News

Kate Donachie: Fraudulent claims – are England and Scotland moving in different directions?
January 21, 2019, Scotland, -- In a time of significant change to the civil litigation system, the approach to fraudulent exaggeration of insurance claims is diverging North and South of the border. This combination of developments may lead to a perfect storm for fraudulent claims in Scotland, writes Kate Donachie. In England and Wales, the treatment of fraudulent cases is set out in statute; in Scotland the courts are bound to interpret and apply the common law. Recent cases put the consequences of those different approaches into sharp focus. In England and Wales, section 57 of the Criminal Justice and Courts Act 2015 requires the courts to ...

Chiropractor, insurance agents to be charged for insurance fraud
January 21, 2019, Singapore, -- Two men and a woman will be charged on Tuesday (Jan 22) for allegedly cheating an insurance company by submitting fake accident claims, said the Singapore Police Force. On Mar 20 last year, the Commercial Affairs Department launched an investigation against the male chiropractor and both insurance agents, aged between 27 and 36. The trio allegedly abetted the submission of false personal accident claims for treatment received at the chiropractor’s clinics, which were located in Tampines and Tanjong Pagar. According to investigations, between June 2017 and March 2018, the trio were believed to have conspired with one another, said police. They instigated ...

Emergency depts seeing up to six fraudulent accident cases each week, doctor claims
January 21, 2019, Dublin, -- Emergency medicine expert Dr Chris Luke claims that staff in emergency departments in Ireland see between one and six fraudulent accident claimants every week. “I would be surprised if they don’t see at least one fabricated or exaggerated case every week,” he told RTE’s Today with Sean O’Rourke show. He said there were three hallmarks of such cases – mystery, misery and massive expense. Such cases usually involve a person “screaming blue murder” at the scene, but the absence of any injury. He said that in his experience the louder the noise at the scene, the less there is to see in the ...

Insurance: Hospitals see false accident claims every week, says A&E doctor
January 21, 2019, Dublin, -- Emergency medicine expert Dr Chris Luke claims that staff in emergency departments in Ireland see between one and six fraudulent accident claimants every week. “I would be surprised if they don’t see at least one fabricated or exaggerated case every week,” he told RTÉ’s Today with Sean O’Rourke show. He said there were three hallmarks of such cases: mystery, misery and massive expense. Such cases usually involve a person “screaming blue murder” at the scene, but the absence of any injury. He said that in his experience the louder the noise at the scene, the less there is to see in the form of ...

Monticello man charged with Medicaid fraud
January 21, 2019, Monticello, NY -- In a continuing investigation into the misuse of Medicaid transportation services, the Sullivan County Welfare Fraud Task Force has arrested Carl M. Wolkoff, age 57, of Monticello. Wolkoff was charged on Jan. 17 with the felony of offering a false instrument for filing and the misdemeanor of theft of services. Police allege that Wolkoff used Medicaid transportation over the last five years as a personal taxi service instead of for its intended use to make doctor visits. Officials believe that Wolkoff racked up approximately $10,000 in fraudulent Medicaid charges. Task force members were waiting for Wolkoff at his residence at about 3:00 ...

Two accused of insurance fraud in Henderson
January 21, 2019, Henderson, NV -- On Monday, police in Henderson served a warrant at a residence in the 900 block of Villagebrook Dr. The warrant stemmed from an investigation which started on December 8. Estella Goodfellow, 66, was arrested on charges of fraudulent insurance acts over $500 and falsely reporting an incident. Dustin Ross, 30, was found hiding in a dryer, police said. Ross was arrested on charges of fraudulent insurance acts over $500, tampering with physical evidence, falsely reporting an incident, and driving DUI suspended license. Police said 27-year-old Jailynna R. Snyder was arrested on a charge of hindering prosecution or apprehension-2nd degree. ...

