News

Okla. agent allegedly steals premiums from 50 customers
February 29, 2016, Yukon, OK -- A Yukon man faces forgery charges after an investigation by the Oklahoma Insurance Department’s Anti-Fraud Unit. Felix Herrera, 36, is accused of forging a former insurance agent’s name and license number on policy paperwork. “Oklahomans need to be able to trust their insurance agent,” Oklahoma Insurance Commissioner John D. Doak said. “This man’s past criminal history and presence in the industry puts consumers at risk.” Herrera’s insurance license was revoked in 2009 for embezzling almost $10,000 in premiums from more than 50 customers. He pled guilty and received a deferred sentence. The Oklahoma Insurance Department (OID) began investigating Herrera ...

N.J. prosecutors: Empty home burned down for insurance
February 28, 2016, Bergen County, NJ -- Three Bergen County men were charged with arson in an attempt to fraudulently collect insurance money on a home they set on fire, authorities said. Terrence L. Philippi, 67, of Hasbrouck Heights, Sean S. Halvorsen, 25, and Zachary F. Rosario, 20 were charged after authorities determined that the men intentionally set fire to an empty Closter home Phillippi owned the morning of Oct. 10, said Acting Bergen County Prosecutor Gurbir S. Grewal. The Bergen County Arson Task Force and the Closter Police Department investigated the fire and determined that Philippi, Halvorsen, and Rosario intentionally set the fire, Grewal said. The men planned ...

Ex-cop in Maine pleads guilty to workers compensation fraud
February 08, 2016, Clinton, ME -- A former police officer in Clinton, Maine has pleaded guilty to workers' compensation fraud, according to the television station WABI TV 5 Scott Francis, indicted by a grand jury in June 2015, pleaded guilty to illegally collecting $16,000 in worker's comp benefits from a claim he filed on March 14, 2013. He was fired two weeks later after he was charged with domestic violence, charges that were later dismissed. He has also been accused of failing to report income from a fishing venture and failing to pay taxes. According to the Kennebec County grand jury indictment, he perjured himself during a hearing before ...

Man in Pennsylvania charged with torching his car for insurance $
February 07, 2016, Dover, PA -- Police say a Dover man helped incinerate his own vehicle, claiming it to be stolen so he could receive insurance money. Adam Franklin Becker, 31, of 1925 Oakley Drive, is charged with criminal conspiracy to commit arson, arson, insurance fraud and false reports, according to charging documents. Arson: At around 2 a.m. on Aug. 2, 2015, Northern York County Regional Police responded to a report of a vehicle fire on the 3500 block of Starview Road, where they found a vehicle fully engulfed in flames, about 30 feet down an embankment, documents state. Police were able to determine the vehicle did not go ...

Four suspects in Ala. allegedly staged crashes, torched structures
February 06, 2016, Montgomery, AL -- Investigating officers from the Alabama Department of Insurance Fire Marshal and Fraud Divisions have announced the arrests of four suspects for allegedly staging structure fires, automobile accidents, vandalism,and personal injury “accidents” in order to receive fraudulent monetary claims from insurance companies. Alabama State Fire Marshal Ed Paulk, and local Deputy Marshal Roderick Reed say evidence has indicated this “fraud operation” had been going on for up to fifteen years with allegedly fraudulent insurance claims totaling hundreds of thousands of dollars. Arrest warrants were served on the four family members beginning early this month and culminating last Wednesday, January 20 for charges of ...

Reputed mob bookie tries to burn down pizzeria near Hartford, Conn.
February 05, 2016, Hartford, CT -- A reputed mob bookmaker faced five years or more in prison Thursday after admitting he jolted a deadbeat gambler with a stun gun and tried to burn down a restaurant in a $190,000 insurance fraud. Organized crime investigators have been watching John A. Barile, 52, of East Hartford, since the early 1990s when he was busted for illegal gambling with a who's who of the Genovese crime family's western New England branch. On Thursday, Barile pleaded guilty in U.S. District Court in Hartford to charges of arson, insurance fraud, gambling and extortion. Judge Alvin W. Thompson ordered him back in court for ...

