News

Insurance agent in Penn. headed to jail for selling worthless policies
May 05, 2016, Lehighton, PA -- A Lehighton man was sentenced to seven months in jail and ordered to pay $200,000 in restitution for selling worthless insurance policies to at least two companies. Alfonso J. Sebia, 64, was sentenced Wednesday by Lackawanna County court Judge Vito P. Geroulo. Sebia pleaded guilty on Feb. 12 to unlicensed broker/agent activity and forgery. An additional 21 counts of forgery and a count of theft were dropped. Efforts to reach Assistant District Attorney C.J. Rotteveel, who prosecuted the case, were unsuccessful early Thursday. Sebia was charged in September 2015 by the Northeastern Pennsylvania Insurance Fraud Task Force, an arm of the Lackawanna County District Attorney’s ...

Ex-legislator in Michigan pleads guilty to healthcare fraud
May 05, 2016, Grand Rapids, MI -- A former state lawmaker who ran pain clinics across Michigan pleaded guilty Thursday to health care fraud for injections given by nurse practitioners in Grand Rapids and Flint. Dr. Paul Nathan DeWeese admitted to bilking Blue Cross Blue Shield of Michigan out of nearly $173,000 between 2012 and 2014. During a brief appearance Thursday in U.S. District Court in Grand Rapids, the former Republican lawmaker from Holt admitted to making false statements relating to health care matters. He faces up to five years in prison. DeWeese, who is free on bond, also faces a fine of up to $250,000. As part of a ...

Ex-cop in Florida accused of faking injury to receive comp money
May 05, 2016, Broward, FL -- While drawing workers' compensation and claiming he was reliant on a wheelchair, the Broward Sheriff's deputy appeared to be able-bodied when an investigation company captured him on surveillance video driving, running errands and shopping at a mall, records show. Now an ex-deputy, Nicolas Carreno, 45, was arrested Tuesday on a charge of workers' compensation fraud. It is a third-degree felony carrying a maximum punishment of five years in prison. "The total amount paid to date on this claim, including indemnity, medical and expenses is $533,672.14," according to a complaint affidavit. "The total amount claimed as a loss … due to Carreno's misrepresentations ...

Plumber arrested for alleged workers' comp fraud
May 05, 2016, Kingsbury, NY -- A man in the eastern New York town of Kingsbury was arrested this week for alleged workers' compensation fraud, the post Star newspaper reported on Tuesday. James Scally was accused of working as a plumber when he was out on leave for an injury he'd sustained working from a home-improvement store, according to the newspaper. The New York Inspector General's Office has charged him with grand larceny, workers' comp fraud and falsifying business records. The Inspector General says Scally received $2,536 in benefits for the injury but failed to notify the New York Worker's Compensation Board that he was also self-employed as ...

Insurance agent in California accused of stealing premiums
May 04, 2016, Bakersfield, CA -- Valerie Ann Verdugo, 38, of Bakersfield, is scheduled to be arraigned today on felony insurance fraud charges for obtaining insurance coverage without paying the carrier on those policies for more than a decade. "Verdugo allegedly used her position as a licensed insurance agent to take advantage of her insurer, which also happened to be her employer," said Insurance Commissioner Dave Jones. Verdugo, a licensed agent, surrendered herself to the Kern County Sheriff's Department and was booked on one felony count of grand theft and one felony count of embezzlement. An investigation by the Department of Insurance's Investigations Branch uncovered evidence that while ...

48 in nationwide gang indicted on RICO violations, including fraud
May 04, 2016, Atlanta, GA -- Forty-eight alleged members of the violent Gangster Disciples Gang – including the top leaders in Tennessee and Georgia – have been charged in two indictments and accused of conspiring to participate in a racketeering enterprise that included multiple murders, attempted murder and drug crimes. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney John A. Horn of the Northern District of Georgia, U.S. Attorney Edward L. Stanton III of the Western District of Tennessee, Special Agent in Charge J. Britt Johnson of the FBI’s Atlanta Division and Special Agent in Charge A. Todd McCall of the ...

