News

Gym employee in NY files false health claims for dead members
April 23, 2015, Orchard Park, NY -- An Orchard Park man pleaded guilty to health care fraud Monday with charges carrying a maximum sentence of 10 years in prison, a fine of $250,000, or both, according to a report from U.S. Attorney William Hochul Jr. Hochul announced that Gary Wannamacher, 50, pleaded guilty before U.S. District Court Judge Elizabeth Wolford to the charge. Assistant U.S. Attorney Elizabeth Moellering, who is handling the case, said the defendant is the owner of Spring Creek Athletic Club in Springville. According to the report, between January 2009 and Dec. 31, 2012, Wannamacher submitted fraudulent claims to private health insurance companies for reimbursement of health ...

Calif. psychologist makes more than $175,000 in fraudulent comp claims
April 23, 2015, San Francisco, CA -- Helena Weil was sentenced today to four months in prison and ordered to pay restitution of $496,101 related to her submission of billings to the federal Office of Workers’ Compensation Programs (OWCP), announced United States Attorney Melinda Haag and United States Postal Service-Office of Inspector General Special Agent in Charge Eileen Neff. Weil, 64, of Kensington, California, pleaded guilty on July 2, 2014, to one count of 18 U.S.C. § 1519, which prohibits alteration or falsification of records. Weil was a psychologist licensed to practice by the State of California and maintained a practice in the San Francisco Bay Area. ...

Trauma center in Ga. settles $2M claim for incorrectly billing Medicaid
April 23, 2015, Atlanta, GA -- Attorney General Sam Olens announced on April 23, 2015, that the state of Georgia has reached a civil settlement agreement with Grady Health System (Grady). Grady has agreed to pay $2,950,000 to settle claims that it inaccurately coded claims for neo-natal intensive care unit (NICU) patients, resulting in alleged damages to the Georgia Medicaid program. Providers generally are permitted to bill only for those codes that are justified by the medical services provided. Here, the state of Georgia alleged that Grady inflated billings for certain services provided to NICU patients, resulting in either unjustified or inflated outlier payments from Georgia Medicaid. ...

Two Mich. agents' licenses suspended for selling false no-fault auto insurance
April 23, 2015, Lansing, MI -- The Michigan Department of Insurance and Financial Services (DIFS) has summarily suspended the licenses of insurance agents Samier S. Mishkoor and Esmeranda Kovacevic (formally Esmeranda Osmonovic) and the insurance agency Affordable Insurance Agency III, Inc. for violating numerous provisions of the Michigan Insurance Code. Affordable Insurance Agency III, Inc. is located at 37053 S. Gratiot, Clinton Twp. Michigan 48036. After receiving a complaint, DIFS opened an investigation and discovered the agents were selling fraudulent Michigan certificates of no-fault auto insurance, keeping the money, and leaving consumers without coverage. “Drivers who made a purchase at Affordable Insurance Agency III, Inc. ...

Former N.J. police chief seeks to overturn conviction for insurance coverup
April 22, 2015, Hackensack, NJ -- A lawyer for former Hackensack Police Chief Ken Zisa told an appeals court panel on Tuesday that prejudicial comments by a prosecutor and notes destroyed by detectives led to his client's unfair conviction on official misconduct and insurance fraud charges. Zisa's lawyer, Paul Bergman, in arguments before three appeals court judges, said Assistant Bergen County Prosecutor Daniel Keitel's comment that Zisa retaliated against five police officers related to the criminal probe was unrelated to the charges against Zisa. The assertion should have resulted in an immediate mistrial, he said. Bergman also said that the indictment against Zisa should have been dismissed when ...

Fla. hit-and-run suspect allegedly reports fake truck theft
April 22, 2015, Homestead, FL -- A 22-year-old Homestead man has been charged with reckless driving and leaving the scene of an accident in the Christmas Eve hit-and-run crash that left a motorcyclist paralyzed from the chest down. Thomas Pathammavong was in custody at the Broward County jail on unrelated charges when he was charged Friday as the driver of a pick-up truck that smashed into Robert Games as Games waited at a stoplight on Federal Highway at Northeast 14th Street, according to the Broward Sheriff's Office. Games, 43, an avid motocross rider, was on his street bike, a Kawasaki Ninja ZX-10R, when he was hit from behind ...

