox’s daughter and son-in-law held a multi-million dollar policy on Fox’s life and sold a portion of the policy to investors they reportedly had never met. These investors were Bernard and Gerard Gorman, a father-son duo, now accused of Fox's murder. The Gormans (aged 27 and 48) were accused of stabbing the 72-year-old to death after her life insurance policy raised suspicions. They had been paying $700 on Fox’s policy but stood to gain $1 million when she died. The housekeeper’s daughter Virginia ...

David Wiseman, 50, owner of S & G Taxi, charged with insurance fraud
July 30, 2015, Rankin, none -- David Wiseman, a 50-year-old Rankin Inlet taxi operator, is accused of making up a company to try and defraud his insurance company of $56,000 after a furnace fire damaged his business in December 2013, The owner of S & G Taxi is charged with falsifying books and documents and filing fraudulent or misleading receipts. Wiseman's insurance company, Aviva Insurance, hired an independent insurance adjuster to investigate approximately $347,000 in claims, following a fire to his taxi business. According to Aviva Canada, the independent adjuster found that a company Wiseman claimed he hired to rent industrial heaters in order to keep his business running ...

Former NHL player, wife charged with filing bogus Medicaid claims
July 30, 2015, Boca Raton, FL -- Former NHL hockey player Sergei Berezin and wife Lyudmila Ustakova were among 13 people arrested this week in connection with a health-care fraud scheme. The Boca Raton couple is charged with filing a false Medicaid claim and conspiracy to commit Medicaid fraud. Berezin, 43, and Ustakova, 46, paid to have their records falsified in order to obtain Medicaid and food stamp benefits, state fraud investigators said. The couple, and others, paid a fee to Irma Davidian, 52, of Boca Raton, who then paid government employees to process and approve falsified benefits applications. The couple falsely billed Medicaid $28,687 and $38,915 between January 2010 and ...

Medical device maker to pay feds $13.5M for paying kickbacks to surgeons
July 30, 2015, Los Angeles, CA -- California-based medical device manufacturer NuVasive Inc. has agreed to pay the United States $13.5 million to resolve allegations that the company caused health care providers to submit false claims to Medicare and other federal health care programs for spine surgeries by marketing the company’s CoRoent System for surgical uses that were not approved by the U.S. Food and Drug Administration (FDA), the Justice Department announced today. The settlement further resolves allegations that NuVasive caused false claims by paying kickbacks to induce physicians to use the company’s CoRoent System. “The Justice Department is committed to holding medical ...

Teacher in Tennessee charged with arson and insurance fraud
July 30, 2015, Happy Valley, TN -- A Happy Valley High School teacher was arrested Monday evening after she was indicted by a grand jury on charges of arson and presenting a fraudulent insurance claim. April Elizabeth Beam, 42, of the Pinecrest community, was arrested by the Carter County Sheriff’s Department. Mike Carlock, public information officer with the sheriff’s department, said the arson investigation stems from a fire at a Stoney Creek home. According to the indictment, the fire occurred on Feb. 25. The indictment said Beam “did knowingly damage a structure by means of a fire or explosion with intent to destroy or damage the structure to collect ...

Rethinking facility inspections in medical investigations
July 29, 2015, Washington, DC -- A physician is suspected of insurance fraud, so an insurer calls for a facility inspection. The investigator arrives unannounced at the clinic and is told to wait outside. A few minutes later, a disgruntled and agitated office manager comes to the door and tells the investigator that the physician is not available and that the investigator will have to call to schedule an inspection. The investigator goes home empty handed, and the suspect physician goes into overdrive, removing or adding items related to the investigation and prepping office staff and even patients in case they are called for recorded statements ...

Federal bill would curb classifying workers as independent contractors
July 29, 2015, Harrisburg, PA -- In general, an independent contractor or freelancer is a worker who runs their own business but is hired by others for specific purposes and projects. But a growing number of employers have been using the independent contractor label on what had long been considered employees, often with the goal of shedding the cost of contributing to insurance and retirement benefits. A new piece of legislation seeks to make sure that businesses aren’t mislabeling employees as contractors. The Payroll Fraud Prevention Act of 2015 [PDF], introduced by Sen. Robert Casey of Pennsylvania and Sen. Al Franken of Minnesota, would amend the Fair ...

