News

California driver gets 11 years after lying about crash time
September 19, 2018, Fairfield, CA -- An ex-con who tried to pull a fast one on an insurance company was sentenced Monday to 11 years behind bars. A jury found Lamont J. James, 34, guilty in May of two felony counts of insurance fraud. With credit for time served and good behavior, James could be released from jail as early as September 2023. At James’ trial, prosecutor Irene Chew presented witnesses who recounted that James was driving Aug. 19, 2015, on Union Avenue when he rear-ended another car. Within an hour of the crash, James, who did not have auto insurance, signed up for an insurance policy. The next ...

Duo sentenced for home arsons in West Virgina
September 18, 2018, Wyoming County, WV -- Two Wyoming County men were sentenced today in federal court for their respective roles in a scheme to commit insurance fraud by arson Dudley Bledsoe, 63, of Hanover, was sentenced to 24 months in prison and ordered to pay $294,085.07 in restitution. Bledsoe previously pled guilty to an unlawful monetary transaction charge. James Keith Browning, 54, also of Hanover, was sentenced to 50 months’ imprisonment and ordered to pay restitution in the amount of $211,553.50. Browning previously pled guilty to arson to commit wire fraud. “Greed leads to reckless, dangerous behavior,” said United States Attorney Mike Stuart. “Crimes ...

UK woman invents daughter for false claims after terrorist attack
September 18, 2018, Manchester, -- A woman who pretended to have a daughter who was seriously injured in the Manchester Arena attack in order to get money has been jailed. Susan Pain, 51, claimed £139,000 through 31 fraudulent insurance claims over seven years. She was sentenced at Liverpool Crown Court to two years in prison for two counts of fraud. Pain, from Kirkby, Merseyside, was caught after her final claim, in which she said she had a daughter named Sophie who had sustained serious injuries in the arena attack on 22 May last year. Twenty-two people died after Islamist terrorist Salman Abedi detonated a homemade bomb as people were ...

California sues pharma giant for alleged arthritis-drug kickbacks
September 18, 2018, Alameda County, CA -- Insurance Commissioner Dave Jones today filed an insurance-fraud complaint in Alameda County Superior Court on behalf of the State of California against AbbVieInc. alleging AbbVie gave illegal kickbacks to health care providers to prescribe HUMIRA—an expensive and dangerous drug with potentially deadly side effects. The case, which is filed on behalf of the State under the Insurance Frauds Prevention Act, alleges that private insurers have paid out $1.2 billion in HUMIRA-related pharmacy claims, making this the largest health insurance fraud case in department history. According to the complaint, AbbVie engaged in a far-reaching scheme including both classic kickbacks—cash, meals, drinks, gifts, ...

Doc writes scripts for pain pills sold on West Virginia streets
September 18, 2018, Wintersville, WV -- Dr. Tod Hagins, of Wintersville, was sentenced Monday to 57 months incarceration for writing fraudulent prescriptions to be sold on the streets from his Weirton practice, U.S. Attorney Bill Powell announced. “This case should send a clear message to all those who practice medicine that neither their medical license nor their white lab coat will protect them from enormous consequences of illegal drug distribution and medical fraud. This doctor violated both our laws and his solemn oath as a physician. He will now pay for those violations.” said Powell. Hagins, 52, pled guilty to one count of conspiracy to distribute controlled substances ...

Florida doc hands pain scripts to patients’ relatives, no exams
September 18, 2018, Clearwater, FL -- Questions about pain prescriptions and Medicare fraud have dogged Dr. Jayam Krishna Iyer for 18 years. Iyer, who runs the Creative Health Center in Clearwater, is expected to plead guilty in federal court Tuesday in a deal that ends her medical career. In a plea agreement signed Aug. 27, Iyer admits to defrauding Medicare by billing for patient treatment she never delivered. According that alleged scheme, spelled out in a 20 page court filing, Iyer gave written prescriptions for Schedule II narcotics to relatives of patients who never actually stepped foot into her offices on 1012 Druid Rd. The plea agreement says Iyer then ...