How to avoid becoming victim of staged auto accident
February 05, 2016, Washington, DC -- Staging a house fire, phony accidents, faking injuries or even faking your own death. The list goes on of the lengths people will go to, to cheat insurance companies. The problem? Insurance fraud is not a victimless crime. That extra money crooks are making comes out of your premiums, so you’re paying for it. November 2012. The infamous subdivision explosion in Indianapolis. “All for a buck. So someone has lost their lives, someone lost a father, mother, brother, sister, child, all for someone else to gain a few dollars,” said Calvin Johnson, State Farm Insurance Agent, South Bend. The people charged with arson: Mark Leonard, ...

Woman in Washington accused of submitting same medical claim twice
February 05, 2016, King County, WA -- The Special Investigations Unit of the Washington State Office of the Insurance Commissioner is asking for your help in finding Jamilia Caston. She has been charged with Theft in the 1st Degree and Theft in the 2nd Degree in King County Superior Court. Caston failed to appear in December and now has a warrant for her arrest. She is accused scamming her insurance company out of $5,600. Investigators say she was involved in an accident in July of 2014. State Farm paid Caston $5,600 directly to her as reimbursement for her Valley Medical Center medical bills. Later in October 2014, Caston was involved ...

Four in Alabama charged with setting home fires, staging auto crashes
February 05, 2016, Mount Vernon, AL -- Four persons have been arrested on charges they set building fires and staged vandalism, personal injury accidents and car wrecks in order to collect claims from insurance companies. Three of the four surrendered to authorities on a first-degree insurance fraud charge, while the fourth was handed his warrant while serving time in prison for an unrelated offense, according to Steve Holmes, a spokesman for the insurance fraud division of the Alabama State Fire Marshal’s Office. Charged in the case were: Lawanda Roberts, 52, of Pentacostal Church Road in Mount Vernon. According to Mobile Metro Jail records, she surrendered Jan. 20 and was released ...

30 years to life in prison for doc in California for prescription deaths
February 05, 2016, Rowland Heights, CA -- A Rowland Heights doctor who was the first U.S. physician to be convicted of murder for overprescribing drugs to patients who died was sentenced Friday to 30 years to life in state prison. Hsiu-Ying "Lisa" Tseng, 46, dressed in a blue jail jumpsuit, showed no emotion as the sentence was read aloud in a downtown L.A. courtroom by Los Angeles Superior Court Judge George G. Lomeli. Moments earlier, however, she apologized to the families of her victims, many of whom packed the downtown courtroom. "I cannot imagine what you have gone through," the bespectacled Tseng said in a soft voice. "I have been ...

Maple Heights woman guilty of fraud, ordered to repay more than $4K
February 05, 2016, Maple Heights, OH -- A Maple Heights (Cuyahoga County) woman has been ordered to repay more than $4,000 to the Ohio Bureau of Workers’ Compensation (BWC) after she pleaded guilty to workers’ compensation fraud. An investigation was opened into Brandy Davis after BWC’s Special Investigations Department received information through a cross match of data with the Ohio Department of Jobs and Family Services. The cross match indicated that Davis had received wages during a period of time when she was receiving benefits for a workplace injury. The investigation confirmed Davis worked for Beech Brook, a children’s behavioral health center, and the Jewish Family Services Association (JFSA), ...

Letter carrier charged with worker's compensation fraud
February 05, 2016, Wadsworth, OH -- A letter carrier for the U.S. Postal Service has been charged with defrauding the Department of Labor, law enforcement officials said. Douglas A. Joachim, 51, of Wadsworth, concealed and falsified his medical condition and physical abilities to the Labor Department’s worker’s compensation program. He is employed as a letter carrier and, on numerous occasions, was receiving disability payments through the worker’s compensation program. He willingly made false, fictitious and fraudulent statements about his medical condition, which resulted in these benefits being paid, according to the information. This case is being prosecuted by Assistant U.S. Attorney Henry F. DeBaggis following an investigation by ...

