News
Texas business pleads guilty to underreporting payroll
February 03, 2012, Midland, TX -- A Midland, Texas-based company has pleaded guilty to misrepresenting the payroll of an affiliated firm, according to workers’ compensation insurer Texas Mutual Insurance Co.
AB Abatement Inc. of Midland, pled guilty to charges that it misrepresented the numbers of employees and payroll associated with the workers’ compensation policies of Vanco Insulation Inc., a related company.
Vanco Insulation Inc., owned by Robert Crow of Midland, obtained workers’ compensation coverage through Texas Mutual from April 2003 to October 2006.
A Travis County district court ordered AB Abatement to pay $70,000 in restitution to Texas Mutual and a $1,000 fine.
Texas Mutual maintains three teams of in-house
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Texas medical equipment fraudster gets 10 years
February 03, 2012, Edinburg, TX -- Juan De Leon, 41, of Edinburg, Texas and owner of United DME Inc., was sentenced today to 120 months in federal prison without parole for his role in a health care fraud and identity theft scheme, United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott announced today.
Following a four-day trial and approximately an hour of deliberations in late September 2011, a federal jury in McAllen convicted De Leon on charges of conspiracy, health care fraud, and aggravated identity theft related to his scheme to submit fraudulent claims to Medicare and Medicaid for a variety of medical items including
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PIP fraud-fighting bill passes Fla. Senate panel
February 03, 2012, Tallahassee, FL -- A Senate panel on Thursday cleared a bill aimed at cutting down the massive fraud plaguing the state's personal injury protection, or PIP, coverage program.
The Senate Committee on Banking and Insurance passed the PIP fraud-fighting bill (SB 1860) by a vote of 9-0 on Thursday.
Sen. Joe Negron's bill requires more detailed police reports after a wreck and places tighter restrictions on pain clinics. State investigators say many clinic owners have no prior health care experience and some even opened pain clinics because they heard they could make a lot of money.
The bill also requires that health care providers found guilty
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Ambulance crew in Va. charged with falsifying records
February 03, 2012, Saltville, VA -- The Saltville Rescue Squad is accused of falsifying doctor’s signatures and sending $2.65 million worth of fraudulent billing slips to insurance companies in a federal indictment unsealed Thursday.
Federal prosecutors allege that for nearly six years the squad chauffeured three able-bodied patients to dialysis treatment despite Medicare regulations that limit the service only to people in need of a stretcher.
In all, prosecutors hope to recoup from the squad $800,000, any vehicles bought with fraudulent proceeds, and 40 acres of rescue squad property, documents show.
A woman at the squad building, at 126 Battleground Ave., slammed the door on a Bristol Herald Courier
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N.C. pro golfer accused of $2.7M agent impersonation
February 03, 2012, Wake County, NC -- A Wake County man who made a regional name for himself as a professional and amateur golfer faces the possibility of federal prison time for a $2.7 million fraud scheme.
C. Dale Fuller, 52, of Wake Forest is scheduled to go before a federal judge in Florida on Feb. 10 for sentencing. He pleaded guilty in November to mail fraud in the case.
Fuller, who at one time was among the top 10 of professional golfers in North Carolina and South Carolina, faces the possibility of 20 years in prison, a $250,000 court fine and restitution.
Golfers and others from the Triangle are
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22 from 'untouchable' drug ring rounded up in Florida
February 03, 2012, Franklin County, FL -- Sheriff’s deputies have rounded up 22 of the 28 suspects indicted Wednesday for engaging in organized crime – becoming the second alleged drug ring with connections to the Florida-to-Franklin County pill pipeline.
Over 12 months this ring imported about 36,000 pills – with a total street value of more than $900,000 – into Franklin County, Sheriff Pat Melton said during a press conference Thursday.
“It’s very, very significant,” Melton said. “It’s a large-scale operation, folks. Anytime you’ve got approximately 3,000 pills per month coming into your community, that’s a lot.”
The six-month investigation, dubbed “Operation Untouchables,” uncovered the second prescription pill “corporation” run
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Aspiring N.Y. reality star accused of auto giveup scam
February 03, 2012, Staten Island, NY -- A wannabe reality star from Arden Heights is accused of falsely reporting her leased luxury SUV stolen, even though she had already been forced to give it back to the Connecticut lawyer who had once agreed to fund her TV dreams.