Agent uses false insurance certificates to dupe clients, Ga. prosecutors charge
April 21, 2015, Milledgeville, GA -- Former Milledgeville, Ga., mayor Richard Bentley, 52, is charged with seven counts of misappropriation of insurance premiums and five counts of issuing fraudulent certificates of insurance. Bentley, who owned and operated the Wilkerson Insurance Agency located at 221 N. Wayne St., in Milledgeville was arrested Monday. Bentley allegedly kept premium payments received from certain customers for insurance coverage and converted the money to his own use instead of sending it to the appropriate insurer, according to a prepared statement issued by the Insurance Commissioner Ralph Hudgens and the Georgia Bureau of Investigation. The investigation also determined that on several occasions, Bentley issued fraudulent ...

Phantom counseling charges lodged in $550K Ala. fraud complaint
April 21, 2015, Montgomery, AL -- Attorney General Luther Strange announced the arrest of Lula Jones Bridges, 58, of Notasulga. Bridges is charged with nine counts of filing false claims with the Alabama Medicaid Agency, which is Medicaid fraud, and one count of first-degree theft of property. The Attorney General’s Medicaid Fraud Control Unit presented evidence to the April 2015 term of the Montgomery grand jury resulting in an indictment* charging Bridges with filing numerous false claims to the Alabama Medicaid Agency totaling over $550,000.00, as well as first-degree theft of property. Bridges is the Executive Director of Hope for Families and Community Services (HFCS), a non-profit agency ...

Pharmacy in S.C. dispenses generic drugs, bills Medicare for costly brand names
April 21, 2015, Charleston, SC -- The former owner of a Charleston pharmacy who admitted to billing Medicare for drugs never dispensed to her will be sentenced in August, after her attorneys asked the judge to delay the hearing. Attorneys for Paula J. Butterfield, 71, and Trivillian’s Pharmacy filed the request last week. Monday, a federal judge delayed the sentencing hearings scheduled for May 28 to Aug. 4 to allow more time for attorneys to provide additional financial information. Butterfield could face a maximum of five years in prison. She pleaded guilty in February to making a false statement in a health care matter. She also pleaded guilty ...

Illegal kickbacks slam door on $29-million Medicare home-health con in Mich.
April 21, 2015, Detroit, MI -- The former operator of a Detroit adult day care center and two former owners of Detroit-area home health care companies were sentenced to prison today for their roles in a $29 million Medicare fraud scheme. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office and Special Agent in Charge Jarod ...

Worker says electrocuted yet collects comp while landscaping, Ga. officials say
April 21, 2015, Rincon, GA -- A six-month investigation conducted by the Georgia State Board of Workers’ Compensation Enforcement Division led to the arrest of a Rincon man and woman on multiple counts of workers’ compensation insurance fraud including theft by deception and conspiracy to commit insurance fraud charges. According to Enforcement Division Director Stan Bexley, Kenny Reddick, 52, and Linda Crawford, 36, were arrested Monday afternoon, April 20, and transported to the Effingham County Jail. Reddick was charged with one felony count of insurance fraud, one felony count of theft by deception, one felony count of conspiracy to commit a crime and one misdemeanor count of giving ...

Calif. soccer coach boots plea deal for fake ATV theft
April 21, 2015, Mendota, CA -- A former Mendota football coach received national attention for his success. But he's refusing to take part in a plea deal for insurance fraud. Beto Mejia is pondering the latest deal from prosecutors, reducing one or possibly two felony insurance fraud counts to misdemeanors. Tuesday he turned down a previous offer to make a video announcement. Attorney Michael Idiart said, "It's debatable now as to what type of outreach that may have to the public or the TV. It's easy to say that it is only going to be limited to a certain area but as we know and the age ...

