News

Washington driver allegedly says prior damage is new hit-and-run
November 19, 2018, Everett, WA -- Brandalynn Monroe, 36, of Everett has been added to Insurance Commissioner Mike Kreidler’s insurance fraud most wanted after she failed to appear in Snohomish County Superior Court to face a felony charge of filing a false insurance claim. A bench warrant for her arrest was issued on and bail is set for $5,000. Monroe was charged on Nov. 9 in connection with filing a false insurance claim after an investigation by Kreidler’s Criminal Investigations Unit (CIU). According to the investigation, Monroe damaged her 2010 Ford Focus in a 2015 collision. At the time, her insurer, Omni Insurance Group, denied a ...

Coalition: More than 30 state fraud laws enacted in 2018
November 19, 2018, Washington, DC -- The introduction of new bills slows down during years when legislators tend to be more concerned with reelection. That’s why 2018 was such a surprise, according to Matthew Smith, director of Government Affairs and general counsel for the Coalition Against Insurance Fraud. On the state level, there was 116 new pieces of fraud-related legislation introduced, resulting in 33 new laws, he said. “There may still be a slight chance of a couple more slipping in before the ball drops in Times Square on New Years’ Eve,” Smith added. Patient brokering laws were passed in Arizona, Illinois, Utah and West Virginia. Workers’ compensation reform continued ...

New Hampshire warns against phony health insurers
November 19, 2018, Concord, NH -- The New Hampshire Insurance Department is advising consumers to be cautious when enrolling in an unfamiliar health plan. The Department strongly encourages all consumers to read the plan details and to ask questions about plan benefits and exclusions before enrolling. There are only three companies selling Affordable Care Act-compliant health plans in the New Hampshire Exchange Marketplaces: Ambetter, Anthem, and Harvard Pilgrim. Plans that are sold by a company other than these three may not be approved to be sold in New Hampshire, and may not include the same consumer protections and benefits as an ACA-compliant plan. Insurance fraud occurs when an ...

Mississippi priest says he informed on alleged cancer con
November 19, 2018, Jackson, MS -- A Jackson priest revealed in Mass over the weekend that he was one of the informants for the federal government fraud investigation of another priest. He's also asking why the Jackson diocese didn't alert authorities. At Mass on Saturday evening and Sunday morning at St. Richard Catholic Church, the Rev. John Bohn told parishioners that he was a "confidential informant" in the recent case involving the Rev. Lenin Vargas-Gutierrez, pastor of St. Joseph Catholic Church in Starkville. Bohn served as pastor at St. Joe in 2007 and 2013. A federal affidavit accuses Vargas of having knowingly devised schemes to obtain money ...

Dentist allegedly bills for unfinished work on Tennessee patients
November 19, 2018, Murfreesboro, TN -- A Murfreesboro dentist is facing federal health care fraud charges for operating a scheme to defraud health care benefits, the Department of Justice said. Richard N. Schott, 51, surrendered to U.S. Marshals in Nashville last week, according to a news release issued on Monday. Kendra L. Glenn, 43, of Hartwell, Georgia, and formerly of Murfreesboro, was arrested Monday morning at her home in Georgia. Schott was charged with conspiracy to commit health care fraud and Glenn was charged with seven counts of health care fraud and one count of conspiracy. Schott, a licensed dentist, owns and operates Dental Excellence in Murfreesboro and ...

Man allegedly burns Pennsylvania home, blames space heater
November 18, 2018, Houtzdale, PA -- A Houtzdale man has been charged with arson for burning down his own home. Cody Lynn Swanson, 26, was charged by state police with three counts of arson, criminal mischief, insurance fraud and recklessly endangering another person in connection to a fire at a West Hannah Street residence in Woodward Township, Clear­field County, on Jan. 2. Investigators discovered that the fire originated on and near a stairway leading to the second floor and it was ignited by a direct flame, according to the affidavit of probable cause. The home had been insured for $200,000. When Swanson was interviewed by police, he said the ...