Ohio trucker claims injury, works as sand blaster on side
January 21, 2019, Zaneville, OH -- A local truck driver will have to return nearly $8,000 in worker's comp benefits he collected while working under the table. Douglas J. Krouskoupf, 53, of Zaneville pleaded guilty in Franklin County Common Pleas to a first-degree misdemeanor of workers compensation fraud. In addition to paying the Ohio Bureau of Workers Compensation $7,924 in restitution, Krouskoupf was sentenced to 180 days in jail. The charges were filed following a BWC investigation. “We found Mr. Krouskoupf working for his brother’s sandblasting business on multiple occasions and that he was also driving a semi-truck while collecting BWC benefits,” said Jim Wernecke, director of BWC’s special ...

Injured New York state employee allegedly works as cabby
January 21, 2019, Monsey, NY -- A state employee with a side taxi business and outside jobs in local municipalities was arrested on charges that he engaged in several fraudulent activities resulting in his theft of more than $100,000 in workers’ compensation benefits and Medicaid payments. Raphael Ziegler, 41, of Monsey, who is a fire protection specialist with the state Division of Homeland Security and Emergency Services, was charged with grand larceny, insurance fraud, two counts of falsifying business records and two counts each of workers compensation crimes of failure to secure compensation and fraudulent practices, all felonies. The charges allege Ziegler worked several side jobs and a ...

NHA ropes in five analytics firms to detect fraud in health scheme
January 20, 2019, New Delhi, -- TAKING A cue from the fraud detection mechanisms of Medicare and Medicaid in the United States, the National Health Agency (NHA) has engaged five analytics firms as part of a pilot scheme to detect fraud in the Pradhan Mantri Jan Arogya Yojana (PMJAY). The company which detects the most frauds over a six-month period will get the job after a tendering process, according to sources. The five firms, shortlisted from among 24 applicants, which are currently collecting their “proof of concept” data are SAS Institute, MFX, Optum, LexisNexis Risk Solutions Private Ltd and Greenojo — the last is a startup. Since January ...

Charlie Weston: 'High time we stopped passing the buck and clamped down on insurance fraudsters'
January 20, 2019, London, -- The fraudsters will be delighted. The decision not to set up a dedicated Garda insurance fraud unit will mean the dodgy claims can continue and the easy money will keep flowing for the claimsters. That is the conclusion that is hard to escape after plans for insurers to fund a new Garda unit to tackle claims fraud were knocked on the head by the Garda Commissioner and the minister responsible for insurance reform. Minister of State Michael D'Arcy said that funding of a Garda insurance fraud unit by the insurance industry "won't be happening". He said he met Garda Commissioner Drew Harris ...

Police: Meth baggies found in possession of woman trying to fake prescription
January 20, 2019, Washington City, UT -- Authorities in Washington City say a woman who was trying to fraudulently acquire prescription medication was also found to be in possession of methamphetamine that appeared to be prepared for sale. The woman, 52-year-old Jacquelyn D. Chavez, of San Jacinto, California, was arrested by Washington City Police officers outside of a grocery store Wednesday on charges of fraudulent prescription activity and drug distribution. Earlier in the week, police were dispatched to the Albertsons store on Red Cliffs Drive after a family clinic in Orem called police in Southern Utah to report a fraud being committed at the Albersons pharmacy. The clinic was alerted ...

Coalition: Social media a prime tool for catching fraudsters
January 20, 2019, Washington, DC -- We know we should be careful with what we post on social media. Who knows who might be looking? It turns out, your insurance company might be. What you post could be used when you file an insurance claim. It happened in the Valley back in October 2015. Court records show, a Valley man wrecked his $60,000 Corvette. He filed an insurance claim, stating he crashed it on an Interstate 10 off-ramp. But a YouTube video posted by a local photographer shows what really happened. In that video, a white Corvette sits on the start line of a drag strip, about to race ...

Man gets 3 years in prison for role in Norwalk meth lab
January 20, 2019, Norwlak, CT -- Brandon W. Henderson, 35, also was fined $250 for one count each of illegal assembly or possession of chemicals for the manufacture of meth, trafficking in meth and attempted intimidation of a witness in a criminal case. As part of a plea deal in November, prosecutors dismissed one count of attempted illegal manufacture of meth. Two of Henderson’s convictions are for a Feb. 15 incident on Cline Street handled by the Norwalk Police Department special response team (SRT). The meth-related drug raid closed Cline from League to Fruen streets. While at the scene, authorities placed two children, ages 7 and 13, in ...

