News

Man in Ohio abandons car, then reports it stolen to collect insurance
April 24, 2014, Cuyahoga County, OH -- Ohio Lieutenant Governor and Department of Insurance Director Mary Taylor announced that Cleveland resident John Deskins was sentenced to two years of probation in Cuyahoga County Common Pleas Court for theft in an insurance fraud case. Evidence gathered by the department showed Deskins abandoned his car at a local repair facility and then filed an insurance claim stating his vehicle had been stolen. After being contacted by Deskins’ insurer, the department found that Deskins claimed to the insurer and police that his vehicle was stolen while parked at a Cleveland bar. Deskins was paid $8,898.22 by his insurer for the supposed theft. After ...

Body shop raided in Michigan in auto insurance fraud investigation
April 24, 2014, Macomb, MI -- Authorities seized rental vehicles and automobile equipment in raids today at two businesses and a home in Macomb and Oakland counties as part of a large-scale insurance fraud investigation. No arrests were made but warrants are pending, Macomb County Sheriff's Lt. Brian Barlog said. Investigators searched Marks One Collision Shop, 2325 Eight Mile in Warren; Marks One Rentals, 21941 Dequindre in Hazel Park, and a residence in Shelby Township. Barlog declined to provide details on the exact location of the residence, but said it is related to the businesses, which he said have one owner. He said the fraud investigation involved repaired vehicles through ...

Philly lawyer paid 45 in long-running $400K slip-n-fall scam
April 24, 2014, Philadelphia, PA -- A Center City personal-injury lawyer ran a slip-and-fall insurance scheme and paid 45 people to help him stage bogus claims, District Attorney Seth Williams said Wednesday. A grand jury alleged that Andrew H. Gaber, 52, a sole practitioner, ran the scam for seven years from his office at 15th and Walnut Streets. Twenty-one insurance companies were defrauded of almost $400,000, the grand jury said. In announcing the investigation, Williams said Gaber - who was aware of the grand jury's work and pending fraud charges - committed suicide April 15. Gaber's death cast a pall over Williams' news conference detailing two years of work ...

Home-health company to pay $150M to settle false claim lawsuit
April 23, 2014, Monroeville, AL -- A Monroeville nurse will get just over $15 million for blowing the whistle on fraud at a national home healthcare company where she once worked, her attorney says. The money comes from $150 million that Amedisys Inc., a Baton Rouge, La.-based home health company operating in 37 states, agreed to pay in a settlement announced today by Joyce Vance, the U.S. Attorney for the Northern District of Alabama, and Department of Justice officials. The company admits no wrong-doing. But justice department officials claim the company made false claims for Medicare and other government healthcare insurance programs. "Amedisys made false Medicare claims, depriving the ...

Medical supplier in Texas sentenced to 11 years in prison for kickbacks
April 23, 2014, Bryan, TX -- Yolanda Nowlin, 42, has been ordered to federal prison for 11 years following her multiple convictions in relation to a large health care fraud conspiracy, announced United States Attorney Kenneth Magidson. A federal jury in Houston convicted Nowlin Sept. 4, 2013, following seven days of trial and less than three hours of deliberations. At the sentencing hearing late yesterday, U.S. District Judge Sim Lake handed Nowlin a total sentence of 132 months in federal prison - 120 months for conspiracy to commit health care fraud to be served consecutively to a 12-month sentence for health care fraud, conspiracy to ...

Miami — by far — tops list of cities of banned medical providers
April 23, 2014, Miami, FL -- If there ever was any question that Miami is the champ when it comes to healthcare fraud, a peek inside Medicare’s list of banned providers should settle it. Of all the people and businesses in the federal government’s “exclusions database,” Miami tops the list — and does so by a long shot, according to a McClatchy analysis. Of the medical providers in the database, 1,491 list Miami addresses. Second place: Los Angeles, with a relatively meager 522 names. They’re followed by Phoenix; Brooklyn, N.Y.; and Houston in the top five. “Despite our measurable successes in combating fraud, South Florida continues to be a ...

