News

23 charged in New York with exploiting homeless to ripoff Medicaid
April 01, 2015, Brookland, NY -- New York City authorities have charged nine doctors and 14 others in a Medicaid scam they say exploited down-and-out people who needed new shoes. Brooklyn District Attorney Ken Thompson announced the arrests Tuesday following an undercover investigation that began in 2012. Prosecutors say the defendants were part of a ring that recruited people outside homeless shelters, soup kitchens and welfare centers. They say the recruits were directed to clinics where corrupt physicians diagnosed phony ailments. In return, they got their pick of cheap, off-brand sneakers, shoes and boots. Authorities say the ring billed Medicaid for nearly $7 million in unnecessary medical tests and devices ...

Insurance agent in Florida accused of filing false health claims
March 31, 2015, Vero Beach, FL -- The Florida Department of Financial Services’ Division of Insurance Fraud today announced the arrest of Jessica Gianna for filing nine fraudulent health insurance claims between May 2012 and January 2014. Gianna filed the fraudulent claims on behalf of herself and a family member while employed at a Vero Beach insurance company. Gianna’s position at the insurance company allowed her the opportunity to usher fraudulent claims through the process without raising suspicions. Before the insurance company’s internal investigative unit became aware of the theft and notified the Division of Insurance Fraud, Gianna secured more than $6,000 in fraudulent claims payments. ...

Hospital system in Ohio to pay $10M to settle kickback charges
March 31, 2015, Portage County, OH -- Robinson Health System Inc. has agreed to pay $10 million to settle claims that it violated the False Claims Act, the Anti-Kickback Statute and the Stark Statute by engaging in improper financial relationships with referring physicians, the Justice Department announced today. Robinson is a nonprofit corporation based in Ohio that operates a number of health care facilities in Portage County, Ohio, including Robinson Memorial Hospital. “The Department of Justice has longstanding concerns about improper financial relationships between health care providers and their referral sources, because such relationships can alter a physician’s judgment about the patient’s true health care needs ...

Agent in California accused of stealing $500K from agency clients
March 31, 2015, Los Angeles, CA -- A licensed insurance broker-agent is accused of stealing more than $500,000 from programs managed by his employer, including $100,000 from the Los Angeles Unified School District, the California Department of Insurance reported. Arthur Cade, 60, controlled funds for DACM Project Management, which, among other programs, disbursed to LAUSD’s rewards and recognition program, established to influence safe behavior and management on new construction sites for the district, the Department of Insurance said in a statement. Cade allegedly stole more than $100,000 from the school district program and $400,000 from other funds run by DACM, according to insurance officials. The theft was uncovered after ...

Six years in prison for owner of ambulance company in Philadelphia
March 31, 2015, Bucks County, PA -- The owner of a Bucks County ambulance company was sentenced to six years in prison Tuesday after pleading guilty for his role in defrauding the Medicare program. Nazariy Kmet, 37, of Jamison, Pa, was co-owner and the president of Life Support Corp., an ambulance company in Feasterville, Pa. Kmet pleaded guilty in November to health care fraud conspiracy and paying kickbacks. The U.S. Attorney’s Office had earlier charged Life Support of Feasterville, Pa., and its owners and a manager with transporting patients who were ineligible for ambulance services under Medicare rules because they could travel safely by other means to medical appointments. ...

Michigan police checking license plates to see if drivers have coverage
March 31, 2015, Lansing, MI -- You don't have to be speeding to get pulled over. A quick check of your license plate could land you in jail. "Now we can see that you do or don't have insurance," said Michigan State Police legislative liaison Amy Dehner. It's called electronic insurance verification. Here's how it works, while you're driving the officer types in your license plate number and it shows them whether or not you have insurance. "This is the first step in a series of larger things that are designed to fight auto insurance fraud," Dehner said. She says this is part of their plan to bring down insurance rates. "We have ...

