News

Bauer Investigations acquired by Claims Verification, Inc.
July 21, 2014, Fort Lauderdale, FL -- Claims Verification Incorporated (CVI), a leading national supplier of special investigation and surveillance services to the insurance industry, has announced its acquisition of all of the assets of Bauer Investigation of Albuquerque, New Mexico. CVI was founded in 1976 and has operations, including offices and field personnel strategically located throughout the United States. Bauer, a national investigation supplier for more than 20 years, is well known for its strong presence in the western and mid-western United States. In particular, Bauer has long been a source for investigative services in the more rural and remote areas of the country that have ...

Deaf workers accused of 'new whiplash' claims in insurance fraud
July 21, 2014, London, none -- Compensation claims for industrial deafness have risen by two thirds over the past two years, according to insurance and legal experts. Despite the increase, however, only one in 10 cases are being paid out amid claims of widespread fraud. An estimated 80,000 claims were made last year, compared with 55,000 in 2012, according to the Institute of Actuaries. With only 10 per cent successfully receiving payouts, Industrial Deafness cases have been dubbed "the new whiplash" by some insurers. AXA insurance had more claims for industrial deafness than any other type of workplace injury or illness in 2012, at a cost of ...

Agency owner in Florida accused of stealing $1.1 million in premiums
July 21, 2014, Miami, FL -- Carlos Gutierrez, the former president and owner of G.M. Underwriters in Miami, was arrested on grand theft and fraud charges after an investigation revealed he stole nearly $1.1 million in insurance premiums from seven insurance and premium finance companies, according to an announcement by Chief Financial Officer Jeff Atwater. An investigation led by the Department of Financial Services’ Divisions of Insurance Fraud and Agent & Agency Services found that Gutierrez directed his staff to divert insurance premiums between March and August 2012 to pay his own business debts. Gutierrez, his agency and top staff have been permanently banned from the insurance business ...

Home health agency owner in Michigan convicted of massive fraud scheme
July 21, 2014, Livonia, MI -- The owner of a Livonia home health care agency and several pharmacies was convicted of health care fraud charges Friday after a seven-day jury trial, United States Attorney Barbara L. McQuade announced today. McQuade was joined in the announcement by Acting Special Agent in Charge James V. Allen, Drug Enforcement Administration, Special Agent in Charge Paul M. Abbate, Federal Bureau of Investigation, and Lamont Pugh, III, Special Agent in Charge, Department of Health and Human Services Office of Inspector General (“HHS-OIG”). Vinod Patel, 41 of Canton, was the 38th defendant convicted out of the 39 defendants charged in a massive health care ...

Chiropractor in Kansas pleads guilty of defraud insurers of $1.3 million
July 21, 2014, Wichita, KS -- A Wichita chiropractor pleaded guilty Monday to defrauding health care insurers of more than $1.3 million. Jeffrey D. Fenn, 33, Wichita, pleaded guilty to one count of health care fraud, two counts of aggravated identity theft and one count of tax evasion. In his plea, he admitted that from March 2011 to October 2013 he executed a health care fraud scheme through his businesses, including Wichita Health and Wellness, Fenn Chiropractic, P.A. and Wichita Pain Associates, P.A. Fenn submitted false claims to Medicare, Blue Cross/Blue Shield of Kansas and Coventry Health Care of Kansas, Inc., and the Federal Employees Health Benefits Program. Sentencing ...

Utah officials warning drivers about windshield schemes
July 21, 2014, Salt Lake, UT -- When faced with the need to replace a windshield, many car owners look for the least expensive option. But in a scam that's hitting Utah, crooks present a nearly irresistible option: replace it for free. “You don’t need to do anything, just give us your personal information, give us your insurance information and your date of birth and those types of things,” said Armand Glick, director of the Utah Insurance Department's fraud division. The division recently investigated six people who were arrested after going door-to-door with offers of windshield replacement. “Initially, those windshields were actually repaired,” he said. “But the sales agent called ...