CONVICTED For Insurance Fraud (Alejandro Mena)
February 05, 2016, Palm Beach County, FL -- Command Investigations, SUNZ Insurance and North American Risk Services (NARS) announce the conviction of Alejandro Mena for insurance fraud. Alejandro Mena was convicted of insurance fraud on February 1, 2016 and was sentenced to 60 months of probation and ordered to pay $12,696.39 in enforceable restitution. A referral was submitted to the Florida Division of Insurance Fraud (DIF) as statutorily required based on the evidence collected during Command’s SSN Verification Program. During the investigation, it was determined that Mena fraudulently utilized a social security number to gain employment and secure workers’ compensation benefits. The social security number provided had been ...

Refusal to pay workers’ comp premiums lands owner of Marion County auto repair business in court
February 05, 2016, Caledonia, OH -- The owner of an auto repair shop in Caledonia (Marion County) has been sentenced for refusing to pay his workers’ comp premiums. Randy Gates, owner of Gator’s Auto Repair and Towing, was sentenced Jan. 21 in the Marion Municipal Court. BWC’s Employer Fraud Team (EFT) discovered that Gates continued to operate his business without valid BWC coverage after conducting two previous investigations on the same issue. He had been previously prosecuted in 2005 for failure to comply for operating his business without the required BWC coverage. The EFT attempted to work with Gates to become compliant with state law but he refused ...

N.Y. woman allegedly buys auto policies using stolen IDs
February 04, 2016, Southold, NY -- Southold Town Police have announced the arrest of Shirley woman yesterday on identity theft and insurance fraud charges. Police said Lakeida Walker-Dent, 39, was arrested by Southold detectives, assisted by the Suffolk County Police Department’s identity theft unit, after an investigation into complaints from a number of people that auto insurance policies and other accounts had been opened using their identities. All of the victims worked in the same Cutchogue office as Walker-Dent, according to police, who did not identify the business. Walker-Dent was charged with two felony counts of identity theft in the first degree and one count of insurance fraud ...

Attorney General Pruitt charges Tillman County woman with insurance fraud
February 04, 2016, Tillman County, OK -- Attorney General Scott Pruitt on Thursday announced insurance fraud charges against Barbara Sheree Vann of Tipton. Vann, 37, allegedly filed false insurance claims for repairs to her vehicle that never occurred. Vann filed repair estimates with her insurance company for hail damage to her vehicle three separate times. On the first two occasions, Vann received a check from her insurance company in the amounts of $2,877 and $2,707.02, respectively. In the third instance, Vann used a different body shop that estimated the damage to be more than $5,000. The insurance agency discovered the body shop performed the estimate but never completed any ...

Oklahoma AG files Medicaid fraud charges against Hugo counselor
February 04, 2016, Hugo, OK -- A licensed professional counselor from Hugo is accused of defrauding medicaid. Oklahoma Attorney General Scott Pruitt filed fraud charges against Adeline Youngblood, 36, this week. He says she billed Medicaid nearly $24,000 for treatment sessions that never happened while she was working in Southeast Oklahoma. Pruitt is charged with two counts of Medicaid fraud, one count of fraudulently obtaining personal identity of other persons, and one count of using access to computers to violate Oklahoma statutes. If convicted, Youngblood faces up to 16 years in prison and 125,000 in fines. ...

Stolen fraud dollars stretch around moon, Coalition tells Ind. TV viewers
February 04, 2016, Washington, DC -- Faking illness or a medical condition; doctors giving you treatments you don’t need. These are things most of us could never imagine, or even understand. But unfortunately insurance companies are duped every single day by con artists looking for a fast buck. It happens everywhere and you could be the next victim. The worst part? Those of us with insurance pay for it through our premiums. It’s not just your typical fraudster who might be in on the scams, but people you’d never expect. And the cost of ‘faking it’ adds up to a whopping eighty billion dollars (per year). “If you took those ...

Gas-fueled insurance arson wrecks Sacramento-area home
February 04, 2016, Antelope, CA -- An Antelope couple was sentenced today by Chief United States District Judge Morrison C. England Jr. to 15 years in prison each for four felony counts related to the arson of their former home and home-based business, United States Attorney Benjamin B. Wagner announced. After a 10-day trial, a jury found Alexander Sakhanskiy, 43, and Larisa Sakhanskiy, 45, guilty of arson to commit another felony, two counts of mail fraud, and arson affecting interstate commerce. Judge England also ordered the defendants to pay nearly $540,000 in restitution to the insurance company that had paid their fraudulent claim. According to evidence introduced at ...