Army veteran in Kentucky accused of faking disability to get benefits
March 30, 2015, Olive Hill, KY -- An Olive Hill Army veteran has been charged with cheating the U.S. Department of Veterans' Affairs out of about $800,000 in compensation and benefits since 1995. A federal grand jury indicted Phillip M. Henderson on nine counts of wire fraud, according to the office of the U.S. Attorney for the Southern District of West Virginia. Henderson, 50, is accused of faking vision problems to be eligible for disability benefits, according to the indictment. The alleged fraud netted Henderson about $800,000, including the money to buy a car and install a swimming pool, according to the indictment. In the alleged scheme outlined in the indictment, ...

Postal worker in Baltimore sentenced to prison for workers comp fraud
March 30, 2015, Baltimore, MD -- A former Postal Service worker was sentenced to 18 months in prison for defrauding the government out of hundreds of thousands of dollars in disability and food assistance payments. Colette Lee, from Baltimore, will also have to pay back $244,912 in workers compensation and nutrition assistance benefits to the Postal Service and the Agriculture Department, according to the Justice Department. "Taxpayers foot the bill for phony disability claims by government workers," said U.S. Attorney Rod J. Rosenstein. "Postal employee Colette Lee filed a fraudulent disability claim in 2007 and kept the scam going for seven years until she was caught. This case ...

Nurse in Ohio who allowed disabled patient to die charged with fraud
March 30, 2015, Dayton, OH -- A nurse serving a 10-year prison sentence after a 14-year-old cerebral palsy patient in her care starved to death in 2011 now faces additional charges for Medicaid fraud, officials said. Mollie Parsons, 45, was supposed to provide daily care for Makayla Norman, who weighed 28 pounds when she died on March 1, 2011. Norman’s body was covered with filth and open bedsores, her hair and eyebrows infested with lice and her diaper hadn’t been changed for some time, according to Dayton police. She couldn’t speak, move or feed herself. In all, five people were prosecuted for various crimes connected to Norman’s death, ...

11 in Pennsylvania charged in automobile damage scam
March 30, 2015, Darby, PA -- The owner of a Darby Borough auto body shop was among 11 people charged Monday in an alleged $85,000 insurance fraud scheme that involved damaging vehicles with a fork lift to falsely inflate claims. Franklin Thomas Wilson, owner of Transformer Collision Specialist at 1006 Summit St., would allegedly meet with customers seeking body work on their vehicles and provide them with an estimate, according to a 30-page criminal complaint and affidavit of probable cause written by County Detective Lawrence Patterson. After the customer departed, Wilson, 45, of the 100 block of Betsy Rawls Drive in Wilmington, Del., would allegedly take the vehicle ...

Man in Alabama charged with reporting impounded motorcycle stolen
March 30, 2015, Morris, AL -- A 39-year-old Morris man is facing up to 20 years in prison after he allegedly filed an insurance claim on a motorcycle impounded by the Birmingham Police Department. The Pelham Police Department arrested Johnny Matthew Dollar, who lists an address on Maderia Circle in Morris, on March 27 and charged him with one felony count of first-degree insurance fraud. According to his arrest warrant, Dollar “intentionally and knowingly … filed a claim with Geico Insurance Co. stating that the motorcycle in question had been stolen, but in fact it had been impounded by the Birmingham Police Department.” The warrant lists a Nov. 8, ...

Maine man charged with torching his grocery store
March 30, 2015, Belfast, ME -- Belfast grocery owner charged with arson The co-owner of Goose River Grocery in Belfast has been arrested and charged with arson and insurance deception, nine months after the store was destroyed in a fire. The Bangor Daily News reported that Kyle Skinner, 35, was arrested as part of an ongoing investigation by Belfast police, the federal Bureau of Alcohol, Tobacco and Firearms, the National Insurance Crime Bureau and the Maine State Police Computer Crimes Unit. Skinner also was charged with theft by deception and more charges are expected. Goose River Grocery caught on fire on July 15, 2014, and was declared a "total ...