Ohio logs a dozen convictions against comp fraudsters last month
July 21, 2014, Columbus, OH -- Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced that 12 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in June 2014. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate and prosecute workers’ compensation fraud. “Our investigators received more than 3,400 tips last year and take each one very seriously in order to protect the State Insurance Fund,” Buehrer said. “BWC staff is always on the lookout for the telltale signs of fraud, and welcome tips through our ...

Utica Physician Acquitted Of Health Care Fraud
July 21, 2014, Utica, NY -- A federal jury in Utica has found Dilip D. Kachare, a Utica physician, not guilty of three counts of health care fraud and 16 counts of mail fraud following a four week trial in U.S. District Court. The verdict follows a prior three week trial in October/November 2013, when a mistrial was declared after a jury was unable to reach a decision after three days of deliberation. Kachare, 58, had been indicted in November 2012, by a federal grand jury on three counts of health care fraud and 16 counts of mail fraud. Kachare maintains an outpatient and inpatient practice in internal medicine. ...

Drug dealers and addicts flocking to Missouri to stock up on painkillers
July 20, 2014, Sikeston, MO -- On his office phone at L & S Pharmacy, Richard Logan listened as a doctor’s office detailed how a patient had just left with her third prescription for painkillers in only nine days — and was quite possibly getting more, illegally, elsewhere. Mr. Logan, 61, holstered two guns, slipped on a bulletproof vest and jumped into his truck. Because in his small corner of America’s epidemic of prescription drug abuse, Mr. Logan is no ordinary pharmacist. He is also a sheriff’s deputy who, when alerted to someone acquiring fraudulent drug prescriptions, goes out to catch that person himself. “I’m only one guy, ...

Pennsylvania woman accused of buying policy minutes after crash
July 19, 2014, Kingston, PA -- When a Kingston woman called to set up an auto insurance policy in April, she told the agent she hadn’t been involved in an accident in the past five years. In fact, it had only been seven minutes, authorities allege. Tiffany Ann Brunson, 32, of 112 Sharpe St., is charged with insurance fraud after allegedly calling Safe Auto to initiate a policy mere minutes after getting into a fender-bender in the parking lot of Walmart in Wilkes-Barre Township. According to the Northeastern Pennsylvania Insurance Fraud Task Force, Brunson had a policy with Safe Auto that lapsed on March 1. At 12:44 p.m. April 11, ...

Former Fairfield Doctor Gets Two Years In Federal Prison For Fraud
July 19, 2014, Fairfield, CT -- A Fairfield man who lost his medical license was sentenced to two years in federal prison for his role in an insurance fraud scheme and a conspiracy to illegally distribute prescription narcotics, according to the U.S. attorney for Connecticut. Francisco R. Carbone, 56, was sentenced Friday by U.S. District Judge Stefan R. Underhill in Bridgeport. Carbone's prison term will be followed by three years of supervised release. Carbone, who was paid $434,529 for participating in the scheme, also was ordered to pay that amount in restitution to the insurance carriers. This matter stems from “Operation Running Man,” a 14-month undercover fraud investigation headed ...

Unlicensed doc in Connecticut gets prison for insurance fraud
July 18, 2014, Fairfield, CT -- A Fairfield doctor whose license was revoked by the state almost a decade ago was sentenced Friday to two years in prison for his role in an insurance fraud and prescription medication scam that defrauded insurance companies out of more than $1.7 million. Francisco R. Carbone, 56, cooperated in the FBI's 14-month investigation of the scam known as "Operation Running Man," which lasted from 2006 to 2010. In the scam, Carbone and six other people provided unnecessary medical services and overstated patients' injuries. Because of Carbone's cooperation, U.S. District Judge Stefan R. Underhill sentenced him below recommended guidelines. In addition to ...

