News
June 18, 2013, Clayton, MO -- One former officer with a now defunct Clayton funeral service company has pleaded guilty to her role in a massive fraudulent scheme involving the sale of prearranged funeral contracts and the misappropriation of the related insurance premiums. Authorities believe that the company -- National Prearranged Services, Inc. -- may have siphoned off as much as $600 million from customers.
Sharon Nekol Province, a 69-year-old Ballwin woman who admitted to her role in the Ponzi-like scheme yesterday in court, could face up to three years in prison and fines.
Authorities believe this is one of the largest frauds ever prosecuted in the Eastern
...
June 17, 2013, Washington, DC -- First of a three-part series
A postal worker who ran marathons found her race times improved after she began drawing federal disability checks for an alleged back injury.
Another disabled federal employee went scuba diving, skied in Switzerland and did flips on a trapeze. She spent part of her $193,000 in disability payments on a boat named "Free Ride" before she was caught.
A Justice Department lawyer collected $90,000 in annual disability checks after claiming the stress of his job kept him off the job. Apparently the cable TV show he began hosting while drawing disability pay wasn't so stressful.
Then there was the
...
June 17, 2013, Boiling Springs, SC -- The S.C. Bureau of Drug Control has charged two Boiling Springs residents with obtaining prescription drugs by fraud, according to arrest warrants.
Warrants state that Marilena Murphy, 31, of 30 Annandale Drive, was charged with 10 counts of violation of drug distribution laws.
According to the warrants, between June 2012 and last month, Murphy tried to obtain alprazolam and hydrocodone by using forged prescriptions at several Spartanburg County pharmacies. The forged prescriptions were under two doctors' names, and the doctors confirmed that they did not write the prescriptions.
Benjamin Loyd McGraw, 33, also of 30 Annandale Drive, has been charged with two counts
...
June 17, 2013, Dennison, OH -- A Dennison man has been convicted of workers’ compensation fraud after he was found working while receiving workplace injury benefits.
Steven Gooding pleaded guilty to the crime and was ordered to repay the Ohio Bureau of Workers’ Compensation more than $22,000.
BWC’s Special Investigations Department in Cambridge received an allegation from a managed care organization indicating Gooding may be working a part-time job while receiving temporary total disability compensation for a workplace injury.
The investigation showed Gooding worked for Natale & Dickerhoof PPL performing maintenance and administrative work during periods when he was receiving the disability compensation.
Gooding failed to notify BWC or
...
June 17, 2013, Flint, MI -- Two Flint men were sentenced to probation after pleading guilty to their role in a scam that bilked AFLAC hundreds of thousands of dollars.
Delano Machico Hinson and Jerome Rodell McMullen Jr. were each ordered to serve probation and repay a total of more than $65,000 in a judgment signed Thursday, June 13, by Flint U.S. District Judge Mark A. Goldsmith after the two each pleaded guilty to aiding and abetting mail fraud.
Hinson admitted to receiving more than $59,000 in inappropriate payments from the insurance company, including a more than $14,000 claim in 2008.
AFLAC paid the 2008 claim after Hinson
...
June 17, 2013, Washington, DC -- A woman in Florida told her auto insurer that a hit-and-run driver had hit her car.
She filed a claim for the damages. Then she went on Facebook and posted on her page how her daughter had caused the automobile accident.
Before the insurer paid her claim, its investigators searched social media and discovered the lie. She was later convicted of filing a fraudulent claim.
Such scenarios are happening more frequently these days.
Property and casualty insurers are increasingly using social media channels to investigate whether their customers' claims are genuine, according to a recent report by Timetric, a provider of online data, analysis
...
June 16, 2013, Chicago, IL -- A surgeon at Chicago’s Sacred Heart Hospital cut a hole in Earl Nattee’s throat Jan. 3, the day before he died. It’s not clear why.
The medical file contained no explanation of the need for the procedure, called a tracheotomy, according to a state and federal inspection report that quotes Sacred Heart’s chief nursing officer as saying it happened “out of the blue.”
Tracheotomies are typically used to open an air passage directly to the windpipe for patients who can’t breathe otherwise.
Now, amid a federal investigation into allegations of unneeded tracheotomies at the hospital, Nattee’s daughter, Antoinette Hayes, wonders whether her
...
June 16, 2013, Carteret County, NC -- Carteret County Sheriff Asa Buck has added a new initiative to his efforts to prevent the abuse of prescription medications.
Buck announced the start of the M.E.D.S. Program, an educational initiative to help raise awareness about the safe storage and disposal of prescription medications.
The program highlights four key points to follow in the home: monitor, educate, dispose and secure.
Monitor prescriptions by tracking refills and knowing the dosage units in each bottle. Only use medications as prescribed and educate friends and family members about the dangers of prescription drug abuse.
The program encourages disposing of unused and expired medication, prescription and over the
...
