News

Ohio woman admits to stealing health benefits of ex-husband's employer
October 29, 2014, Toledo, OH -- A Toledo woman pleaded guilty Tuesday to insurance fraud for collecting more than $30,000 in health care benefits from the city of Toledo. Jana Davis, 37, of 731 Eleanor Ave. admitted in Lucas County Common Pleas Court that she remained on her ex-husband’s health care plan after they divorced in 2011. Jack Davis was employed as a utility worker in the city’s housing division but resigned in November, 2013. Melissa Nowakowski, an assistant Lucas County prosecutor, told the court that between October, 2011 and October, 2013, Davis received $27,816 in medical benefits, $2,421 in dental benefits, and $1,674 in prescription benefits through ...

Staged automobile crash nets Indiana man prison time
October 29, 2014, Michigan City, IN -- A Michigan City man was sentenced Wednesday to 15 months in prison for staging car crashes to collect insurance payouts, federal court records show. Robert Lemon also must pay $191,449 jointly with several co-defendants and serve two years on supervised release. Lemon and seven of his co-defendants each pleaded guilty to one count of conspiracy to commit mail fraud. Nine people were indicted in November in the alleged insurance fraud scheme. They were accused of staging car crashes in Northwest Indiana and Illinois and reporting them to local police and insurance companies between December 2005 and July 2009. Melissa Yates, of Michigan City, was ...

Las Vegas man pleads guilty to helping to torch pet shop
October 29, 2014, Las Vegas, NV -- A 28-year-old fledgling boxer pleaded guilty to arson and attempted animal cruelty charges, telling a judge he didn't want to be remembered as the man who set fire to a Las Vegas pet store where firefighters rescued 27 puppies earlier this year. Kirk Bills entered his plea Wednesday in Clark County District Court to avoid trial on 31 felonies in the Jan. 27 fire at the Prince and Princess pet shop. Bills could face up to 19 years in prison, but his lawyer hopes for less. Bills will remain in jail until sentencing March 2. Store owner Gloria Lee is due for sentencing Feb. ...

Lawyer in Pennsylvania pleads guilty to aiding auto fraud ring
October 29, 2014, Philadelphia, PA -- He fought the charges for more than three years, but suburban lawyer Michael B. Wolf has pleaded guilty to participating in a Philadelphia-based auto insurance fraud scheme. Wolf, 56, pleaded guilty before Philadelphia Common Pleas Court Judge Jeffrey P. Minehart on Tuesday – one day before the start of his nonjury trial before the judge. Wolf pleaded guilty to one count of insurance fraud and one count of conspiracy to commit insurance fraud in a deal negotiated by his attorney, Brian J. McMonagle, and Assistant District Attorney Vicki Markovitz. Minehart accepted the plea and sentenced Wolf to the agreed-on two years probation ...

Woman in Pennsylvania convicted of illegally collecting $45K in comp money
October 28, 2014, Milton, PA -- A 51-year-old Milton woman charged with workers compensation insurance fraud was sentenced Monday by Northumberland County President Judge William H. Wiest to 1 to 6 years in a state correctional institution. Margaret Black also was ordered to pay $45,000 restitution to Zurich Insurance Company and a $100 fine plus costs. Black, who was represented by county public defender Michael Suders, was charged by the state Attorney General's Office with fraudulently receiving $45,000 in workers compensation insurance belonging to her father after he died. The offenses occurred in December 2010, but the charges weren't filed until 2013 after it was discovered Black's father ...

Feds sue NYC's Medicaid contractor for billing fraud
October 28, 2014, New York City, NY -- U.S. Attorney Preet Bharara's office is accusing New York City, through a contractor, of inappropriately processing tens of thousands of Medicaid reimbursement requests for as much money as possible, without first seeking reimbursement from private insurers. Between 2008 and 2012, Computer Sciences Corporation allegedly obtained hundreds of millions of dollars in Medicaid reimbursements on behalf ofthe city for medical care provided to children that the city was responsible for. “Billing frauds like those alleged undermine the integrity of public healthcare programs like Medicaid,” Bharara said in a statement. “All public healthcare program participants, whether they are healthcare providers, localities like the City, ...