Cosmetic surgeon in Georgia pleads guilty to Medicaid fraud
July 18, 2014, Atlanta, GA -- Six years after the I-Team first raised questions about Dr. Nathaniel Johnson's medical practices, the noted OB/GYN and cosmetic surgeon pled guilty to Medicaid Fraud and aiding the unlicensed practice of medicine. The surprise plea came in the middle of a criminal trial ends the medical careers of both the high profile doctor and Jeff Romeus, a young medical school graduate. In 2008, the I-Team talked to two dozen OB/GYN patients who told us Jeff Romeus treated them. They had no idea he was not a licensed doctor. Following our story, Dr. Johnson and Jeff Romeus were indicted. Jeff Romeus pled guilty ...

Comp claimant in New York accused of stealing $27K in insurance benefits
July 18, 2014, Harriman, NY -- A Harriman resident is accused of illegally receiving more than $27,000 in workers compensation insurance benefits while he was working full time. The Orange County Sheriff's Office arrested Trent Mitchell, 43, and charged him with Insurance Fraud in the third degree, a felony. It's alleged that while Mitchell was living in the Town of Montgomery he illegally obtained workers comp benefits from April 2011 to August 2012. In addition to insurance fraud Mitchell was charged with a misdemeanor count of Falsifying Business Records and two felony charges under the Workers Compensation Law. The charges stem from a joint investigation conducted by the ...

Madison County man charged with TennCare fraud
July 18, 2014, Madison County, TN -- A Madison County man is charged with TennCare fraud in connection with obtaining benefits through the health care insurance program, even though he wasn't eligible, according to a news release. The Office of Inspector General (OIG), with the assistance of the Madison County Sheriff's Office, today announced the arrest of Joe Ray Phelps, 54, of Jackson. Phelps was indicted by a Madison County grand jury and charged with fraudulently obtaining TennCare medical assistance benefits to which he was not entitled. "When a person intentionally misrepresents their situation – whether it's income, dependents, access to insurance or other issues – that's fraud against the ...

Co-owner of California auto body shop sentenced for false billing
July 17, 2014, Vallejo, CA -- The co-owner of an auto body repair shop in Vallejo has been sentenced to 30 days OF home detention, placed on probation and ordered to pay restitution of about $40,000 to Farmers Insurance after an investigation revealed damaged vehicles were patched with filler material and painted, rather than fitted with new replacement parts as paid for by Farmers. Armand Terence Eulano was sentenced July 10 in Solano County Superior Court after his earlier no-contest pleas to three felony counts of automobile insurance fraud, the District Attorney’s Office said in a press release. G Collision, his business, has since permanently closed. The case began ...

Staged collisions a 'catalyst' for larger insurance fraud
July 17, 2014, Toronto, none -- Car crash scams are becoming increasingly sophisticated, investigators say, with the latest wrinkle involving organized groups gaining access to medical clinics to cash in on lucrative payouts for phoney insurance treatments. "We've seen a definite increase in identity theft within the medical clinics with regard to claiming accident benefits," said Rick Dubin, vice-president of the Insurance Bureau of Canada's investigative services. Why dashcams are growing in popularity Did a dashcam save this man from a Hamilton parking lot crash scam? Dubin leads a group of 50 investigators who focus on probing organized auto-insurance crime for private insurers across the country. At any time, they ...

July 17, 2014, Wilmington, NC -- A Wilmington couple is facing arson and insurance fraud charges after investigators say they intentionally set fire to their home on May 12. The North Carolina Department of Insurance announced Thursday the arrests of Mark Dwayne Geer, Jr., 23, and Michelle Alaina May, 21. Investigators allege that Geer set fire to the couple's Wilmington residence at 622 Sharease Circle on May 12, 2014, to collect insurance funds and conspired with May to provide fraudulent information to USAA Insurance Company. The couple received approximately $9,800 in living expenses from the insurer. Geer was arrested and charged with one count each of second-degree arson, fraudulently ...

Couple in North Carolina charged with setting fire to their home
July 17, 2014, Wilmington, NC -- A Wilmington couple is facing arson and insurance fraud charges after investigators say they intentionally set fire to their home on May 12. The North Carolina Department of Insurance announced Thursday the arrests of Mark Dwayne Geer, Jr., 23, and Michelle Alaina May, 21. Investigators allege that Geer set fire to the couple's Wilmington residence at 622 Sharease Circle on May 12, 2014, to collect insurance funds and conspired with May to provide fraudulent information to USAA Insurance Company. The couple received approximately $9,800 in living expenses from the insurer. Geer was arrested and charged with one count each of second-degree arson, fraudulently ...