Alleged Theft Ring Mastermind Faces New Insurance Fraud Charge
April 21, 2015, Chesterfield, MO -- According to court documents obtained by Eyewitness News, Thomas Elpers, one of the alleged masterminds of a $1.5 million equipment theft ring that was dismantled earlier this year, The 62-year-old has been charged with felony insurance fraud. Elpers allegedly registered a VIN number, or vehicle identification number, on a vehicle that had been fraudulently reported stolen, court records state. Thomas Elpers, his son Andrew, Jordan Wedel and Jason Habermel were indicted in early April on numerous federal charges. Andrew Elpers, 37, faces 32 counts of interstate transportation of stolen motor vehicles and one count of money laundering Thomas Elpers, 62, faces ...

Conn. firm torched for insurance score and to avoid creditors
April 21, 2015, Thomaston, CT -- A 32-year-old Thomaston man has pleaded guilty to conspiracy to commit mail and wire fraud. Dustin Whitten pleaded guilty on Friday before United States District Judge Janet Bond Arterton in New Haven. According to the documents and statements presented in court, in May 2009, an alleged co-conspirator of Whitten’s transferred to Whitten a residential property in Old Forge, New York, while the co-conspirator continued to use the property and pay the mortgage and maintenance expenses. At the time, the co-conspirator was being sued by a creditor who was seeking to collect a debt and identify the co-conspirator’s assets. In March 2011, Whitten and ...

Norwalk man accused of golf-related scam arrested again
April 21, 2015, Norwalk, CT -- A Norwalk man and convicted felon accused of selling insurance without a license in 10 states is in trouble again with the law. Kevin Kolenda, 57, of 33 North Water St., Apt. 802, was charged with fugitive from justice on April 20 and arraigned on April 21 at Norwalk Superior Court. Judge William Wenzel ordered Kolenda held in lieu of a $100,000 cash bond. He is scheduled to return to court on May 23. According to court documents, Norwalk police worked alongside Detective Sgt. Dan Sharp of the Washington State Patrol Criminal Intelligence Division during an investigation into Kolenda’s business, Hole in Won ...

Government Sues Skilled Nursing Chain HCR Manorcare for Allegedly Providing Medically Unnecessary Therapy
April 21, 2015, Washington, DC -- The government has intervened in three False Claims Act lawsuits and filed a consolidated complaint against HCR ManorCare alleging that ManorCare knowingly and routinely submitted false claims to Medicare and Tricare for rehabilitation therapy services that were not medically reasonable and necessary, the Department of Justice announced today. ManorCare is one of the nation’s largest healthcare providers, operating approximately 281 skilled nursing facilities (SNFs) in 30 states. “The Department of Justice is committed to ensuring that healthcare providers who pressure their employees to provide medically unnecessary services to Medicare beneficiaries and Tricare recipients solely to increase their own profits are held ...

Employee collects comp while working construction, Fl. officials say
April 21, 2015, Tallahassee, FL -- Receiving benefits he was not entitled to, one Florida resident could be staring at more than a decade behind bars. According to the Florida Department of Financial Services, James “Mike” Millard was recently arrested for workers compensation fraud. An investigation by the agency discovered that Millard reportedly obtained more than $20,000 in benefits from Dec. 9, 2012 through Feb. 7, 2014, when he filed numerous reports claiming he had no earnable income. After an investigation began, it was discovered that Millard was in fact employed and compensated by a concrete construction business during this time period. Millard was facing a ...

Md. couple tried to torch convenience store for insurance payday
April 21, 2015, Caroline County, MD -- A Caroline County man pleaded guilty and received 18 months in jail for the 2011 arson at the Stop & Go Mini-Mart in Federalsburg. According to the Office of the Maryland State Fire Marshal, Gary Greenwood, 62, of 4620 Laurel Grove Road, entered guilty pleas for first-degree malicious burning and false misleading information in Caroline County Circuit Court Monday, April 20. Greenwood received a five-year prison term with all but 18 months suspended for the first-degree malicious burning conviction. He received a 10-year suspended sentence for the misleading information conviction. Greenwood also received five years of supervised probation, and he is ordered ...

Feds removing SSNs from Medicare cards
April 20, 2015, Washington, DC -- Concerned about the rising prevalence and sophistication of identity theft, most private health insurance companies have abandoned the use of Social Security numbers to identify individuals. The federal government even forbids private insurers to use the numbers on insurance cards when they provide medical or drug benefits under contract with Medicare. But Medicare itself has continued the practice, imprinting Social Security numbers on more than 50 million benefit cards despite years of warnings from government watchdogs that it placed millions of people at risk for financial losses from identity theft. That is about to change, after President Obama signed a bill last ...