Burlington Twp. doctor accused of taking part in prescription scam
November 16, 2018, Burlington Twp., NJ -- A South Jersey doctor is accused of prescribing expensive drugs to patients who did not need them — and apparently did not know about them. Dr. Bernard Ogon, 45, of Burlington Township, allegedly accepted payments from telemedicine firms to prescribe “exorbitantly expensive compounded medications,” according to the U.S. Attorney’s Office for New Jersey. The scam victimized healthcare benefits programs that ultimately paid for the unneeded drugs, the federal prosecutor's office said Friday. It alleged Ogon was paid $20 to $30 per prescription from one telemedicine firm, and caused more than $20 million in losses to benefit programs. “The telemedicine companies sent Ogon prescriptions to ...

Florida pharmacy owner sentenced to prison for conspiracy to illegally distribute Hydromorphone and Oxycodone
November 16, 2018, Tampa, FL -- Joseph Owusu, 63, of Tampa, was sentenced November 14 to 135 months in prison after pleading guilty on August 17. The sentence was announced by Christopher P. Canova, United States Attorney for the Northern District of Florida. Co-conspirators Abbisina Hepburn, 39, and Damian Hepburn, 41, both of Miami Gardens, pleaded guilty on August 10. Co-conspirator Angela Denise Clark, 48, of Sebring, Florida, was charged in the Hepburn superseding indictment and pleaded guilty on October 22, 2018. All four defendants pleaded guilty to conspiracy to distribute and possess with intent to distribute hydromorphone (Dilaudid) and oxycodone. Additionally, the ...

LoJack signal uncovers suspected auto ring in California
November 16, 2018, Sacramento, CA -- Detectives from the California Department of Insurance, arrested four people early this morning for allegedly ripping off four auto insurers for more than $34,000 by filing fraudulent insurance claims. One additional suspect was taken into custody Thursday, November 15, 2018. All suspects were booked into the Sacramento County Jail. Investigated by the Urban Auto Fraud Task Force, which is supervised and led by the California Department of Insurance Enforcement Branch and includes the California Highway Patrol and Sacramento County District Attorney’s Office, which will prosecute the suspects, the case involves suspects attempting to collect from their auto insurer by ...

New Jersey doc arrested for alleged $20M telemed ring
November 16, 2018, Burlington, NJ -- A Burlington, New Jersey, man was arrested Friday for his role in a telemedicine scheme to prescribe expensive compounded medications to patients who did not need them, U.S. Attorney Craig Carpenito announced. Dr. Bernard Ogon, 45, is charged by complaint with one count of conspiracy to commit health care fraud. He made his initial court appearance this afternoon before U.S. Magistrate Judge Joseph A. Dickson in Newark federal court and was released on $500,000 secured bond. According to documents filed in this case and statements made in court: Telemedicine allows health care providers to evaluate, diagnose, and treat patients remotely – without the ...

Missouri doc bills for dates he was out of the U.S., forges records
November 16, 2018, St. Louis, MO -- Dr. Vidal Sheen, 58, St. Louis County, Missouri, was sentenced today to two years’ probation, after previously pleading guilty to obstructing an investigation by the Federal Bureau of Investigation (“FBI”) regarding whether he billed the Medicare program and private insurers for “face to face” office visits performed on dates when he was actually traveling outside of Missouri, and sometimes traveling outside of the United States. The Court further imposed a fine of $45,000 and restitution in favor of Medicare and several private insurance companies in the total amount of $142,053, which he has paid in full. According to his ...

Alleged no-fault ring inflates crash injuries in Brooklyn
November 15, 2018, Brooklyn, NY -- Attorney General Barbara D. Underwood today announced a 61-count indictment charging David Safir, 48, of Brooklyn; Dr. Alexander Haselkorn, 78, of Franklin Lakes, NJ; Roberta Haselkorn, 61, of Franklin Lakes, NJ; attorney Nadezdha Ursulova, 63, of Brooklyn; and Theron Grinage, a.k.a. Timothy Russell, 52, of Brooklyn for their alleged participation in an auto insurance fraud scheme that cheated no-fault insurance carriers out of hundreds of thousands of dollars. Code-named “Operation Dr. Know,” a joint investigation by the Attorney General’s Auto Insurance Fraud Unit and the New York City Department of Investigation revealed that Safir, aided by his co-conspirators, allegedly illegally ...