Florida insurance agent accused to helping client commit comp fraud
May 04, 2016, Vero Beach, FL -- An insurance agent was charged Tuesday with falsifying workers' compensation records for a construction company, according to state officials. Robin Yencho, 50, of Professional Insurance Providers of Vero Beach, was charged with 16 counts of making false or fraudulent insurance certificates by the state Department of Financial Services. He posted $16,000 bail at the Indian River County Jail on Wednesday. The state began investigating Yencho last summer when an auditor determined Banker's Maintenance & Inspection of Vero Beach had been operating without workers' compensation insurance. Investigators said Yencho began in July 2014 to produce fake certificates of insurance for the company. This ...

Foot doc in Wisconsin order to pay $1M for committing Medicare fraud
May 04, 2016, Cedarburg, WI -- For ripping off Medicare, a Cedarburg podiatrist was sentenced Wednesday to five years of probation and agreed to repay $1 million in restitution and to settle claims in a related False Claims Act civil case. Alan Balkansky avoided 18 months in prison that federal prosecutors had recommended, if not a moral lecture from U.S. District Judge Pamela Pepper. She acknowledged his career of hard work, caring for family and patients and activities in his former profession and at his synagogue, saying: "In the vast majority of respects, you've lived an exemplary life." But Pepper noted concern that Balkansky still seemed to regard his ...

Health Care Fraud Prosecutions Down 23 Percent
May 04, 2016, Washington, DC -- Fiscal year 2016 is on pace to have the lowest level of federal prosecutions for health care fraud since FY 1998. The latest available data from the Justice Department show that during the first six months of FY 2016 the government reported 239 new health care fraud prosecutions. If this activity continues at the same pace, the annual total of prosecutions will be 478 for this fiscal year. According to the case-by-case information analyzed by the Transactional Records Access Clearinghouse (TRAC), this estimate is down 23.2 percent from the past fiscal year when the number of prosecutions totaled 622. The comparisons ...

Tips on Investigating Contents Claims Fraud
May 04, 2016, Washington, DC -- Recognizing the difference between hard and soft fraud can aid in investigating fraudulent contents claims, according to two Property & Liability Resource Bureau national conference panelists who spoke recently on the subject. Both Florida-based experts, Greg Nelson with UPC Insurance and Andy P. Rock, owner of the Rock Law Firm, said that Miami in particular, is a hotbed when it comes to new fraud trends. According to the Federal Bureau of Investigation, insurance fraud totals more than $40 billion per year and costs U.S. families an estimated $400 and $700 per year. The federal agency’s data is supported by an industry fraud ...

Health Care Fraud Prosecutions Down 23 Percent
May 04, 2016, Washington, DC -- The current fiscal year is on pace to have the lowest level of federal prosecutions for health care fraud since 1998. That’s according to a report from the Transactional Records Access Clearinghouse (TRAC). The latest available data from the Justice Department show that during the first six months of FY 2016 the government reported 239 new health care fraud prosecutions. If this activity continues at the same pace, the annual total of prosecutions will be 478 for this fiscal year. This estimate is down 23.2 percent from the past fiscal year when the number of prosecutions totaled 622. The comparisons of the number of defendants ...

Margate HOA president contacts Call Christina; alleges failing roofs
May 04, 2016, Margate, FL -- For 10 years, some Fairway Views homeowners say they have been making constant repairs to their roofs. Water has flooded their garages, their skylights have leaked and water has dripped through their roofs. Residents in the Margate neighborhood blame the shoddy workmanship on the contractors hired to replace their roofs after Hurricane Wilma. The Fairway Views Homeowners Association in Margate had hired ABC/Tri-Coast Roofing, which subcontracted the job to Taylor Contracting and Roofing, which state records show is owned by roofing contractor David B. Taylor. This isn’t the first time Taylor has faced complaints about his work. Taylor is currently the subject of a ...

Los Angeles medical worker nabbed for workers’ comp fraud
May 04, 2016, Bellflower, CA -- Johana Magnolia Paredes, 45, of Bellflower, Calif. was arrested by California Department of Insurance detectives on two felony counts of workers’ compensation insurance fraud after allegedly misrepresenting her injuries to collect $39,953 in disability payments that she was not entitled to. Paredes claimed she injured her right wrist while working at the UCLA Medical Center. An investigation by the CDI and video evidence reportedly revealed Paredes was able to exercise at the gym using her right hand and right shoulder with no limitations. Upon reviewing the video evidence, the medical examiner stated Paredes had misrepresented her injuries and he would not have ...