Cardiologist in New Jersey accused with double-billing insurers by $600K
February 04, 2016, Wyckoff, NJ -- Roger Coletti, MD, a cardiologist from Wyckoff, N.J., was indicted on Feb. 3 for allegedly double-billing insurance companies more than $600,000. A state grand jury charged Coletti with nine counts of healthcare fraud, one count of second-degree insurance fraud and one count of second-degree attempted theft. New Jersey’s acting attorney general, John J. Hoffman, and the state’s Office of the Insurance Fraud Prosecutor announced the indictment in a news release. For eight months beginning in December 2010, Coletti, 69, allegedly filed fraudulent bills to Horizon Blue Cross Blue Shield of New Jersey and UnitedHealthcare. Between April 2006 and October 2011, he ...

Assignment of benefit bills stalling in Florida legislature
February 04, 2016, Tallahasse, FL -- Proposed laws aimed at curbing exactly what insurance companies call fraud by contractors hired to repair non-weather-related water loss prove to signs of stalling for a fourth-straight year, a statewide insurance reform group says. House and Senate versions of bills that would certainly impose restrictions on homeowners’ ability to authorize over incentives of their insurance policies to water restoration companies and others contractors have actually been advanced by banking and insurance committees in each chamber yet are not yet on any type of others committee agendas. Paul Handerhan, senior vice president for the Florida Association for Insurance Reform — or Reasonable — ...

Medical providers urge Supreme Court to limit false claims suits
February 04, 2016, Sacramento, CA -- More than a dozen major healthcare organizations and associations have jumped into a Supreme Court case over the validity of a legal theory now used to bring many fraud lawsuits against them. The case has the potential to reduce - or increase - the number of False Claims Act suits brought against healthcare providers and other companies, depending on which way the high court rules. The US Supreme Court has agreed to hear Universal Health Services v. United States ex rel Escobar. The case focuses on situations in which whistle-blowers allege providers have submitted false claims to government programs by failing ...

9 Investigates: Group formed fake after-school program to commit Medicaid fraud
February 04, 2016, Orlando, FL -- 9 Investigates found out a group pf men are accused of stealing from at-risk youth and disabled seniors to fund lives of luxury. Investigators said the men used families across central Florida to run up Medicaid bills so high, that the government stopped paying. Documents said the suspects ran a bogus after-school program to get the information they needed from families. Some families found out they were fraud victims when they received letters from the government, denying Medicaid claims they never knew existed. Investigators believe many of the victim were recruited from Jones High School. A victim, who asked not to be identified, said the ...

Congress needs to fix disability insurance (for Real this time)
February 04, 2016, Washington, DC -- COMMENTARY BY Rachel Greszler Rachel Greszler is a senior policy analyst in economics and entitlements at The Heritage Foundation's Center for Data Analysis. Read her research. After two decades of ignoring blatant inefficiencies, widespread abuses, and outright fraud Congress has used Social Security’s retirement program to bail out the Social Security Disability Insurance program. And now it’s on track to ignore the program’s problems again. Sen. James Lankford, R-Okla., and Joe Manchin, R-W.V., have sent a message to their Finance Committee colleagues: Don’t make the same mistake twice. That is, don’t kick the can on disability insurance reform until the program runs out of money ...

11 Defendants Indicted for $1.2 Million Oxycodone Conspiracy
February 04, 2016, Kansas City, MO -- Tammy Dickinson, United States Attorney for the Western District of Missouri, announced today that 11 defendants have been indicted by a federal grand jury for their roles in a $1.2 million conspiracy to distribute Oxycodone that they obtained by using forged and fraudulent prescriptions. Robert G. Joy, also known as “Bear,” 33, Gary D. Dickinson, also known as “James DeJong,” 49, Nicholas Destefano, 37, Katherine E. Beaven, 22, Douglas R. Parker, 56, Michelle C. Newton, 45, Felicita A. San Miguel, also known as “Cassandra Jasso,” “Susan Hernandez,” and “Sarah Buckner,” 37, Jermaine C. Brooks, 28, and Timothy D. Kroenke, 26, all ...