Bar owner lies about payroll to avoid premiums in California
November 15, 2018, Monterey, CA -- Salvatore Carbone, 58, pleaded no contest to insurance fraud and will serve 40 days in Monterey County Jail. Carbone, a Sand City resident, has owned and operated Sal’s Alley Side Cafe and Carbone’s Bar in Monterey since 2007. The Workers’ Compensation Fraud Unit at the Monterey County District Attorney’s Office received a tip in June 2017 that Carbone had presented to his workers’ compensation carrier — State Compensation Insurance Fund — that he had no employees for the insurance policy period of August 2014 through August 2015. Investigators with the District Attorney’s Office obtained business and payroll records and interviewed Carbone, his ...

Detroit clinic prescribes opioids with few exams, fake patients
November 15, 2018, Detroit, MI -- An indictment was unsealed today charging Dr. Otis Leon Crawford, D.O., and two other individuals with conspiracy to illegally distribute prescription drugs, U.S. Attorney Matthew Schneider announced today. Schneider was joined in the announcement by Special Agent in Charge Timothy Plancon of the Drug Enforcement Administration, Detroit Division and Special Agent in Charge Lamont Pugh, of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office. Charged in the indictment are: Otis Leon Crawford, 80, of Detroit Debbie Ann Taylor, 37, of Detroit Earnie Ronnie-Jaew Taylor, 49, of River Rouge The indictment alleges that in July of 2016, Dr. Crawford ...

Pennsylvania ambulance firm allegedly adds crony to health plan
November 14, 2018, Morrisville, PA -- Two former officials from the now-defunct Morrisville Ambulance Squad have been charged with stealing some $130,000 through the misuse of company bank accounts and insurance fraud. Ex-chief Brian Michael Eckert, 41, of Falls, and former operations supervisor Ruth “Roxy” Rookstool, 58, of Morrisville, each were charged Nov. 8 with multiple felony counts of theft, receiving stolen property, identity theft, forgery, various computer crimes and criminal conspiracy, as well as misdemeanor counts of insurance fraud. Bucks County Detectives, alerted to allegations of theft by members of the ambulance squad, began investigating in July and determined Eckert and Rookstool used company credit cards and ...

Former New York fire fighter accused of setting home afire
November 14, 2018, Stockport, NY -- A former volunteer firefighter was charged Wednesday in connection to allegedly setting fire to his house in October 2017 for $1 million in insurance. Barry Goldstein, 74, of Stockport, was arraigned in Columbia County Court on charges of first-degree insurance fraud, a class B felony; third-degree arson, a class C felony; and first-degree reckless endangerment, a class D felony. Goldstein is suspected of setting fire to his home at 290 Route 25 in Stockport on Oct. 1, 2017, for insurance funds, which put neighbors and firefighters at risk. Goldstein, via his attorney Roy K. Nestler, of Delmar, pleaded not guilty to the charges ...

Detroit home-health owner gets 13-plus years for $8.9M plot
November 14, 2018, Detroit, MI -- The owner of two Detroit-area clinics was sentenced to 160 months in prison today for her role in a scheme involving approximately $8.9 million in fraudulent Medicare claims for home health care and other physician services that were procured through the payment of kickbacks, were not medically necessary, were not actually provided, or were provided by an unlicensed physician. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Special Agent in Charge Timothy Slater of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of ...

Michigan man up for parole in crash murder of business partner
November 14, 2018, Spring Lake, MI -- For Chris Kunkel the memories come back to him like snapshots. Bursts of illumination paint the saddest pictures he's dreaded to see. Chris was 15-years-old when he was told his father died in a car crash. "It was really a shock," Kunkel told 13 ON YOUR SIDE. "It was such a blow to my system." On the afternoon of February 4, 1991 a car left Leonard Road in Polkton Township and slammed into a tree. Kenneth Kunkel, a well known businessman, was pronounced dead on scene. His business partner Ronald Redick was transported to the hospital with minor injuries. From his hospital ...