Consumers warned about life insurance and annuity scams
October 28, 2014, Washington, DC -- Insurance scams are far too common, often targeting seniors. While no area of insurance is immune, a lot of the fraud is happening within annuities and life insurance. “Most agents are honest, but the unpleasant truth is that agents typically are at the heart of annuity and life-insurance cons,” says James Quiggle, a spokesman for the Coalition Against Insurance Fraud http://www.insurancefraud.org. “They know how to manipulate the products and sales pitches to their favor. Agents also have the incentive of earning large commissions when they make a sale, whether or not the sale benefits the trusting client.” According to experts a ...

Couple in Pennsylvania accused of shooting out car windows, filing bogus claim
October 28, 2014, Fayetteville, PA -- Two people from Fayetteville were charged with insurance fraud after allegedly shooting the windows of their vehicles and filing a false insurance claim. Pennsylvania State Police, Chambersburg, said Mason J. Prosser, 45, and Crystal R. Prosser, 45, reported to police on Oct. 9 that someone shot a rifle into their unattended vehicles while they were parked in the driveway. They told police they didn't know who did it and filed an insurance claim for the losses totaling $26,000. Following an investigation, police allege that Mason Prosser shot the vehicles himself and Crystal Prosser was an accomplice. Charges were filed against the two on Friday. ...

Orthopedic surgeon, office manager in California charged in billing scheme
October 28, 2014, Castro Valley, CA -- A Castro Valley surgeon and his office manager have been charged with dozens of felonies in a long-running scheme to defraud insurance companies, prosecutors announced Monday. Dr. Douglas Abeles, who ran an orthopedic practice in Castro Valley, conspired with his office manager, Gabriela Cuevas, to file false insurance claims through several medical businesses operated out of an office on the Castro Valley-Hayward border, prosecutors said. A criminal complaint filed last week alleges that Abeles had his employees manually override billing software and charge higher prices to insurance companies for prescription drugs. He also had workers falsify reports indicating that physicians had spent ...

Jury in Washington buys that false claim by cop was just a misunderstanding
October 28, 2014, Spokane, WA -- A Spokane jury acquitted on Tuesday a 15-year veteran of the Spokane County Sheriff’s Office who faced charges of insurance fraud. Deputy Jeremy B. Jeske was placed on paid administrative leave in June, and in July the state Attorney General’s Office filed two criminal counts of insurance fraud stemming from claims in April for snow damage to a trailer he was storing near Priest Lake, Idaho, and damage to a carport in Davenport. The jury found Jeske not guilty Tuesday afternoon after a two-day trial. The Washington State Attorney General’s Office handled prosecution of the case at the request of Spokane County ...

Sheriff's deputy in Washington accused of buying property policy after loss
October 27, 2014, Spokane, WA -- Prosecutors from the Attorney General Bob Ferguson’s Criminal Litigation Unit are in Spokane today for the start of a trial against a Spokane County Sheriff’s deputy accused of insurance fraud. Jeremy Jeske has been charged with two counts of “false claims or proof” for allegedly submitting false claims for property insurance coverage. He’s accused of obtaining coverage then reporting a loss that occurred prior to him securing the coverage. Jeske is a Spokane County deputy sheriff, and he is currently on administrative leave. The charges are only allegations. A person is presumed innocent unless and until he or she is proven guilty ...

Prosecutors in Louisiana say wife had husband killed for insurance $
October 27, 2014, Port Allen, LA -- Greed and failing finances motivated Corey Kitts’ wife to hire someone to shoot Kitts as he slept in his bed one morning in July 2010, prosecutors said Monday. Assistant District Attorney Tony Clayton laid out for jurors the murder-for-hire conspiracy between Kitts’ wife, Monique O. Kitts, 45, of Livingston, and Karl Michael Howard, 30, of Roswell, Georgia, during opening statements on the first day of Monique Kitts’ and Howard’s murder trial. Clayton said Corey Kitts, 40, worked nights at Shintech and was focused on supporting his wife and children and their nice life in an Addis subdivision. ...