Kathleen M. Kleuskens sentenced to 21 months in prison for Medicaid fraud and related charges
January 20, 2019, Riley County, KS -- A Riley County nurse has been sentenced to 21 months in prison after being found guilty of Medicaid fraud and related charges in three Kansas counties, Attorney General Derek Schmidt said. Kathleen M. Kleuskens, 57, of Ogden, entered pleas and was found guilty in October of a total of 10 charges filed by the attorney general’s office in Clay, Geary and Pottawatomie counties. Earlier this month, Clay County District Judge John F. Bosch sentenced Kleuskens to 20 months in the Department of Corrections and Geary County Senior District Judge Robert J. Fleming sentenced Kleuskens to 21 months in the Department ...

Viral video claims to expose Bajaj Allianz scam against Maharashtra farmers
January 19, 2019, New Delhi, -- A video, in which a former employee of Bajaj Allianz Life Insurance is claiming that the company is indulging in fraud against farmers, is going viral. Former employee Yogesh Shelke shot the video. Shedding light on video he wrote, "How the insurance company is indulging in fraud." Shelke has given out his phone number as well and has asked people to share the video in order to expose the scam. Shelke alleged that in Maharashtra, Bajaj Allianz has a tie-up with local banks. The banks are given business targets for Bajaj Allianz. According to Shelke, if the targets are met then as an ...

Kellogg police close nearly 40-year old homicide case
January 19, 2019, Kellogg, ID -- Kellogg Police Chief Dave Wuolle believes that his agency, along with the help of Idaho State Police, have put to bed a nearly 40-year-old unsolved murder case. Unfortunately, the suspected murderer is no longer alive. On Aug. 7, 1980, former Panhandle Dry Cleaners owner Donald Folkman was shot with a 22. caliber pistol in the upstairs room of his business. KPD discovered Donald after his then-wife, Fizzy Folkman, ran to the Kellogg Police Station and frantically reported the incident. The North Idaho Press reported on Aug. 7 that “details of the shooting were sketchy and police said there were no witnesses.” Early investigation ...

Doc writes scripts for Connecticut patients she never saw
January 19, 2019, New Haven, CT -- A physician pleaded guilty Friday in U.S. District Court in New Haven to a count of conspiracy to commit health care fraud — in an alleged scheme with her husband to defraud Connecticut’s state-employee prescription benefit plan, as well as other government health programs, by submitting prescriptions for very expensive “compound medications” produced by a Mississippi-based pharmacy in 2014 and 2015. Dr. Kakra Gyambibi, 38, entered the plea before U.S. District Judge Jeffrey Meyer under an agreement with the office of U.S. Attorney John H. Durham that 18 other criminal counts against her would be dropped. Sentencing was set for April ...

Home-health owner allegedly steals $11M in New York
January 19, 2019, Brooklyn, NY -- The CEO of a New York home health aide company has been accused of embezzling $11 million from Medicaid to fund a lavish lifestyle with her NYPD cop husband. Farrah Rubani, 51, was arrested on December 18 on a first-degree grand larceny charge in an alleged scam to submit false claims through her Brooklyn-based company Hopeton Care. The New York Attorney General's office claimed in a civil suit that Rubani and her partners billed New York State Medicaid for home care for children when was none provided, then paid the kids' parents to stay quiet, the New York Daily News reported. 'Rubani misrepresented ...

Sheriff’s office warns of potential insurance scam
January 18, 2019, Decorah, IA -- A man dressed in a snowmobile jacket, shiny dress shoes or cowboys boots is going door-to-door asking questions about your insurance. According to the Winneshiek County Sheriff’s office, a male subject has been reported inquing about insurance needs and previous claims. Witness reports indicate the male drives a car with a loud muffler. The sheriff’s office is reminding residents to ask for ID and don’t give out personal information. If you have any additional information, contact the sheriff’s office or if you feel in danger call 911. ...