42,000 customers affected by Health First data breach
November 13, 2018, Brevard County, FL -- Personal information of about 42,000 Health First customers may have been compromised by email scammers. Health First officials told FLORIDA TODAY on Monday the data breached was fairly low-level, though it could have included some customers' Social Security numbers. Mostly it appears to have involved information such as addresses and and birth dates. No medical information was compromised. Health First has arranged to have AllClear ID — an identity protection services company — to guard impacted customers’ identities for a year for free. Health First said the AllClear ID includes identity theft monitoring and identity repair if needed. "We apologize for this breach ...

Federal Trade Commission freezes health insurance scam
November 13, 2018, Washington, DC -- Exit polls from last week’s election indicate that health care was the number one issue for voters. These findings suggest that consumers are still struggling to find adequate and reliable health care insurance coverage. Health care has been an ongoing issue amongst policymakers and lawmakers alike for quite some time and this is no shock to the general public. Unfortunately, however, as scammers have caught onto consumer’s desperation in finding coverage: the FTC is warning people to be cautious. The Federal Trade Commission has recently secured a court order temporarily shutting down an insurance scam operation that was based out of Florida. ...

Iowan lies he was robbed of cash, valuables at gunpoint
November 13, 2018, Des Moines, IA -- Dustin K. Barnhill, age 27, of Des Moines, was sentenced to five years suspended prison sentence, two years of supervised probation and $750.00 fine after pleading guilty in Polk County District Court to the charge of Insurance Fraud (Fraudulent Submissions), a Class “D” Felony. Barnhill was originally charged after an investigation conducted by the Iowa Insurance Division’s Fraud Bureau concluded that Barnhill falsified a renters insurance claim seeking insurance proceeds. Barnhill claimed to have been robbed at gunpoint of nearly $5000.00 of cash and valuables by two unknown men in the parking lot of a Des Moines area grocery store in ...

Coalition: Robocalls raining down on consumers in health cons
November 13, 2018, Washington, DC -- Health insurance scams continue to a big problem. In one month, a software company, reported more than 400 million robocalls related to health insurance. “Robocalls are raining down on consumers and epic numbers right now,” explained James Quiggle with the Coalition Against Insurance Fraud. “They’re peddling fake health insurance of water down juke coverage that’s not worth the paper it’s printed on.” It’s making for a dangerous time for people shopping for health insurance during open enrollment happening now . Quiggle said no one is safe. Scammers are targeting both millennials and seniors. "Millennials are young and new to the healthcare market and ...

Couple posing as agents bang on door of South Carolina couple
November 13, 2018, Salters, SC -- Citizens need to be on the lookout for a couple posing as insurance agents. A homeowner in the Salters area alerted law enforcement Monday morning regarding a black man and woman asking to enter her home to talk about her insurance. According to the homeowner, the pair banged on the door several times before the owner answered. She did not open the door but asked what they needed. The man claimed he was with a specific insurance company and said the owner had made an appointment. The man asked the owner several times to open the door so they could come ...

Unqualified doc writes med evaluations about California patients
November 13, 2018, Menifee, CA -- A Menifee physician who billed insurance companies for bogus work and lied about his license status was sentenced on Tuesday, Nov. 13 to five years felony probation and ordered to complete 100 hours of community service. Dr. Benjamin Gould Cox, 87, was convicted by a Riverside jury last month of seven counts each of insurance fraud and perjury. Riverside County Superior Court Judge Thomas Glasser imposed a low-end sentence because Cox has no prior convictions. The defendant was facing a maximum of 18 years in prison. In addition to probation and community service, the judge ordered Cox to pay victim restitution, in an ...

Californian allegedly drives car off dock, drowns autistic kids
November 13, 2018, Hawthorne, CA -- A Hawthorne man is accused of fraud after collecting the life insurance policies of his two sons who died when he drove off a dock at the Port of Los Angeles in 2015, officials said. Ali Elmezayen, 44, is believed to have intentionally driven off a dock in San Pedro on April 9, 2015, two years after he bought the last of his insurance policies, according to the United States Attorney Central District of California. His two sons, who were 8 and 13 and had severe autism, died. His domestic partner and the children's mother, Rabab Diab, was rescued after a nearby ...