Rehab center owner in Florida pleads guilty to $2.5M billing scam
October 27, 2014, Tampa, FL -- The former president and owner of a rehabilitation therapy services clinic pleaded guilty in Tampa today to health care fraud and money laundering charges. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney A. Lee Bentley III of the Middle District of Florida, Acting Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office made the announcement. Laura Leyva, 45, of Miami Lakes, Florida, pleaded guilty in the U.S. District Court ...

New insurance fraud prosecutor named in Dallas County, Texas
October 27, 2014, Dallas County, TX -- The Texas Department of Insurance (TDI) announced Amy Allen as a fraud prosecutor who will work exclusively with criminal prosecutors in the Dallas County District Attorney’s Office to combat insurance fraud. Allen worked previously as an assistant city attorney and community prosecutor for the City of Dallas. She has litigation experience in Dallas, Tarrant and Harris counties and worked in Washington, D.C., for an international prison ministry. She is a Special Assistant United States Attorney for the Northern District of Texas as part of the national Project Safe Neighborhood program. Allen graduated from the University of Houston – Bates School of ...

Harley owner in North Carolina accused of dumping motorcycle in pond
October 27, 2014, Martin County, NC -- Two men were arrested for insurance fraud last week, according to an announcement by North Carolina Insurance Commissioner Wayne Goodwin. Department of Insurance criminal investigators accuse Timothy Jay Styons of filing a false police report and making a fraudulent insurance claim in July 2010 that his 2009 Harley Davidson motorcycle had been stolen. Progressive Insurance Company paid Styons $12,903 for the claim. After a joint investigation with the North Carolina Division of Motor Vehicles and the Martin County Sheriff’s Office, investigators allege that David Brent Long helped Styons hide the motorcycle in a Martin County pond and that the motorcycle had not ...

Ten in Virginia accused of defrauding Medicaid of $2.4 million
October 25, 2014, Virginia Beach, VA -- Progressive Counseling Services in Virginia Beach has been hit with more than 50 violations of its license by state regulators since 2011. Now its owner, Baffour E. Opoku, is facing a criminal indictment charging him and nine associates with bilking Medicaid out of more than $2 million. Authorities on Friday arrested the nine associates but still were searching for Opoku. The 48-year-old citizen of Ghana lives in Virginia Beach. He faces 101 counts in the 105-count indictment, which had been under seal since Wednesday. Eight others who were arrested Friday made appearances in U.S. District Court. A ninth person was arrested in another ...

Video at Target store in Florida shows woman faking fall
October 25, 2014, Lake Worth, FL -- A Lake Worth woman tried to file a claim against Target after taking a tumble. But after investigators watched her intentionally take a seat on the floor through surveillance video, she landed in jail, authorities said. Margaret Dagniewska, 38, told a Target representative that she slipped on a "watery substance" and injured her neck, back, legs and shin at the store at 650 N. Congress Ave., according to report from the Florida Department of Financial Services' Fraud Division. The supposed fall, which happened Oct. 22, 2013, led to Dagniewska's arrest this week, records show. An investigator representing Target who watched the surveillance video ...

Woman in Montana posed as nurse to get access to painkillers
October 24, 2014, Billings, MO -- A Billings woman who was given a suspended sentence each of the four times she was convicted of fraudulently obtaining prescription painkillers has now pleaded guilty to a federal alleging she committed the same crime in February. The Billings Gazette reports (http://bit.ly/1ytVMAL ) 54-year-old Laurie G. Dukart told U.S. District Judge Susan Watters on Thursday that she posed as a nurse in a doctor's office, called in three prescriptions for hydrocodone using the names of other people and picked up the medication at Wal-Mart. She pleaded guilty to acquiring a controlled substance by fraud or deception. Watters was a state judge when ...

Probation officer in California charged with worker comp fraud
October 24, 2014, Los Angeles, CA -- Cynthia Wesley, 46, of Claremont, was arrested by Los Angeles Sheriff's Deputies on two felony counts of insurance fraud after allegedly altering workers' compensation documents and illegally collecting $1,036 in disability payments. "Falsifying documents to receive unearned disability payments is a serious offense," said Commissioner Dave Jones. "The fact that Wesley was a trusted member of law enforcement adds insult to injury in this case. We will investigate and bring to justice anyone that commits insurance fraud, regardless of where they are employed." An investigation by the California Department of Insurance Fraud Division revealed Wesley, a Los Angeles probation officer, filed an ...