Ethnic mobs that have diversified continue to drive organized crime, FBI says
March 30, 2015, Trenton, NJ -- Organized crime is alive and well in New Jersey, despite ongoing efforts by law enforcement, in part because there are so many criminal enterprises from all over the world operating in the Garden State. According to the FBI’s Newark Division, crimes in New Jersey are being committed by organized crime groups that span the globe including: La Cosa Nostra, also known as the Sicilian Mafia, Asian groups, African criminal enterprise groups and the Russian and Eurasian mobs. New Jersey is also seeing crime activity from Balkan organized crime groups, which includes people who emigrated from Albania, Macedonia and Yugoslavia. In addition, ...

Women in North Carolina charged with inflating home fire loss
March 29, 2015, Surry County, NC -- A Surry County woman has been charged with insurance fraud for allegedly inflating the loss from a fire at her home last year. The arrest of Amanda Nicole Anderson, 39, of 720 Shoals Road, Pinnacle, was announced Wednesday by state Insurance Commissioner Wayne Goodwin. She is charged with one count each of insurance fraud and attempting to obtain property by false pretense, both of which are felonies. Criminal investigators with the N.C. Department of Insurance accuse Anderson of presenting false documents for an insurance claim related to an Aug. 29, 2014, fire. It occurred at her previous residence at 1530 Pinnacle Hotel ...

Key developments in insurance fraud this week
March 27, 2015, Washington, DC -- The governor of Kentucky placed his signature on anti-fraud legislation, giving fraud fighters in the state a new tool to go after auto BI scams. There also was a major win in New Mexico this week, according to today's edition of Fraud New Weekly. Legislation out of New York this week on auto insurance scams has fraud fighters hopeful. The Coalition newsletter also includes several major cases that broke this week, including a contractor who was busted from a tip the AG received after giving a talk at the local senior center. Other cases include details of the businessman busted in ...

Contractors in California convicted of failing to buy comp coverage
March 27, 2015, La Mesa, CA -- Three executives of a La Mesa-based firm that buys and renovates homes for resale were sentenced Thursday to three years probation and ordered to pay $290,000 to the 8-month-old son of one of their workers, who died in a tree-trimming accident. David Scott Wolfe, 48, and his company, Three Frogs Inc., along with Chief Financial Officer Jonathan D. Cox and Chief Operating Officer John Murphy, were charged last year with tax and insurance fraud counts. Wolfe was also charged with a violation of OSHA safety standards in connection with the Nov. 12, 2013, tree-trimming accident that killed Joshua Pudsey, 42. He was ...

Fostering Fraud
March 27, 2015, Lansing, MI -- Adult daycare centers or adult foster care homes provide specialized programs and a place to live for developmentally disabled or mentally ill individuals who are no longer able to care for themselves in their own homes. The idea behind the concept is to have residents live in a safe and caring family-like environment while receiving assistance that helps them to live as independently as possible. An article posted on mlive.com tells about two Michigan men who took advantage of residents living in adult care homes in order to bilk Medicare of $1.6 million. The story states that one of the perpetrators ...

Soldier in Georgia convicted of killing his brother-in-law for $500K in insurance
March 26, 2015, Fort Stewart, GA -- Carl Swain has been found guilty on all counts in the murder of a Ft. Stewart soldier. Swain, the victim's brother-in-law, faces a maximum of life in prison for the death of 29-year-old specialist John Joseph Eubank. Swain's sister, Lillie Eubank, allegedly admitted to investigators the murder was part of a plan to collect her husband's $500,000 life insurance policy. She is also charged. Swain will be sentenced within the next three months. ...

Feds convict two medical suppliers in California for $6.8M wheelchair scam
March 26, 2015, Los Angeles, CA -- A federal grand jury in Los Angeles on March 20 convicted two former owners of California medical device companies of submitting fraudulent claims to Medicare for power wheelchairs and other equipment totaling $6.8 million, according to the U.S. Department of Justice. The trial proved that former Colonial Medical Supply owner Hakop Gambaryan personally delivered power wheelchairs to beneficiaries who were able to walk without assistance, according to the DOJ. In one case, Gambaryan carried a power wheelchair up a flight of stairs for a woman who lived in a second floor apartment with no elevator. Between 2006 and 2012, Gambaryan, 55, of ...