Georgia agent allegedly issues fake comp certificates
September 17, 2018, Franklin, GA -- Former Franklin Mayor and local insurance agent Michael Brad Yates has been indicted by a grand jury in Heard County Superior Court on 30 counts of Insurance Fraud and one count of false statements. The counts were handed down by the grand jury on Monday, Sept 17, 2018. Included in the indictment are 30 counts of Insurance Fraud (O.C.G.A. 33-1-9) and one count of Making a False Statement (O.C.G.A. 16-10-20). The first 23 counts of Insurance Fraud allege that Yates did knowingly and did willfully issued fake certificates of insurance purporting contractors as having workers compensation insurance coverage. Counts 23-29 on the indictment ...

Houston airport auditor suspected of false disability claim
September 17, 2018, Houston, TX -- Arrests at Houston airports tend to happen at a Transportation Security Administration checkpoint, not inside of the airport's executive offices. This, however, is what happened in March 2013. The airport system's chief auditor, Kerticia Mond, was arrested on out-of-state felony charges of "forging or counterfeiting a doctor's certificate of examination" as well as filing a false insurance claim to collect short-term disability benefits while employed at the Jacksonville Aviation Authority. According to the Florida Department of Financial Services, Mond collected $16,200 in disability payments when she was only entitled to less than $2,000. Following her arrest, former Houston Mayor Annise Parker ...

Newtown psychologist charged in scheme to defraud Medicaid
September 17, 2018, Newtown, CT -- Authorities tipped off by a former employee today arrested a Newtown psychologist on charges that she bilked the Medicaid program out of thousands of dollars for services she never performed. Jeannie Pasacreta, age 61, of Abbey Lane, Newtown, was arrested by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State's Attorney and charged with one count each of Larceny in the First Degree By Defrauding A Public Community, Health Insurance Fraud and Identity Theft in the First Degree. The investigation was initiated by a complaint to the state Attorney General's Office from a former employee of Pasacreta's ...

Four children removed from Camdenton home, man and woman charged for drugs, ID theft
September 17, 2018, Camdenton, MO -- Two people are facing felony charges and four children have been removed from a home after authorities say they found drugs and identity theft documents in a Camdenton home. Authorities say on Friday, Sept. 14, 2018, officers of the Lake Area Narcotics Enforcement Group (LANEG) and the Camden County County Sheriff’s Office executed a search warrant at the 100 block of Seven Ridge Ct. in Camdenton. There authorities say they found methamphetamine, prescription pills, drug paraphernalia used in the distribution and consumption of controlled substances, counterfeit United States currency, prepaid debit cards in different names, lists of gift card account numbers, stacks ...

Prescription drug fraud investigation
September 17, 2018, St. George Police, AZ -- St. George Police are asking the public for information about three individuals recently arrested for prescription fraud case. Dachandra Shirley and Bryan Jermain James were arrested on multiple counts of prescription fraud Saturday and investigators want to talk with a third individual, Stephany Washington, who at this point is not a suspect but authorities want to talk with her. If you recognize any of these individuals or have information about them police are encouraging you to contact them with the details. Contact the St. George Police Department at 435-627-4300. ...

Mississippi pharmacist pleading guilty to role in $400M con
September 17, 2018, Hattiesburg, MS -- Another Mississippi pharmacist is pleading guilty to helping run a fraud that collected millions from insurers. Marco Moran of Raymond pleaded guilty in Hattiesburg federal court on Thursday to one count of attempt and conspiracy to commit health care fraud. In the plea, Moran admits to participating in fraud that collected $22 million between May 2014 and January 2016. Some came from a federal military health insurer. The 45-year-old Moran co-owned Medworx, a Ridgeland pharmacy. He also owned a second pharmacy. Prosecutors say Moran is part of a far-reaching scheme that took in more than $400 million. So far, nine people have been convicted ...