Health-care sector is far too vulnerable to cybersecurity threats
January 18, 2019, Washington, DC -- The digitization of health care promises to be transformative for patients and medical practitioners alike. New technologies and techniques — including big data, machine learning and artificial intelligence — are already helping to make health-care delivery more efficient, effective and less expensive. In spite of this vast potential, though, there exists a serious challenge that hospitals and health-care organizations have not yet managed to overcome: keeping patients’ personal data out of the hands of hackers. Health care suffered more breaches last year than any other industry, according to the Verizon Data Breach Investigations Report. As a result, personally identifiable information was ...

California deputy sets car on fire for insurance
January 18, 2019, Fresno County, CA -- A former Fresno County sheriff’s deputy was sentenced Friday to time served in jail for attempting to commit insurance fraud. Sher Moua, a deputy sheriff for 18 years, last year pleaded no contest to one count of making a false or fraudulent claim after setting his car on fire to collect the insurance money. Three related charges were dropped. Judge David Gottlieb on Friday placed him on probation. He ordered Moua to stay away from alcohol, attend a substance abuse training program, and said he cannot possess weapons. Moua spent 60 days in jail, including for failing to appear in court for sentencing ...

South Carolina man falsely claims injuries in 2 crashes
January 18, 2019, Sumter, SC -- A 29-year-old Sumter has been sentenced to two years in prison after being charged with insurance fraud and third-degree burglary on Thursday, according to Attorney General Alan Wilson. Arthur Goodman submitted two fraudulent insurance claims in 2017. The first claim was submitted after Goodman was involved in a collision in Sumter County in April 2017. After going to a local hospital, Goodman submitted a claim for his alleged injuries, which was later flagged as suspicious. Two months later, Goodman claimed to be involved in another collision that took place on Interstate 20. He submitted a claim to a different insurance company in ...

Unlicensed Florida adjuster charged with falsely filing liens
January 18, 2019, Tallahassee, FL -- An unlicensed insurance adjuster has been arrested over unlicensed public adjusting activities and the filing of false and fraudulent liens on individuals’ homes following Hurricane Irma, according to a statement from the Florida Department of Financial Services. Chief Financial Officer (CFO) Jimmy Patronis reported Mary Bruce is accused of stealing $14,000 in total from homeowners. Following Hurricane Irma in September 2017, DFS investigators discovered that Bruce approached roofing companies and homeowners in Central Florida and falsely identified herself as a “claims manager.” Bruce is alleged to have told homeowners she could increase prior hurricane insurance claim settlements up to $30,000, but would require ...

Ohio bar owners buy comp coverage — after being charged
January 18, 2019, Middletown, OH -- The owners of a Middletown bar recently entered guilty pleas to disorderly conduct after being charged with Workers Compensation Fraud. The Ohio Bureau of Workers Compensation’s Employer Fraud Team received an allegation from the BWC Employer Compliance Department detailing their attempts to work with the employer, Old Crow Bar, 1217 Jackson Lane, to establish coverage with a BWC policy in order to become compliant with state law. Ohio law requires employers with one or more employees to obtain workers’ compensation coverage. Noncompliant employers are responsible dollar for dollar for claim costs incurred during a non-covered period. BWC officials said because the employer failed ...

Son shoots father for life insurance in California
January 18, 2019, Antioch, CA -- An Antioch man was sentenced Friday to 50 years to life in prison for the June 2016 shooting death of his father in what prosecutors had said was part of a plan to secure money from a life insurance policy. Because of an enhancement for using a firearm in committing first-degree murder, 24-year-old Scott Eastman will serve a minimum of 25 years before he is eligible for parole. In handing down the sentence, Contra Costa County Superior Court Judge Anita Santos noted the "gravity and planning" that went into the June 25, 2016 shooting of 43-year-old Relis Eastman in their ...