Pediatrician in New Jersey jailed for submitting 1000-plus false claims
July 29, 2015, Jersey City, NJ -- A Jersey City pediatrician was sentenced to 21 months in prison on Wednesday for fraudulently billing Medicaid for more than 1,000 wound repair procedures that were never performed, U.S. Attorney Paul Fishman announced. The previous owner and operator of Sinai Medical Center of Jersey City LLC, Dr. Badawy M. Badawy, was charged back in 2013 for his scheme and later pleaded guilty this past February to one count of an indictment charging him with health care fraud. Badaway, 52, ran a pediatric and family medicine focused practice in Jersey City from January 2004 to December 2008. Over that time span ...

Doctor in Alaska headed to prison for filing $600K in false Medicaid claims
July 29, 2015, Anchorage, AK -- An Anchorage physician accused of Medicaid fraud was sentenced in Superior Court Wednesday. Dr. Shubhranjan Ghosh was sentenced to a total of seven years, with three and a half of those years suspended. He was also sentenced to 10 years probation. Ghosh, of Ghosh Psychiatric Services, specialized in treating children and adolescents with autism and mental health disorders. He was arrested in 2014 for Medicaid fraud. State prosecutors said he assisted in filing more than $600,000 in false claims. Ghosh was also ordered to pay back $605,000 in restitution. Originally facing multiple charges in connection with falsifying records and writing false prescriptions for ...

Four charged with various insurance fraud offenses in Washington
July 29, 2015, Pierce County, WA -- Four people were charged with felonies on July 27 in connection with insurance fraud investigations by Insurance Commissioner Mike Kreidler’s Special Investigations Unit (SIU). David Arnold Cook, 50, of Tacoma was charged in Pierce County Superior Court with one count of false insurance claims in excess of $1,500 and one count of first-degree attempted theft. Cook was involved in an auto collision in August 2013 with a truck owned by a plumbing business. The driver of the commercial vehicle ran a red light and Cook, who had the right of way, collided with him. According to the investigation, Cook filed a ...

Nurse arrested for stealing drugs from Pocopson nursing home
July 29, 2015, Chester County, PA -- Chester County District Attorney Tom Hogan announced the arrest of defendant Carolyn Howett. The defendant was a nurse at the Pocopson Home, a nursing home located in Chester County. The defendant used her position as a nurse to steal morphine and other drugs from Pocopson Home. The drugs were marked as destroyed by the defendant, but the police later located these drugs in the defendant’s home. The drugs still had unique identification from Pocopson Home when they were recovered in the defendant’s home. District Attorney Hogan said, “Nursing is a noble profession, dedicated to caring for sick and disabled patients. This defendant ...

Trio handed fines, jail time for insurance fraud
July 29, 2015, Vancouver, none -- Work by investigators with ICBC’s Special Investigation Unit is being credited for the jail sentences and fines that three people were handed after claiming injuries from a bogus accident. The three were fined a total of $5,000 and two were given jail sentences in June after they were found guilty in provincial court of making fraudulent injury claims. Thai Yuen (Lisa) Vo, her sister Michelle Vo and friend Ryan Rillo all claimed they were injured in a crash after leaving a Surrey gas station parking lot in June 2013. But ICBC’s Adam Grossman said as adjusters took a closer look, their stories ...

Prescription fraud yields 1,000 pills
July 29, 2015, Traverse City, MI -- A Traverse City woman is suspected of illegally obtaining more than 1,000 prescription painkiller pills in two weeks. City police interim Chief Jeff O'Brien said a pharmacist at a Rite Aid on Garfield Avenue confronted the woman, 43, on July 24 when she tried to fill a prescription. The pharmacist found the woman also had visited several other local pharmacies. "He told her he would investigate, and she left," O'Brien said. Authorities believe the woman obtained more than 1,000 pills from July 10 to that point. O'Brien said she apparently obtained a prescription pad and used it to obtain painkillers at Meijer, Walgreens ...

Suspended Pelican Rapids doctor pleads guilty to stealing prescription drugs
July 29, 2015, St. Paul, MN -- United States Attorney Andrew M. Luger today announced the guilty plea of BLAIR A. NELSON, 43, who obtained Hydrocodone, Oxycodone, and other prescription drugs by writing and filling fraudulent prescriptions. NELSON pleaded guilty to obtaining a controlled substance by fraud today before Judge Susan R. Nelson in United States District Court in St. Paul, Minn. “Prescription drug diversion is an ongoing threat to both public safety and public health,” said U.S. Attorney Luger. “Working closely with colleagues at the Drug Enforcement Administration and in local law enforcement, we are clamping down on prescription drug fraud and abuse.” According to the defendant’s guilty ...