Doctor in New York sought to have two insurer investigators beaten
May 03, 2016, Ramapo, NY -- A podiatrist and his girlfriend plotted to kill his wife and have two insurance investigators looking into his business beaten up, town police said Tuesday. Police arrested Ira Bernstein, 41, and Kelly Myzner Gribeluk, 36, Monday night following a month-long investigation they said was sparked when the person the couple reached out to about killing Bernstein's wife initially reported the plot to the Spring Valley police. Ramapo Detective Lt. Mark Emma said Bernstein and Gribeluk thought the man they approached had the connections they needed. He called the man "an exceptional citizen" for reporting what happened. "This person had some sort of relationship ...

Jury in Florida convicts doctor of 162 counts of healthcare fraud
May 03, 2016, Gainesville, FL -- A doctor who practiced in Gainesville and Hawthorne has been convicted of 162 counts of health care fraud for false billing and for using drugs not approved in the United States, reported the U.S. Attorney’s Office. Ona Colasante, 59, can be sentenced to up to 10 years in prison on each count. The jury trial lasted five weeks before returning a verdict Monday. Sentencing is set for July 25. The charges stem from practices at both the Colasante Clinic at 810 NW 16th Avenue in Gainesville and the Hawthorne Medical Center. “The Medicare system relies on doctors to diagnose and treat beneficiaries,” ...

Woman in California charged with lying about auto accident
May 03, 2016, Santa Ana, CA -- A 40-year-old woman pleaded not guilty Monday to submitting a false insurance claim for a vehicle driven by someone else involved in a traffic collision last year. Orange County prosecutors believe Amezuca Alejandra Rodriguez of Santa Ana filed a $16,000 insurance claim for a traffic collision on May 29, 2015 in Garden Grove. She is charged with two felony counts of insurance fraud. Rodriguez’s relative struck a guard rail on Harbor Boulevard and Trask Avenue. She was not in the vehicle at the time, the DA said. Three days after the incident, Rodriguez filed a claim with Infinity Insurance, saying she was the ...

Urgent care doc in Michigan charged with fraud in billing scam
May 03, 2016, Canton, MI -- A Canton-based doctor has been charged in a 22-count medical fraud case involving allegations he billed Medicaid and Blue Cross Blue Shield for services he didn’t provide. Charges against Dr. Bassel Altantawi, 45, of Farmington Hills were announced Tuesday by Michigan Attorney General Bill Schuette, whose office was notified of the accusations after Canton police received a complaint. “We were alerted to the (alleged) fraudulent activity that was going on and we contacted the attorney general’s office and turned it over to them,” Canton Special Services Lt. Craig Wilsher said Tuesday. Wilsher said he couldn’t elaborate on the details brought to Canton police ...

Postal worker in Virginia sent to prison for workers comp fraud
May 03, 2016, Suffolk, VA -- Ronald Henderson, 58, of Lewiston, North Carolina, was sentenced today to 13 months in prison for Federal Employees’ Compensation Fraud. He was also ordered to pay $163,956.23 in restitution to the Department of Labor. Henderson pleaded guilty on Dec. 2, 2015. According to court documents, on June 11, 2011, Henderson falsely claimed to have injured his shoulder while performing his duties as a mail carrier in Suffolk. The injury had actually occurred previously while off-duty. In addition to receiving compensation as a result of the false disability claim, Henderson filed hundreds of false travel claims seeking reimbursement for ...

Dentist in Kentucky guilty of prescribing drugs for himself
May 03, 2016, Barren County, KY -- A Barren County, Kentucky, physician pleaded guilty today in United States District Court to seven criminal counts of knowingly and intentionally distributing and dispensing controlled substances outside the course of professional medical practice and health care fraud, while he was a practicing physician in the Western District of Kentucky, announced United States Attorney John E. Kuhn, Jr. Dr. Christopher Steward, of Cave City, was a dentist and a nurse practitioner with a practice located at 212 Broadway in Cave City and had a Drug Enforcement Agency registration number which authorized him to write prescriptions within the course of professional medical practice. According ...