Rebecca Kudryavsky, 27, of Krissa Court, was among four Staten Islanders arrested in an insurance fraud sweep, which involved probes into three separate alleged scams. The other schemes involve two Islanders whose car was found burning in the woods of Ocean Breeze, and another Island resident who ditched his car at Newark Liberty Airport and reported it stolen.
Ms. Kudryavsky,
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N.C. woman arrested for falsifying crash letter in fraud
February 02, 2012, Concord, NC -- Insurance Commissioner Wayne Goodwin today announced the arrest of Tanisha Lozada, 25, of 3120-K Patrick Henry Drive, Concord; she is charged with one count of obtaining property by false pretense.
Investigators allege that in June 2011, Lozada was treated by Carolinas Healthcare System for minor injuries from a car accident. Farm Bureau Insurance overpaid CHS in the amount of $2,010.73, which was owed to Lozada. Investigators allege that Lozada crafted a fraudulent letter on fake Farm Bureau letterhead and faxed it to CHS with instructions to send the overpayment directly to her. Farm Bureau was unaware of this and also issued
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Kentucky looks to Florida for success fighting pill mills
February 02, 2012, Frankfort, KY -- The pill pipeline may have been broken up, but federal officials say prescription drug abusers are now finding new ways to get their fix.
As part of "Operation Pill Nation" Florida cracked down on pain clinics, and that state has seen a big drop in the number of doctors prescribing oxycodone, but now the numbers have risen in other states including Kentucky.
"You wake up in the morning, you at least have one pill, and then a few hours later, if you didn't have your own, you'd be sure that you could get a couple more," said the man we'll call, "Jim."
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Medical suppliers in La. charged in $1M Medicare scam
February 02, 2012, Baton Rouge, LA -- A Plaquemine couple were charged in an alleged $1 million Medicare fraud Wednesday in Baton Rouge.
Henry Ray Stewart and his wife, Helen Faye Stewart, were each charged in a bill of information filed by Assistant U.S. Attorney Shubhra Shivpuri. The case is assigned to U.S. District Judge James J. Brady.
The Stewarts could not be reached at their listed telephone number. Henry Stewart’s attorney did not return requests for comment left with his secretary and sent to his email address. The court file did not list an attorney for Helen Stewart.
Bills of information contain criminal charges that have not been considered
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N.Y. nutritionist charged with submitting false claims
February 02, 2012, Ridgewood, NY -- A New York City nutritionist with offices in Ridgewood and Passaic was indicted Wednesday on charges that she fraudulently billed health insurance companies for nutritional counseling services that never took place, authorities said.
Azadeh Ahmadi, 42, was charged with two counts of healthcare claims fraud and two counts of theft by deception, state Attorney General Jeffrey S. Chiesa said in a statement.
Ahmadi is accused of falsely collecting more than $40,000 in payments from two insurance companies, Horizon Blue Cross Blue Shield and Aetna, between May 2005 until June 2007, Chiesa said.
The payments were made after Ahmadi told the companies she had
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Florida lawmakers tackle check-cashing ties to comp
February 02, 2012, Tallahassee, FL -- Florida lawmakers are looking to give regulators and law enforcement officials more flexibility to investigate check cashing companies that may be facilitating fraud in the construction industry.
The House Subcommittee on Insurance and Banking yesterday approved HB 1277, sponsored by Rep. Daniel Davis (R-Jacksonville), which is designed to rein-in the use of checking cashing companies by individuals seeking to avoid paying workers’ compensation premiums.
Among other things, the bill eliminates a current law that requires state regulators to give check cashing firms 15-days advance notice before conducting an examination of their records. While retaining a current requirement that all firms undergo an
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Insurance investigators add social media to research
February 02, 2012, Washington, DC -- Given the swell in user-generated content housed on social media sites, it is no surprise that investigators turn to them when conducting background investigations.
Doing the Digging
With all of this potentially useful information hiding in social media sites, many investigators are adding online social media research to their investigative strategies. The SIU director of a major insurer says, “depending on the type of case, it could be a routine investigative action.”