New report: Give payers access to state drug monitoring data
April 22, 2014, Washington, DC -- Policymakers should work with urgency to grant health insurers and other payers access to state prescription-monitoring databases, the Coalition Against Insurance Fraud said in supporting a report released today by a leading university policy and research center. Insurers, federal agencies and prescription-monitoring leaders have reached a national consensus that the state databases should be open to insurers and other third-party payers. The consensus emerged at a late-2012 national summit convened in Washington, D.C. by the prescription drug monitoring center at Brandeis University. “Payer access to drug-monitoring databases will empower thousands of groups to better choke off trafficking in addictive ...

Florida Supreme Court clears path for full implementation of PIP reform
April 22, 2014, Tallahassee, FL -- The Florida Supreme Court denied a petition to review a case involving personal injury protection (PIP) reforms from 2012. Donovan Brown, counsel for state government relations with the Property Casualty Insurers Association of America (PCI), said in a news release that PCI is pleased with the Florida Supreme Court's decision. "Recent evidence reveals implementation of the 2012 PIP reforms led to reduced fraud and suppression of the PIP portion of auto rates, yet certain individuals still sought to put the brakes on the reforms benefiting Florida's drivers," the statement continued. "PCI and its members will continue to support full implementation of the ...

Chiropractor in New Jersey admits he ripped off insurer for $13K
April 22, 2014, Bayonne, NJ -- A Bayonne chiropractor has admitted submitting numerous fraudulent claims to an insurance company for treatments and office visits that were never performed. The state Attorney General’s office says 66-year-old Charles Boas of Matawan pleaded guilty Monday to insurance fraud. The state will recommend that he get three years of probation when he’s sentenced in June, and his plea agreement also calls for a minimum one-year suspension of his chiropractic license. Boas, whose practice was based on Broadway in Bayonne, was charged in September 2012 with stealing about $13,000 as a result of the fraud, which occurred between October 2006 and August 2009. Authorities ...

'Patient' in Virginia gets prison for aiding home health scheme
April 22, 2014, Orange County, VA -- An Orange County man has been sentenced to serve three years in prison for charges that include Medicaid fraud. James H. Fincham Jr. also was sentenced in Louisa County Circuit Court on Monday for burglary and two counts of obtaining money by false pretense, according to Louisa Assistant Commonwealth’s Attorney Adam Ward. For more than a year, beginning in 2012, Fincham was at the center of a scheme to defraud Medicaid “by greatly exaggerating a supposedly debilitating medical condition,” Ward wrote in a statement released Tuesday. Fincham teamed with so-called “aides” who received government funding for taking care of Fincham, according to Ward, ...

Ex-cop and metal rocker pleads guilty to disability fraud in New York
April 22, 2014, Albany, NY -- A former police officer accused of rocking out on stage as the lead singer of a metal band called Cousin Sleaze while he claimed he couldn't work because of an arm injury pleaded guilty to fraud on Tuesday. Christopher Inserra entered the plea in federal court in Brooklyn. He left court without speaking to reporters. Inserra, 32, was arrested last year on charges accusing him of fraudulently collecting more than $30,000 in disability payments in the nearly two years he was out sick from the Port Authority of New York and New Jersey Police Department. He returned to work in March 2012 ...

Pair in Tennessee charged with torching SUV for insurance money
April 22, 2014, Surgoinsville, TN -- Two Surgoinsville men charged in an arson and insurance fraud scheme dating back to 2012 were indicted Monday by a Hawkins County grand jury. Michael S. Caldwell, 39, 1985 Longs Bend Road, and Brandon Eugene Frost, 28, 103 Forest View Drive, were arrested in February in connection with a 2012 scheme to "get rid" of a 2007 Chevy Tahoe, which later resulted in a $28,054 insurance settlement. Both were indicted on charges including felony filing a false report, insurance fraud, and arson. Frost was additionally charged with burglary and theft over $1,000 in an unrelated case. Caldwell reported the Tahoe stolen via telephone ...