June 14, 2013, Fulton County, NY -- The state Supreme Court Appellate Division on Thursday upheld the Fulton County Court conviction of arsonist and murderer Jeffrey Alnutt for the December 2007 Gloversville fire in which tenant Deborah Morris died.
The 60-year-old Alnutt was convicted by a jury on May 10, 2010, of second-degree murder, second-degree manslaughter, second-degree reckless endangerment and second-degree arson in connection with the fire Dec. 21, 2007, at 22 Park St., a building he owned.
The 39-year-old Morris lived in the second-floor apartment.
Court papers stated Morris died as the result of "asphyxia due to smoke inhalation and the inhalation of heated products of combustion." Her death
...
June 14, 2013, Waterbury, CT -- A city woman was charged with insurance fraud Wednesday after police say she reported her car stolen two days after it had burned up in a vehicle fire on Route 8.
Police say that after her 2001 Chevy Impala caught fire on the highway, Markeshia Dennis, 24, of 29 Irion St., added additional coverage that included theft, but didn't mention the fire to her insurance company.
Police charged Dennis with second-degree making a false statement and insurance fraud after an investigation that began last year.
...
June 14, 2013, Longwood, FL -- Channel 9 was there Friday when Drug Enforcement Administration agents raided the Professional Pain Clinic in Longwood.
Undercover agents were at the clinic Friday working on what they said is a two-year investigation into a possible pill mill.
Authorities confiscated paper records, computer equipment and prescription drugs. Channel 9 learned the feds also seized the bank accounts of multiple suspects, including James Long, the business' administrator.
"It is a fairly large-scale operation that generated a large amount of illegal proceeds," said DEA agent Jeffrey Walsh.
A nearby business owner told Channel 9 he would see people leave the clinic by the dozen and walk
...
June 14, 2013, Oxnard, CA -- A former Oxnard police officer was sentenced to 120 days in jail on Friday after pleading guilty to two counts of felony workers’ compensation insurance fraud.
Edward Idukas, 28, told his supervisors that he had hurt his back on the job and was too injured to work.
The police department offered to let Idukas do desk duty, but he claimed he was just in too much pain.
Later, sources tipped off the Ventura County District Attorney’s office that he was playing baseball in an adult league while out on disability.
KTLA’S Mary Beth McDade exclusively reported that an investigation was launched and surveillance video
...
June 14, 2013, Claiborne County, TX -- A father and two sons accused in a $3 million doctor-shopping ring are headed to prison.
Jackie Mize is a Claiborne County patriarch accused of turning a prescription pill operation into a family business. A federal jury found him and his sons, Kelvin Mize and James Mize, guilty this afternoon of conspiracy to distribute prescription painkillers and to commit money laundering after a weeklong trial.
Father and sons face sentencing in November.
Assistant U.S. Attorney Zachary Bolitho told jurors today Jackie Mize footed the bill for as many as 10 people at a time — most all of them family — to make
...
June 14, 2013, St. Francis County, TN -- Attorney General Dustin McDaniel announced today that a St. Francis County woman has been arrested for felony Medicaid fraud following an investigation by the Attorney General's Medicaid Fraud Control Unit.
Jessica Desha Reed, 20, of Madison, admitted to investigators that she lied on timesheets regarding personal-care services she was alleged to have provided to a woman who at the time was incarcerated in a Memphis jail. The fraudulent information was given to Reed's employer, and the state Medicaid program was billed for services that Reed did not render.
Reed was arrested for Medicaid fraud, a Class B felony. She turned herself in
...
June 13, 2013, Elgin
, -- A 52-year-old man has been charged with insurance fraud after admitting to authorities that he filed a series of fake "slip and fall" lawsuits against fast food restaurants and grocery stores, according to Elgin police.
Juventino Guzman, of the 500 block of Prospect Street, Elgin, is charged with aggravated insurance fraud and three counts of insurance fraud of more than $100,000, according to court records.
An investigator from the National Insurance Crime Bureau contacted Elgin police last week about a suspected insurance fraud in which Guzmans's attorney demanded $180,000 for injuries. Elgin police say they learned that Guzman, using an alias, filed
...
June 13, 2013, Miami, FL -- A Miami federal judge denied bail Tuesday to TV entrepreneur Roberto Marrero, indicted on charges of stealing millions in a massive Medicare fraud scheme.
Justice John O. Sullivan denied the petition because of Marrero’s potential flight risk. Marrero has traveled to Cuba on four occasions, according to government arguments presented at the 40-minute hearing.
Defense attorney Frederick S. Robbins was upset by Sullivan’s decision.
“I disagree [with the decision], but I hope Mr. Marrero will eventually be freed on bail,” Robbins said after the hearing. “I honestly believe he is not a flight risk.”
Justice Department attorney Brendan Stewart said Marrero and his
...
June 13, 2013, Las Vegas
, NV -- A Las Vegas couple charged with scamming hundreds of elderly people through fake insurance plans pleaded guilty Wednesday to counts that will put the husband in prison for 11 years and require both to pay more than $3 million in restitution.