Chiro accused of $2M in phantom treatments in New York
September 17, 2018, Long Island, NY -- An indictment was unsealed today in federal court in Central Islip charging chiropractor Raymond R. Pellegrino with health care fraud. The indictment alleges that Pellegrino billed Anthem Blue Cross Blue Shield over $2 million for health care services that were never performed. Pellegrino was arrested today in Texas, and will be arraigned at a later date in the Eastern District of New York. Richard P. Donoghue, United States Attorney for the Eastern District of New York, and William F. Sweeney, Jr., Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI), announced the charges. “Pellegrino abused his position as a licensed ...

Office visits done by unlicensed employee in New Hampshire
September 17, 2018, Windham, NH -- A Windham nurse practitioner pleaded guilty in U.S. District Court on Monday to health care and prescription fraud. Kristen Khanna, 42, a nurse practitioner licensed to practice in New Hampshire, operated Total Pain Care and Wellness, PA in Salem from October 2009 until December 2015. The charges focus on 2014 and 2015, when Khanna was the only licensed provider at Total Pain Care. The government’s investigation, which included interviews with patients, a review of prescribing data and other investigative techniques, revealed that Khanna was often not present at Total Pain Care and allowed office visits to be conducted by an unlicensed ...

Connecticut doc pleads to illegally selling 900 pain scripts
September 17, 2018, Darien, CT -- A Darien doctor accused of running a pill mill out of the Family Health Urgent Care facility in Norwalk pleaded guilty Monday to health care fraud and money laundering. Dr. Ramil Mansourov, 49, of Tokeneke Road, appeared before Senior U.S. District Judge Janet Bond Arterton. She set sentencing to Dec. 5. Federal authorities said Mansourov billed Medicaid nearly $5 million for home, office and nursing home visits that never occurred. He transferred some of the stolen money to a Swiss bank account and used the money for personal purposes, authorities said. A co-defendant, Dr. Bharat Patel of Devine Place, Milford, pleaded guilty in ...

Medicare strike force tallies 70 convictions, $355M recovered
September 17, 2018, Dallas, TX -- The Justice Department in June announced charges against more than 600 people responsible for more than $2 billion in health care fraud losses over a 12-month period. That stems in part from 10 strike forces across the country created to investigate Medicare fraud. The Dallas unit began in 2011. C.J. Porter, the special agent in charge of investigations for the U.S. Department of Health and Human Services Office of Inspector General’s Dallas Region, said the numbers clearly identified the need for a strike force. "Data analytics identified Dallas as a hot spot where home health services was an issue," Porter said. "And our ...

Texas doc allegedly gets kickbacks for compound referrals
September 16, 2018, Waxahachie, TX -- A Waxahachie anesthesiologist refutes the allegations of health care fraud that led to his Aug. 8 indictment by a federal grand jury in a United States District Court. However, Adam Gallardo Arrendondo, 56, now faces up to 10 years in prison and a $100,000 fine after being charged with illegal remuneration for health care referrals. “It is totally bogus and is a totally untrue accusation. This comes from a time when I served as medical director for seven months,” said Arrendondo during an interview Wednesday at his office, Texas Anesthesia and Pain Management Institute, in Waxahachie. According to the website for the Texas ...

Insurers claim gardaí 'failing to pursue scammers'
September 15, 2018, Dublin, -- Gardaí have been accused of failing to pursue people who make false insurance claims. Insurers said they handed gardaí files on scores of fraudulent claims in 2016, but nothing has been done since. Junior Minister Michael D'Arcy, who is responsible for insurance, said he was "displeased" with the failure of gardaí to prosecute insurance fraudsters. Businesses claim they are being besieged by fraudulent personal injury claims, and are often forced to pay legal costs even when they win. Insurance Ireland's Kevin Thompson said members of the representative organisation handed over 167 files on fraudulent cases in 2016. The cases were "resting" with gardaí and ...

Irish surgeon ‘tries to pay off massive debts by lying about raising money
September 15, 2018, England, -- A debt-ridden Irish surgeon tried to flog antiques by lying that he was raising cash to build a Syrian child refuge, it’s claimed. But when Anthony McGrath, 45, and his GP wife Anne-Louise didn’t rake in enough dough, they made a €200,000 fake insurance claim, a trial was told this week. He allegedly told cops the cottage he was renting outside Luton, England, was robbed in April 2015. It’s alleged McGrath, who wanted to raise funds to renovate the couple’s new €1.2million home, claimed antiques, jewellery and a marble fireplace had been taken. But cops became ­suspicious because of an absence of clues, Luton ...