Destrehan man pleads guilty in $50 million Medicare bust
March 26, 2015, Baton Rouge, LA -- A Destrehan man has pleaded guilty in a $50 million medical clinic-accountant Medicare fraud scheme exposed by a federal Medicare Fraud Strike Force. Christopher White, 48, of Destrehan and Paige Okpalobi, 58, of Slidell, both pleaded guilty before before Chief U.S. District Judge Sarah S. Vance of the Eastern District of Louisiana to one count of conspiracy to commit health care fraud and one count of conspiracy to falsify records in a federal investigation. Sentencing hearings for each are scheduled for July 1, according to the U.S. Department of Justice. The owner and operator of a New Orleans-based medical clinic and an ...

Officer pleads guilty in insurance fraud
March 26, 2015, Ontario, none -- A York Regional Police officer has pleaded guilty in an insurance fraud case. Police say Const. Stuart Coleman pleaded guilty to a charge of knowingly making a false or misleading statement or representation to an insurer under the Insurance Act. A Bradford, Ont., judge ordered Coleman to pay a $3,000 fine and $21,547 restitution to the Regional Municipality of York. Coleman and two others were charged in July 2014 following alleged misuse of company insurance benefits. Criminal charges laid by the York Regional Police Professional Standards Bureau were dismissed, as were all charges against the two co-accused, Ruth Coleman and Michael McCleary. Coleman remains suspended ...

HHS takes strong steps to address opioid-drug related overdose, death and dependence
March 26, 2015, Washington, DC -- Evidence-based, bipartisan efforts focus on prescribing practices and treatment to reduce prescription opioid and heroin use disorders U.S. Health and Human Services Secretary Sylvia M. Burwell today announced a targeted initiative aimed at reducing prescription opioid and heroin related overdose, death and dependence. Deaths from drug overdose have risen steadily over the past two decades and currently outnumber deaths from car accidents in the United States. The President’s FY 2016 budget includes critical investments to intensify efforts to reduce opioid misuse and abuse, including $133 million in new funding to address this critical issue. The Secretary’s efforts focus on three priority areas ...

AG: Woman who claimed to be physician's assistant faces charges
March 26, 2015, Jackson, MS -- A woman who claimed to be a licensed physician's assistant at a Jackson medical clinic is facing fraud charges, the Mississippi attorney general said. Theresa Lane Fisher, 46, formerly of Madison County, was arrested Tuesday and charged with Medicaid fraud and mail/wire fraud, Attorney General Jim Hood said. The loss to the Medicaid program is alleged to be over $30,000, Hood said. If convicted, Fisher could be sentenced to up to 35 years in prison, Hood said. Fisher was released from the Madison County Jail after posting a $35,000 bond. ...

Storm-chasing roofer in Ohio gets nearly five years in prison
March 25, 2015, Union County, OH -- Ohio Attorney General Mike DeWine and Union County Prosecuting Attorney David Phillips have announced that a storm-chasing home repair contractor will serve prison time for stealing more than $150,000 from 40 victims throughout central and southwest Ohio. James Twaddle, of Reynoldsburg, was sentenced Tuesday to 59 months (nearly five years) in prison. In December, he pleaded guilty to felony charges of attempted engaging in a pattern of corrupt activity, grand theft, and theft from the elderly after running an elaborate home improvement scheme that involved taking homeowners’ insurance checks and providing no services in return. Twaddle previously was ordered to pay full ...

North Carolina woman accused of inflating home fire loss
March 25, 2015, Pinnacle, NC -- Insurance Commissioner Wayne Goodwin today announced the arrest of Amanda Nicole Anderson, 39, of 720 Shoals Road, Pinnacle; she is charged with one count each of insurance fraud and attempting to obtain property by false pretense. Department of Insurance criminal investigators accuse Anderson of presenting false documents for an insurance claim related to an Aug. 29, 2014, fire at her previous residence at 1530 Pinnacle Hotel Road. Anderson allegedly submitted a property loss inventory form to North Carolina Farm Bureau that included items not lost in the fire. Anderson was arrested on March 23. She was charged in Surry County and released ...