Social media provides a form of voluntary (and free) surveillance. As users create new content, the data they produce and the metadata stored by the platforms they use can be a
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La. man played role in $1.5M medical equipment scam
February 01, 2012, Baton Rouge, LA -- An Atlanta man has pleaded guilty for his role in a Louisiana-based Medicare fraud scheme involving fraudulent claims for unnecessary durable medical equipment, including leg and arm braces, power wheelchairs and wheelchair accessories.
The U.S. Department of Justice says 61-year-old Fred D. Belcher pleaded guilty Tuesday before U.S. District Judge James J. Brady to one count of conspiracy to commit health care fraud.
Federal prosecutors say Belcher admitted working as a recruiter for Healthcare 1 LLC, Medical 1 Patient Services LLC and Lifeline Healthcare Services Inc., Louisiana companies that fraudulently billed about $1.5 million to the Medicare program from 2004 to 2009.
Belcher
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Man in Pa. accused of passing 76 fake prescriptions
February 01, 2012, Wilson Borough, PA -- A 51-year-old Wilson Borough man who police said used 76 fake prescriptions to get amphetamine salts at four area pharmacies waived a preliminary hearing today.
Steven Piperato, of the first block of North 16th Street, was scheduled for a hearing before District Judge Gay Elwell but waived the proceeding. The charges against him have been forwarded to the Northampton County Court.
According to court documents, Piperato turned in fake prescriptions for amphetamine salts at two pharmacies in Easton and two in Palmer Township over a 2 1/2-year span beginning in January 2009.
Police became aware of the alleged prescription fraud when a
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Mass. senate leaders call for prescription monitoring
February 01, 2012, Boston, MA -- Massachusetts Senate leaders Tuesday called for passage of legislation designed to toughen existing state regulations for the monitoring of dangerous prescription drugs.
The bill would make it mandatory for all doctors who prescribe controlled substances, including legal painkillers such as OxyContin and Vicodin, to register with the state's prescription monitoring program. Participation in the program is voluntary under a 2010 state law, and officials said only about 1,700 out of 40,000 prescribers in Massachusetts have registered to date.
Data collected under the program can be used by doctors to screen patients to determine if they have a history of prescription drug abuse
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Wide use of doctor ID numbers enable fraud, CMS says
February 01, 2012, Washington, DC -- Widespread use and distribution of physician identifier numbers makes it easy for fraudsters to steal the identity of doctors and bill insurers for services in the doctor's name, according to a viewpoint article from two doctors who work at the Centers for Medicare and Medicaid Services (CMS).
Shantanu Agrawal, MD, and Peter Budetti, MD, JD, explained that theft of a physician's identity involves stealing the doctor's National Provider Identifier (NPI), Tax Identification Number (TIN) and medical licensure information, and submitting false claims to either a public payer or a private insurer.
More than 3,600 cases of physician and patient medical identity theft
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FBI finds boxes of hemophilia meds in suspect’s home
February 01, 2012, Loxley, AL -- The FBI found boxes of hemophilia medication in the garage of a woman accused of defrauding Alabama Medicaid and private insurance companies, an agent testified this afternoon.
Special Agent George Glaser testified that he participated in a pair of search warrants in 2009, one at the Robertsdale house where defendant Lori Skowronski Brill was living at the time, and one at a specialty pharmacy in Loxley.
Jurors at the federal trial saw several boxes containing various kinds of Factor mediation, a protein replacement used to treat hemophilia. Much of the medication came from plastic bags that were inside a black bag in
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Miami clinic owner arrested for fraudulent PIP claims
February 01, 2012, Miami, FL -- Florida Chief Financial Officer Jeff Atwater announced today the arrest of a Miami clinic owner for submitting fraudulent Personal Injury Protection (PIP) claims from his unlicensed clinic.
Juan M. Dieguez, who also used the false identity Jorge R. Gonzalez, is charged with operating a health care clinic without a license, grand theft and insurance fraud following an investigation by the Department of Financial Services’ Division of Insurance Fraud (DIF). Dieguez has owned and operated Venetian Rehab Center, located at 434 SW 12th Ave., since October 2010, but was arrested while working at another clinic, Therapy-Diagnostic, Tech Medical. Dieguez was
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N.Y. Senate OKs bill to crack down on fake auto cards
February 01, 2012, Albany, NY -- Legislation sponsored by Senator Jeffrey D. Klein (D-Bronx/Westchester) that would impose tougher penalties on those who commit auto insurance fraud passed the State Senate today.