Medical supplier to pay $306M to settle nationwide kickback suit
May 02, 2016, Albany, NY -- Attorney General Schneiderman announced today a joint settlement with the federal government and a coalition of states to resolve allegations that Olympus Corporation of the Americas paid illegal kickbacks to healthcare providers, in violation of federal and state False Claims Acts, including New York’s statute. The national settlement is $306 million, with the New York Medicaid Program receiving over $7.7 million dollars in damages. Between January 1, 2006 and December 31, 2011, Olympus, a subsidiary of Olympus Corporation of Japan located in Center Valley, PA, used improper financial incentives to induce doctors and hospital executives to buy a wide ranging array ...

'Injured' grocery store worker seen playing drums in rock band in Penn.
May 02, 2016, Montgomery County, PA -- A 58-year-old Hatfield Borough man is facing three felony criminal counts for alleged insurance fraud after Montgomery County authorities said he was seen playing drums with his band despite claiming he could barely lift his arms after a purported injury for which he was receiving regular worker’s compensation payments, court documents indicate. William R. “Russ” Downey, of the 400 block of West Vine Street, was taken into custody by county detectives Friday and arraigned in Lansdale district court on one count each of insurance fraud, theft by deception and receiving stolen property — all graded as third-degree felonies. According to an affidavit ...

Pair in Oklahoma accused of burying 'stolen' pickup truck
May 02, 2016, Langley, OK -- Over a year after the incident, the cooperative efforts of several law enforcement agencies have resulted in two men facing felony insurance fraud charges. Larry Ezell, of Spavinaw, and Robert Campbell II are both facing felony charges of causing a false insurance claim to be filed in Mayes County District Court. Court records show on Dec. 4, 2014 the vehicle owner reported a vehicle insured by him as stolen to the Langley Police Department. Around Jan. 15, 2015 Cpt. Wells of the Mayes County Sheriff’s Office, and Cpt. Jason Hutchison of the Craig County Sheriff’s Office, were contacted by the car dealership where ...

Office manager in Ohio sentenced for aiding workcomp fraud scheme
May 02, 2016, Lima County, OH -- A Spencerville (Lima County) woman has been sentenced for colluding to commit workers’ comp fraud with an acquaintance who was sentenced for fraud last year. Angela Pugin pleaded guilty to a felony count of complicity to commit workers’ compensation fraud on April 18 in the Franklin County Court of Common Pleas. BWC’s Special Investigations Department (SID) began investigating Pugin after receiving an allegation that a claimant, Douglas Roop, may have been working while receiving permanent total disability benefits he was awarded following a workplace injury. Roop had filed for a settlement and noted that his brother-in-law owned a business and ...

Kingston Rx fraud case nets arrest in Niagara Falls
April 30, 2016, Kingston, none -- A woman wanted by Kingston Police in a pharmacy fraud case has been arrested in Niagara Falls. The search began in late February — when a woman went to the Pharmasave on Gardiners Road…. And picked up a prescription for fentanyl, an extremely powerful opiate pain killer. The prescription had been called in earlier in the day by a woman claiming to be a pharmacist from Kanata. Police believe the same person later posed as a cancer patient to pick up the drugs. The suspect was caught while allegedly planning a similar prescription fraud in the falls. 29-year-old Saundra Macneill ...

State workers in N.Y. got nice earbuds; provider billed for hearing aids
April 29, 2016, Onondaga County, NY -- A state correction officer who received about $70,000 through an alleged insurance scam that provided hundreds of state workers with high-quality earbuds that were billed as hearing aids is the target of a criminal probe by the Onondaga County district attorney's office, according to a person with knowledge of the investigation. The identity of the correction officer, Joshua S. Powers, 36, was not revealed last November when state Inspector General Catherine Leahy Scott and Onondaga County District Attorney William J. Fitzpatrick announced the arrest of a Syracuse business owner who was accused of devising the scheme. The business owner, Joshua Miller of ...