Man in New York convicted of home arson and insurance fraud
July 17, 2014, Canandaigua, NY -- Samuel Crawford of Canandaigua was convicted of three counts of arson, one count of attempting insurance fraud and one count of conspiracy Thursday afternoon in Ontario County Court. According to testimony in the trial — including a taped confession — Crawford conspired with his wife and a friend to burn a Saltonstall Street home his wife owned. The 33-year-old construction worker could face up to 15 years in prison in connection with the December fire. Judge Frederick Reed will sentence him on Sept. 25. His wife, Shallamar Hayward-Crawford, is next to be tried. A jury of nine women and three men deliberated ...

Florida attorney general charges 3 Orange County women with Medicaid fraud
July 17, 2014, Orange County, FL -- Three Orange County women are facing charges that they fraudulently billed Medicaid more than $45,000 for mental health services that were never completed or not covered, according to the state attorney general's office. Shirley Simmons, owner of A & S Quality Care, would tell employees to solicit "people who look like they have Medicaid." The employees would receive a $25 kickback for any client they signed up, which is not allowed, authorities allege. Keisha Carter and Kandida Michel-Ross, both 36, also were charged in the case. Medicaid's mental health targeted case management services are designed to link up patients with mental health ...

Las Vegas man sentenced, fined for Medicaid fraud
July 17, 2014, Las Vegas, NV -- A Las Vegas man today received a suspended sentence and fined $30,000 for Medicaid fraud. Cornell Horn, 52, pleaded guilty to one gross misdemeanor offense of attempting to submit false information in a Medicaid application. District Court Judge Michael Villani sentenced Horn to 364 days in jail, suspended, and payment of $30,000 in restitution, penalties, and costs. “Prosecutions like these ensure that only individuals who are qualified enroll as Medicaid providers in order to deliver a skilled level of services to our State’s Medicaid recipients,” said Nevada Attorney General Catherine Cortez Masto. An investigation by the Nevada Attorney General’s Medicaid ...

Comp claimant caught bowling pleads guilty to defrauding insurer
July 16, 2014, Los Angeles, CA -- Workers comp claimant Ronald Fortune, 36, was working as a package handler for Golden State Overnight when he alleged an industrial injury and filed for workers compensation benefits. While adjusting the claim, LWP Claims Solutions became suspicious and referred the case to Probe Information Services, a California-based investigations company. Video surveillance conducted depicted Fortune participating in bowling games in which he displayed no evidence of an injury, according to Probe. Further, a search of social networking revealed online bowling scores which provided further evidence of Fortune’s participation in bowling games which he was off working collecting disability benefits. During a ...

Man in Florida charged with filing claim for phantom auto injuries
July 16, 2014, West Palm Beach, FL -- A West Palm Beach man faces a charge after the Division of Insurance Fraud said he filed false claims for more than $25,000, according to an arrest report. A woman hit Frank Assouman’s parked truck in Boca Raton in March causing more than $1,500 in damages to the vehicle, the report said. Assouman, 51, was not in the car at the time, according to the crash report and witness statement. But along with the car repairs, Assouman filed a claim to State Farm Insurance for $21,815 for injuries as a result of the crash, the report said. He also filed a claim ...

Insurance fraud raid in Florida nets 105 workers with false IDs
July 16, 2014, Naples, FL -- Investigators from the Department of Insurance found out of 168 employees at the Incredible Fresh or Fresh Fruit Dynamics, 146 employees had some sort of fraudulent identification. Of those, 27 were stolen identifications from Florida and 24 other states and included identifications from the dead. Of the 146 employees investigated, 105 were taken into custody and arrested for providing fake identification for employment purposes. Some of them may even be undocumented. Investigators were tipped by activities of one employee when he went to the doctor for a work-related injury. He confessed to his attorney that he was using a fake ...