Social Security: Don’t be misled by false Medicare or Social Security ads
September 15, 2018, Washington, DC -- Online and otherwise, there’s a lot of information out there, and sometimes it’s difficult to tell what sources are credible. With millions of people relying on Social Security, scammers target audiences who are looking for program and benefit information. The law that addresses misleading Social Security and Medicare advertising prohibits people or non-government businesses from using words or emblems that mislead others. Their advertising can’t lead people to believe that they represent, are somehow affiliated with, or endorsed or approved by Social Security or the Centers for Medicare & Medicaid Services (Medicare). People are often misled by advertisers who use the terms ...

Recognize these people? Police asks public for info related to prescription fraud arrests
September 15, 2018, St. George, UT -- Police are asking if anyone recognizes three people whose photos they posted on Facebook Saturday related to prescription fraud arrests. “We are looking for information about where these individuals may have stayed in St. George over the last few days,” the St. George Police Department wrote. The individuals involved include Dachandra Gabriella Shirley and Bryan Jermain James, who were arrested on multiple counts of prescription fraud Saturday afternoon, according to St. George Police. A third individual, Stephany Washington, is someone police want to talk to. She is not a suspect, according to text attached to the photo shared by police. If anyone believes they ...

Illinois social worker falsely bills insurers for $500K
September 15, 2018, Mahomet, IL -- A former Mahomet counselor who admitted to falsely billing health care insurers for more than $500,000 over five years was sentenced Thursday to 18 months in federal prison. According to a release from U.S. Attorney John Childress' office, Christopher "Kip" DiFilippo, 40, of Bakersville, Calif., formerly of Mahomet, pleaded guilty May 11 to one count of health care fraud. DiFilippo admitted that between 2012 and 2017, he submitted false billings to insurers while working as a counselor out of his home. In addition to the prison time, he was also ordered to pay $514,297 in restitution to various insurers and will have ...

FCA warns against UK Insurance clone firm
September 14, 2018, London, -- The UK Financial Conduct Authority (FCA) has put out details of the cloned firm UK Insurance. Fraudsters are using the details of firms, authorised by the FCA, to try to convince people that they work for a genuine, authorised firm. Fraudsters are using or giving out the following details as part of their tactics to scam people in the UK: UK Insurance (clone of FCA authorised firm) Telephone: +3025258106 Email: info@ukifx.cc Website: www.ukifx.cc Be aware that the scammers may give out other false details or mix these with some correct details of the registered firm. To see the official FCA warning, click here. ...

Centre calls on IT firms to detect fraud in Ayushman insurance scheme: Report
September 14, 2018, Ayushman, -- The central government has called on leading IT companies to develop a framework that will detect and send alerts for “suspicious” transactions in its ambitious PM Jan Arogya Yojana (PMJAY) health insurance scheme, reported The Economic Times. The government is planning to appoint partners for this project in the next four months after holding consultations starting this week, senior officials aware of the development told the paper, adding that firms such as IBM, L&T Technologies, Lexis-Nexis, IQVIA and Wipro have already expressed interest in designing such a framework. The move comes after directions were issued from the highest quarters of the ...

National insurance register mooted to prevent fraud
September 14, 2018, Denmark, -- Last year, insurance companies were hit by more than 3,200 false claims totalling a staggering 530 million kroner. The claims were for both personal insurance and also for goods and property, reports Finans. To combat this trend, insurers want to set up a compulsory register containing all damages claims nationwide so that it is possible to cross-check claims to weed out fraudsters. “When a customer reports a loss of some kind the company can quickly see what the person has claimed for,” said Hans Reymann-Carlsen, the deputy head of the insurance branch organisation Forsikring & Pension. Pulling a fast one “If a customer has ...