By Nearly Any Measure, Sunny South Florida Tops in Fraud
July 29, 2015, Palm Beach, FL -- Psssst -- Need a phony ID? A fraudulent tax refund? Insurance money from a sham car crash? Florida may have just what you're looking for. Since the first settlers hacked their way into the mangrove tangles and drained much of the swampland, sunny South Florida has been virtually synonymous with shady deals and scams. Over the past decade or so, the three most populous South Florida counties, Miami-Dade, Broward and Palm Beach, have become less renowned for old-school "Miami Vice''-style drug shootouts than for scammers stealing hundreds of millions from the government, banks and individuals by using laptops, stolen identities and fake ...

Case of Interest: Steven Thompson & Michelle Marks
July 29, 2015, Sacramento, CA -- District Attorney Anne Marie Schubert announced that on July 13, 2015, 28-year-old Steven Thompson pled no contest to felony insurance fraud and was sentenced to 364 days in the county jail and placed on five years formal probation. On July 29, 2015, 27-year-old Michelle Marks pled no contest to misdemeanor insurance fraud and was sentenced to 180 days in the county jail and placed on three years formal probation. Both defendants were sentenced by the Honorable Ben Davidian. On March 4, 2014, a driver was traveling at a low speed and accidentally rear-ended a vehicle driven by Thompson. ...

Mother, nurses plead guilty to defrauding TennCare of $400,000
July 29, 2015, Jackson, TN -- A mother and four nurses assigned to care for her now-deceased son have all pled guilty to conspiring to commit health care fraud. According to the charging documents and plea agreements in the case, Josephine Coach’s son had a tracheotomy and required a ventilator for breathing assistance. The child, who was wheel-chair bound, also had gastrointestinal problems that required frequent monitoring. The child’s doctor ordered 19 hours of daily nursing care for the child. The child received health care through TennCare, the state of Tennessee’s Medicaid program, which provides health care services to qualifying indigent individuals. Nurses employed with On Call Staffing, ...

N.Y. AG announces sentencing of executive director of Westchester not-for-profit company
July 29, 2015, Poughkeepsie, NY -- Attorney General Eric T. Schneiderman today announced that Darlington Odidika, 47, of Poughkeepsie, Executive Director of Systems and Abilities, Inc., was sentenced today to 90 days in jail and five years’ probation, after pleading guilty to Grand Larceny in the Fourth Degree, a felony, for defrauding the Medicaid system of monies earmarked to allow the elderly and infirm to live in the community, rather than in an institutional setting. The corporation was also sentenced to pay a fine of $5,000 on its plea of guilty to Grand Larceny in the Fourth Degree. “The Nursing Home Transition and Diversion program was ...

N.Y. AG announces sentencing of executive director of Westchester not-for-profit company
July 29, 2015, Poughkeepsie, NY -- Attorney General Eric T. Schneiderman today announced that Darlington Odidika, 47, of Poughkeepsie, Executive Director of Systems and Abilities, Inc., was sentenced today to 90 days in jail and five years’ probation, after pleading guilty to Grand Larceny in the Fourth Degree, a felony, for defrauding the Medicaid system of monies earmarked to allow the elderly and infirm to live in the community, rather than in an institutional setting. The corporation was also sentenced to pay a fine of $5,000 on its plea of guilty to Grand Larceny in the Fourth Degree. “The Nursing Home Transition and Diversion program was ...

Prison likely for podiatrist in Pennsylvania accused of drug fraud
July 29, 2015, Uniontown, PA -- A Uniontown podiatrist accused of prescribing thousands of pain pills to patients in exchange for receiving up to half of them back testified he won't fight the allegations and expects to be sentenced to prison. Dr. William Ainsley on Wednesday testified he has not yet signed off on a formal plea offer, but he has been advised a deal has been worked out that calls for him to be incarcerated. “I know they will ask for jail time for me,” Ainsley testified during a hearing for one of his alleged co-conspirators, Palmer Frank Sabatine. “I don't know if that's a deal or ...