'Newlywed murderer' convicted of killing bride for $1M in life insurance
April 22, 2014, Miami, FL -- A jury deliberated approximately two and a half hours before finding Michel Escoto guilty of first degree murder for the 2002 death of his wife Wendy Trapaga. Escoto was emotionless as the verdict was read. Trapaga’s mother, cried in court after learning her ex-son-in-law’s fate. Escoto, jurors agreed, murdered Trapaga, his wife of four days, so he could collect on a one million dollar insurance policy. Wendy Trapaga’s family offered no comment at the courthouse, but her sister, Rita Stephan, spoke to CBS4′s Lauren Pastrana over the phone Tuesday night. “The truth is out and he’s finally going to pay after almost 12 years,” Rita ...

Catskill woman charged with Medicaid fraud
April 22, 2014, Catskill, NY -- A Catskill woman is facing felony charges for allegedly stealing close to $2,500 in Medicaid benefits over a three-month period in 2012 from the Greene County Social Services Department, authorities said. Gail Jubak, 53, was arrested by the Greene County Sheriff’s Office on Friday and charged with grand larceny and welfare fraud. Authorities said the arrest was the result of an investigation by the Department of Social Services’ Fraud Unit, the Greene County District Attorney’s Office and the sheriff’s office. They said that between May 1 and Aug. 31, 2012, Jubak stole $2,445.04 in benefits and did not report household income. She was arraigned ...

Report recommends insurers use prescription monitoring data to reduce opioid abuse, deaths
April 22, 2014, Waltham, MA -- The Prescription Drug Monitoring Program Center of Excellence at Brandeis University has issued a ground-breaking report recommending that medical insurers use prescription monitoring data to reduce the overdoses, deaths and health care costs associated with abuse of opioids and other prescription drugs. "At a time when the misuse and abuse of prescription opioids has reached epidemic levels, it's important that third party payers be able to use states' prescription monitoring data to make sure these drugs are prescribed appropriately," said Peter Kreiner, principal investigator of the Prescription Drug Monitoring Program (PDMP) Center of Excellence. The report, available online, describes the proceedings of ...

Insurance company signs up to anti-fraud database
April 22, 2014, West Norfolk , none -- A West Norfolk insurance broker has become the first in the UK to sign up to an anti-fraud database. With fraud thought to be costing motorists up to £50 per motor policy in additional premiums, Adrian Flux will use SIRA (the Syndicated Intelligence for Risk Avoidance) database to check information from new business proposals against known fraud data shared on the system by other financial organisations. The system, powered by Synectics Solutions, is already used by more than 20 insurers, but Flux is the first broker to adopt the solution as an underwriting aid to enhance its current anti-fraud and risk management ...

Comp claimaint in Maine opened engine repair business on the side
April 21, 2014, Augusta, -- On Friday, an Aroostook County trial jury convicted Stephen Tucker Sr., 63, of the theft of more than $10,000 in workers’ compensation benefits. Tucker of Monticello received more than $45,000 in benefits from the Maine Employers Mutual Insurance Company from July 2009 through February 2012 by claiming that he could not work because of a hand injury he suffered in 2006 while working at Brewer’s Service Station in Mars Hill, according to a news release issued by the Maine attorney general’s office. However, Tucker opened his own small engine repair business — Littleton Service — in Littleton in January 2009. The attorney ...

Michigan doc who saw 100-plus patients a day convicted of drug fraud
April 21, 2014, Detroit, MI -- A Detroit-area doctor who would see more than 100 patients a day at his Hamtramck clinic has been convicted of 34 crimes. It was a slam-dunk for federal prosecutors Thursday as Dr. Basil Qandil was found guilty of all charges, including illegal drug distribution, health care fraud and money laundering. The 36-year-old doctor was accused of writing prescriptions for drugs that would be sold on the streets. In turn, he would bill Medicare and Medicaid. According to the government, Qandil would write prescriptions for an entire family when only one member of the family was in the clinic. Lines would form at 8 ...

Six in New Jersey accused of staging car crash for insurance money
April 21, 2014, Passaic County, NJ -- State authorities say six Passaic County residents played roles in a staged-automobile accident scheme that defrauded two insurance companies out of more than $78,000. Acting state Attorney General John Hoffman announced the charges Monday. He said five of the suspects were arrested last Wednesday, while the sixth was issued a summons. The suspects were charged with conspiracy, insurance fraud and theft by deception in an indictment handed up April 10 by a state grand jury. Each could face lengthy prison terms if convicted on the charges. Authorities say the accident occurred on April 29, 2009. They say four suspects were in a minivan ...