Michael and Melissa Woodward, who remain out of jail on $1 million bail each, appeared before San Diego Superior Court Judge Laura Halgren to admit tax fraud, among other charges.
Prosecutors said they have identified 240 to 250 victims in San Diego County and another 150 to 200 victims in the rest of California, who lost an estimated total of $3.6
...
June 13, 2013, Tumwater, WA -- Brian Cox’s divorce proceedings with his wife of roughly 41/2 years were bitter and acrimonious, according to Thurston County court filings that include mutual restraining orders requiring the pair stay away from one another.
But one of Cox’s co-workers, his brother and even his estranged wife all stated Wednesday that they are shocked by allegations that he solicited a co-worker Tuesday to have her murdered for $10,000.
Thurston County Superior Court Judge Carol Murphy on Wednesday ordered Cox held in the Thurston County Jail on suspicion of a count of solicitation to commit first-degree murder. His bail was set at
...
June 13, 2013, Washington, DC -- Ten percent of the incurred losses and loss adjustment expenses each year in the property & casualty insurance industry are due to insurance fraud, according to an analysis by The Insurance Information Institute (III). Worse yet, the number of fraudulent claims are on the increase—statistics from the National Insurance Crime Bureau (NICB) show a 19 percent increase in questionable claims from 2009 to 2011.
However, most suspicious claims are paid by the insurers; it is estimated that today only one in five fraudulent claims are detected or denied by insurers. Thus insurance fraud costs insurers tens of billions of dollars
...
June 13, 2013, Washington, DC -- People with Medicare will soon see a redesigned statement of their claims for services and benefits that will help them better spot potential fraud, waste and abuse.
These newly redesigned Medicare Summary Notices are just one more way the Obama Administration is making the elimination of fraud, waste and abuse in health care a top priority. Because of actions like these and new tools under the Affordable Care Act, the number of suspect providers and suppliers thrown out of the Medicare program has more than doubled in 35 states.
“The new Medicare Summary Notice gives seniors and people with disabilities accurate
...
June 13, 2013, Charlotte, NC -- Each year, the two elderly ladies traveled from New York to Florida. And about three times a year, after stopping at a convenience store, one of them would slip, fall and hurt herself. Were they just incredibly accident-prone, unlucky or something a bit more nefarious?
Try the latter. These two grandmotherly types had filed about 14 accident claims against the c-stores they visited. At each stop, they would take turns playing the victim and the witness.
"Fraud is everywhere and it's committed by everyone," said Andris Berzins, team leader of special investigative services for Federated Insurance, Owatonna, Minn., and a presenter at
...
June 13, 2013, Plainville, CT -- An eighth person was charged Thursday in connection with a scheme to defraud the state's Medicaid program, and more arrests are expected, the Office of the Chief State's Attorney said.
Anna Khanutina, 27, formerly of New Britain, was arrested Thursday and charged with conspiracy to unlawfully obtain a controlled substance, conspiracy to make a false prescription and conspiracy to distribute a controlled substance, authorities said. She is currently living in Oceanside, N.Y.
Khanutina is accused of conspiring with physician Richard Luzietti and others to obtain prescription drugs paid for by the government health program Medicaid, which then were sold illegally on the
...
June 13, 2013, D'Iberville, MS -- A D'Iberville man has been sentenced to prison and ordered to repay $6,409.36 to Nationwide Insurance Co. for defrauding the company on medical bills involving claims on two auto accidents.
Circuit Judge Lisa also ordered James Eric Reed, 35, to a three-year prison term and to pay $2,240 to cover court costs and costs of the investigation. She suspended one year of the prison term, leaving two years to serve.
He also was ordered to pay $300 to the Attorney General's Crime Victim Compensation Fund.
Reed was sentenced Monday in Harrison County Circuit Court on a guilty plea to two counts of insurance
...
June 13, 2013, Portland, OR -- An instructor at Oregon Health & Science University was arrested Thursday and charged with 47 counts of defrauding Medicaid and tax evasion in a secret indictment issued May 31 by the State of Oregon.
Dean Howard Westwood, 48, a Disability Awareness Trainer and Community Outreach Specialist at OHSU, was charged with theft, making false claims for health care payments, unlawfully obtaining public assistance and income tax evasion.
A spokesman for OHSU confirmed Westwood is an instructor at the University and would get back to KGW with further details about his employment.
The charges were filed after an investigation by the DA’s Medicaid Fraud
...
June 13, 2013, Taiwan, none -- A Taiwan court on Thursday upheld a death sentence on a "merciless" woman who murdered three close family members in an insurance scam.
The final ruling in the high-profile case made Lin Yu-ru the first woman to be sentenced to death in Taiwan for 23 years.
The 32-year-old, accused of murdering her mother, husband and mother-in-law for 20 million Taiwan dollars ($678,000) in insurance money, was convicted and sentenced to death by a High Court last year.
Her appeal was rejected by the Supreme Court Thursday after a hearing last month.
"What she did was cruel and merciless... the pain she caused to her
...