The measure (S.578) would make it a felony to forge an auto insurance card, or certificate of insurance. In New York State, these documents are necessary to obtain government issued documents -- such as a vehicle registration -- that are required to legally operate a motor vehicle.
“It's law-abiding New Yorkers who ultimately have to pay the price of auto insurance fraud,” Senator Klein said. “With this commonsense legislation, we will help punish those who seek
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Two in Calif. arrested for doctor shopping for pain pills
January 31, 2012, Sarasota, CA -- Holly Costa, 48, of Venice, obtained 12,800 oxycodone pills and similar controlled substances between August 2010 and July 2011, the sheriff's office reported.
The investigation began when a pharmacy reported to the Venice Police Department that Costa tried to fill two prescriptions for Oxycodone from two different doctors on two consecutive days.
Venice Police Department contacted a detective with the Sheriff’s Office, who determined that Costa visited at least 15 different practitioners in Sarasota, Bradenton, Tampa, Brandon, Wesley Chapel, St. Petersburg and Fort Myers during that 12-month period.
Costa was arrested Friday and booked into the Sarasota County Jail on 15 counts of
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W. Va. man gets 6 years for role in $4M fake clinics
January 31, 2012, Kanawha County, WV -- A man charged in connection with a $4 million health care fraud scheme will serve six years in prison, officials with the West Virginia Division of Justice announced Jan. 30.
Sargis Tadevosyan, 42, appeared in federal court Jan. 30 for charges of conspiracy to commit health care fraud and aggravated identity theft.
Two other individuals also were charged in connection with the year-long attempted Medicare fraud scheme. Igor Shevchuk, 23, and Arsen Bedzhanyan, 22, were charged with using fake IDs to create bank accounts for six fraudulent Kanawha County businesses.
Tadevosyan allegedly drove the men to Charleston to set up the bank accounts.
However,
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Wash. agent sentenced for pocketing $24K premiums
January 31, 2012, Tacoma, WA -- An insurance agent in Tacoma has pleaded guilty to second-degree theft for misppropriating checks from dozens of policyholders.
Michel Anthony James, an independent contractor working as an agent for State Farm, is believed to have deposited checks from more than 40 policyholders into his own business bank account.
State Farm discovered the problems when it audited James' accounts.
Based on a subsequent iinvestigation by Insurance Commissioner Mike Kreidler's Special Investigations Unit, James:
• failed to apply premiums to policies,
•wrongly withdrew cash from his premium fund account (which is where those policyholder checks were supposed to go),
•failed to refund overpayments to policyholders,
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Fla. witness reveals accident was staged: 3 arrested
January 31, 2012, Lee County, FL -- Two people were arrested for filing a false report and a third was arrested for perjury for allegedly lying to deputies about the location of a vehicle accident in Lehigh Acres Sunday night, according to Lee County Sheriff's Office reports.
"It was in fact a scam for an insurance fraud deal, which we're seeing more and more of," said Lee County Sheriff Mike Scott.
Deputies initially responded to an accident between an Oldsmobile car and a Nissan SUV at 5th Street West and Venice Avenue N.
The driver of the Oldsmobile told deputies he didn't stop at the intersection and crashed into the
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Texas man must pay $10M in restitution for scam
January 31, 2012, Sugar Land, TX -- A Sugar Land man was sentenced to six years in federal prison Monday and ordered to pay almost $10 million in restitution to the Medicare and Medicaid programs, a federal prosecutor said.
Aghaegbuna "Ike" Odelugo,39, was convicted last August of conspiracy to commit health care fraud, health care fraud and money laundering, said Assistant U.S. Attorney Al Balboni.
As part of the sentence, Odelugo was ordered to forfeit $7.45 million in illegal proceeds to the United States that he personally profited by bilking the federal health-care programs.
According to federal authorities, Odelugo agreed with 14 durable medical equipment supply owners in several states,
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