Woman in Wyoming convicted of Medicaid fraud in federal court
April 21, 2014, Cheyenne, WY -- U.S. Attorney Christopher A. Crofts announced today that Cheyenne resident Deborah Kay Person has been convicted in federal court. Person was charged by indictment with a violation of 18 U.S.C. § 1347, health care fraud. A jury found Person guilty on the sole count of the indictment after a four-day jury trial in the U.S. District Court in Cheyenne. Person is scheduled to be sentenced by Chief Federal District Court Judge Nancy D. Freudenthal on June 24, 2014. The investigation in this case was conducted by the Medicaid Fraud Control Unit, Wyoming Attorney General’s Office. ...

Door-to-door life insurance scam reported in Pennsylvania
April 21, 2014, Lackawanna County, PA -- Lackawanna County leaders are warning people to be on the lookout for a new scam. Officials say someone is going to homes claiming to be from the Lackawanna County Veteran's Affairs Office and trying to sell life insurance on the spot. County leaders say they don't sell life insurance and anyone who makes house-calls will have proper identification. So far, people have reported the scam in Dickson City, Eynon and Peckville. ...

Operators of California construction company charged with comp fraud
April 21, 2014, Santa Clara County, CA -- After investigations by the Santa Clara County District Attorney’s Office, operators of two South Bay construction companies have been charged with felony workers’ compensation fraud. Both underreported the number of their employees to insurance companies and ended up paying a combined total of $300,000 less in premiums. Sandra O’Neill, 44, and William O’Neill, 34, both of Cupertino, of Sunnyvale’s WM O’Neill Lath and Plastering Company, have been charged with four felony counts of workers’ compensation insurance fraud. They are scheduled to be arraigned on April 22. If convicted, the O’Neills face a maximum of 10 years incarceration. Teofilo Oceguera, 62, and ...

N.D. farmers accused of poisoning seeds to collect on crop insurance
April 21, 2014, Fargo, ND -- Federal prosecutors have increased allegations against farming brothers from Northwood, accusing them of adding chemicals to potato seeds to cut production in a crop insurance fraud case where they took in $2 million from fraudulent insurance claims since 2002 as well as federal disaster funds. Aaron Scott Johnson, 50, and Derek Martin Johnson, 47, pleaded not guilty to the allegations, which were originally filed in January but doubled and amended this month. The case is set to go to trial on July 15 in Fargo. In court, prosecutor Nick Chase has said he thought the case would take seven to 10 days ...

Allstate awarded $3.8M in lawsuit against notorious chiropractor
April 21, 2014, Austin, TX -- Based on a six-week jury trial, the United States District Court for the Northern District of Texas has entered a $3.8 million judgment in favor of Allstate Insurance Company. The jury found that Michael Kent Plambeck, D.C., Jennifer Giessner, Douglas Friedman, Randal Toca, and other persons and entities engaged in a pattern of racketeering activity in violation of the Federal Racketeering Influenced and Corrupt Organizations Act (RICO) and the Ohio Corrupt Practices Act. This judgment sets the stage for the company to vigorously fight this type of healthcare fraud, so it can continue offering competitive products in the involved states. "Insurance ...

Death of two patients leads to drug charges against N.M. doctor
April 18, 2014, Las Cruces, NM -- A Las Cruces physician has been arrested for allegedly overprescribing pain medication that resulted in the deaths of two patients. Prosecutors say 61-year-old Pawan Kumar Jain was taken into custody Thursday. A federal grand jury indicted Jain on 61 counts of unlawfully dispensing controlled substances and 50 counts of health care fraud. According to the indictment, Jain allegedly committed the offenses between April 2009 and June 2010. At the time, Jain was a licensed physician with a neurology subspecialty who operated a Las Cruces pain management medical practice. His medical license was suspended in June 2012 and revoked six months later by the New Mexico ...