Caregiver provides uncaring service to disabled Ky. patients
April 20, 2015, Hopkins County, KY -- This morning, 35-year-old Terri Henry of Hopkins County was sentenced in Hopkins Circuit Court to three years prison, which will be diverted for a period of five years. Henry was ordered to give up her CMT license which will prevent her from working in long term care facilities in the future. During this five-year period, Henry will be supervised by the Division of Probation and Parole. Henry worked as a caregiver for Dawson Springs Health and Rehabilitation Center, a company based in Hopkins County, which provides Medicaid funded treatment to patients with intellectual disabilities. On March 18, 2015, Henry pled guilty ...

Pa. dentist allegedly charges insurers for peddling painkillers
April 20, 2015, Berwyn, PA -- A Berwyn dentist and his wife are under arrest after allegedly distributing narcotics including fentanyl and hydrocodone at his practice. The dentist is also accused of distributing the drugs to members of his staff; his wife allegedly used up to 500 pills a month and replaced drugs meant to be used to sedate patients with saline solution. Dr. Chad Gretzula and his wife, Rebecca, are charged with multiple counts of drug violations, theft, insurance fraud, receiving stolen property, forgery, theft by deception, tampering with records, recklessly endangering another person and endangering the welfare of children, among others. Chad Gretzula, 44, and his wife, ...

Fake golf insurer bogeys hole-in-one payout, Wash. insurance dept. says
April 20, 2015, Olympia, WA -- Detectives in Insurance Commissioner Mike Kreidler’s Special Investigations Unit today arrested hole-in-one insurance scammer Kevin Kolenda in Norwalk, Conn., during a search of his residence. Kreidler’s detectives worked in partnership with the Norwalk Police Department and seized evidence to analyze when they return to Washington. The King County Prosecuting Attorney’s Office charged Kolenda, 57, with attempted first-degree theft and two counts of selling insurance without a license, all felonies, through his golf tournament marketing website, hole-in-won.com. He is being held in Norwalk on $300,000 bail while he awaits a hearing. “I appreciate the collaboration with and the hard work of the ...

Ala. police chief torches home for insurance payday, officials say
April 20, 2015, Dekalb County, AL -- A former police chief has been charged with an insurance scam in Dekalb County Alabama. The Sheriff reports that Thomas and Glenn Fuller have been arrested by State Fire Marshall investigators. Despite the same last name, they are not related. But they did leave together. The investigation dates back to a house fire in Valley Head last October. Tom Fuller was police chief at the nearby Hammondville Police Department at the time. Fuller is no stranger to home disasters. WHNT reported on fire that destroyed his home in 2013. They noted that it was the third home he had lost, two to fires and one to the tornadoes ...

Contractor takes client money then does no work, S.C. prosecutors allege
April 20, 2015, York County, SC -- A York County man was arrested after officials say he scammed residents out of money, promising to do home and remodeling work that never happened. Earl "Trey" Ocey Gulledge was arrested Monday and served six warrants for fraud and breach of trust. In two cases, officials say Gulledge took money but never bought materials or returned to complete the job he promised. Both cases totaled a loss of around $10,800. Gulledge's business Palmetto Remodeling and Roofing would also hire out sub-contractors to do work for him but, would later not pay the contractors after they completed the work. Those cases totaled around ...

N.J. home healthcare firm overbills Medicaid $7 million for bogus services
April 20, 2015, Linden, NJ -- The owner of a Linden home healthcare agency pleaded guilty to carrying out a multimillion dollar Medicaid fraud, bribery and other offenses that could lead to decades in prison, the office of U.S. Attorney for New Jersey Paul Fishman announced Monday. Irina Krutoyarsky, 61, of Springfield, owner of HHCH Health Care, is scheduled to be sentenced in September after admitting she told the state's Board of Nursing that the aides she employed had completed required training and testing when in reality she charged the aides hundreds each for obtaining fraudulent credentials. Krutoyarsky also billed Medicaid for aide visits that never occurred, in ...