After 8 drug overdose deaths, Indiana finally pulls doc's license
October 24, 2014, Indianapolis, IN -- The Indiana Medical Licensing Board on Thursday suspended Fort Wayne doctor William Hedrick's license for 90 days after hearing hours of unsettling evidence about his northeast Indiana pain clinics. Hedrick was already on probation, and several board members said nothing has changed in his practice since probation was instituted in March 2013. “I'm very uncomfortable with what I'm hearing,” said Dr. Bharat Barai, a board member. “There's no control. There's no accountability. “Is this an assembly line running patients in and out for prescriptions, or a good quality clinic? My feeling is this is not a good quality clinic. Certainly the citizens of ...

Owner of food market in Kentucky charged with torching business
October 24, 2014, Edmonson County, KY -- Kentucky State Police arrested an Edmonson County man Thursday on an indictment warrant charging him with arson, fraudulent insurance acts and burning personal property to defraud insurer. Arson Investigator Terry Scott presented testimony to an Edmonson County grand jury about the Sept. 29, 2013 fire that destroyed Ring’s Crossroads Market at Ky. 259 and U.S. 31-W, according to a release from KSP. The market owner, David Kevin Ring, 53, of Brownsville, is in Hart County Jail in lieu of a $250,000 cash bond. Ring awaits trial in January on felony weapons and drug charges that stemmed from the same investigation. The Bureau ...

Garden City man sentenced for insurance fraud
October 24, 2014, Garden City, KS -- A Garden City man convicted of insurance fraud in July has been sentenced to two years probation and ordered to pay $20,000 in restitution. Eric Alan Hansen, a former insurance adjuster for Farm Bureau Insurance in Ford and Finney counties, was sentenced in Ford County District Court on Sept. 26 and ordered to repay the money to FBL Financial Group, Inc.Farm Bureau is a subsidiary of FBL. He pleaded no contest to charges that he reported vehicles as totaled and retained by owners, then sold the cars to a body shop, according to a press release from the Kansas Insurance Department. The crimes ...

Owner of IHOPs in Ohio convicted of worker compensation premium fraud
October 22, 2014, Middleton Township, OH -- Though he had faced up to 40 years behind bars, the former owner of seven IHOP restaurants in northwest Ohio and Indiana was sentenced Tuesday to eight years in prison. Tarek Elkafrawi, 57, of Middleton Township near Perrysburg pleaded guilty July 3 to 53 counts contained in a federal indictment charging him with a series of criminal schemes between 2003 and 2012 intended to defraud the government, corporate IHOP, an insurance company, and his own employees of millions of dollars. He admitted to hiring in excess of 200 undocumented workers, giving some of them multiple identities so that they could work extra ...

Agent in California arrested for stealing her clients' premiums
October 22, 2014, El Cajon, CA -- An East County insurance agent was arrested and accused of stealing her clients’ premiums, the California Department of Insurance announced. Dawna Louise Ernster, also known as Dawna Louise Salois, 48, of El Cajon, was arrested Oct. 15, on 14 felony counts of grand theft, 14 felony counts of failure to disclose events affecting insurance coverage and two misdemeanor counts of petty theft. “Ernster violated her fiduciary responsibility and placed her customers at unnecessary risk for her own personal gain,” commissioner Dave Jones said. Ernster was an agent at JND Insurance Services and specialized in selling general liability insurance to construction companies. More than ...

Increasing fraud-fighting budget a good payoff says new gov report
October 22, 2014, Washington, DC -- Fraud investigators and agency data-miners charged with curbing improper health care payments might take heart from a new Congressional Budget Office report on “program integrity” efforts in Medicare, Medicaid and the Children’s Health Insurance Program. In a Monday report describing the budgetary impact of anti-fraud efforts by the Justice and Health and Human Services departments, the legislative cost-scoring agency said it has estimated that additional funding for anti-fraud activities “would yield savings that exceed the cost of carrying out those activities.” Such savings might not always be applied to reducing the federal deficit, CBO cautioned, because of the cost of implementation. But ...