Consumer information
Regular people who fought back — and won
Insurance fraud is costly crime against us all. But there's much that regular citizens like you can do to stop insurance cheaters, protect yourself, and help control everyone's insurance premiums. We want to share some real-life stories about how concerned citizens fought back — and won. They're everyday people who cared. Read their stories and be inspired.
Home is where the heart fraud isDoctors' house calls are mostly quaint relics of a bygone era. But when federal officials reviewed cardiologist Dr. Krishnaswami Sriram's billing records, they saw a human tornado who never met a home visit or heart ailment he didn't like. His nonstop housecalls and snappy service to elderly Chicago-area patients defied impassible blizzards, gridlocked city traffic and human endurance. Sriram billed Medicare for thousands of patient visits that never happened, the feds believe. He was outed by a bunch of sharp-eyed seniors who read his medical bills and didn't believe what they saw. Click here for more details.
Fraud victim
gets mad — and even
When Sherri Holder found herself on the losing end of an insurance
scam, she decided citizen action was the best revenge. After two
people stole her Lexus by paying for it with a fake insurance check,
the UPS worker dogged them all over the county and led police right
to her stolen car. Holder got mad, and even. Click
here for more details.
How Lo
can you go?
When Matthew Lewin walked into the Lawrence, Mass. police station
one June morning to report his car stolen, he may have figured he’d
staged the perfect fake theft: Strip the car, sell the parts, dump
the car body somewhere, and make a fat insurance claim. It all sounded
too, easy — but it wasn’t. Unknown to Lewin and the police,
his girlfriend had attached to his car a tiny electronic tracking
device called a Lo-Jack. Click here for more details.
Cleaning
woman comes clean
Wanda Leonard knew she’d done something wrong when she
saw the ominous billboard by a Pennsylvania roadside. The towering
sign pictured a cold and gloomy jail cell with the message, "Commit
Insurance Fraud, Enjoy Luxury Living." Wracked by guilt, Leonard
called her insurance company right away and withdrew an illegal
claim she'd made four days earlier through her cleaning business,
Ms. Detail. Click here for more details.
His Quaker
conscience nailed hospital scheme
Rick Newbold developed software that collected info on pneumonia
treatment trends from client hospitals. The Philadelphia-area consultant's
program discovered a large spike in an uncommon form of life-threatening
pneumonia. A practicing Quaker, Newbold realized the hospitals were
faking cases to charge Medicare, Blue Cross and other taxpayer-supported
programs millions more for treating a worse condition than the patients
actually had. Newbold's Quaker conscience couldn't stand the scams,
so he sued 100 hospitals for fraud as a federal whistleblower. The
feds joined his suit, which rocked the hospital industry and outed
shady billing practices across the U.S. In fact HCA-The Healthcare
Company settled for an eye-popping $745 million, the largest such
hospital settlement ever. Newbold's conscience also made him a multi-millionaire.
As a federal whistleblower, he receives a part of every recovery
– $5 million-$9 million against HCA alone. "I'm a dangerous
man," Newbold told the Philadelphia Inquirer Magazine. "I don't
have delusions of grandeur. I have delusions of relevance."
Home is where the heart fraud is
Doctors' house calls are mostly quaint relics of a bygone era. But when federal officials reviewed cardiologist Dr. Krishnaswami Sriram's billing records, they saw a human tornado who never met a home visit or heart ailment he didn't like.
His nonstop house calls and snappy service to elderly Chicago-area patients defied impassible blizzards, gridlocked city traffic, human endurance — and the time-space continuum itself.
Physics books may be rewritten if it's all true.
The feds think it isn't. Sriram swindled taxpayers by billing Medicare for thousands of patient visits that never happened, they now charge.
Sriram specializes in house calls to senior citizens. Though he may still convince a court the charges are baloney, Sriram will have to explain away some unusual patient visits.
Like how he visited the homes of 31 patients and saw 18 others at hospitals and nursing homes — on a day when 18 inches of snow shut down Chicago in 1999.
Or how he treated 32 patients — after each had died.
Or workdays that added up to 70 hours.
And then there's the time Sriram somehow visited the homes of 131 seniors in one memorable day, the feds charge. Alltold, he saw 187 seniors that day, and by a remarkable coincidence fully 178 patients had exactly the same diagnosis: congestive heart failure. And wonder of wonders, 70 of those seniors had the same home address — his own. This assured their Medicare paperwork went directly to him instead of the patients.
Sriram helped 380 patients in another three-day period. Not to mention the 90 he saw on Labor Day 1997.
Or the 50 patients he saw on each of 90 separate days.
Sriram gathered a long list of phantom patients by taking names during free health screenings at senior citizen complexes and private nursing homes around the Chicago area, the feds say.
He banked on the seniors being too confused and forgetful to challenge phony claims, the feds believe.
Well guess what... several of those supposedly muddled old folks poured intently over the treatment statements that Medicare sent them each month, and saw some numbers that didn't add up.
The seniors called the fraud hotline run by Wisconsin Physician Services, which had the FBI bloodhounds chase down Sriram.
Ironically, the house-call doctor had to post his home and $3.1 million in investments so he wouldn't flee to the home that might mean the most — his native India.
How Lo can you go?
When Matthew Lewin walked into the Lawrence, Mass. police station one June morning to report his car stolen, he may have figured he’d staged the perfect fake theft: Strip the car, sell the parts, dump the car body somewhere, and make a fat insurance claim.
It all sounded too, easy — but it wasn’t. Unknown to Lewin and the police, his girlfriend as a routine safety measure had attached to his car a tiny electronic tracking device called a Lo-Jack.
After Lewin reported his black 1991 Nissan 240SX coupe stolen, a string of fishy coincidences began piling up that day.
First, police suddenly began receiving a Lo-Jack signal, meaning a stolen car was probably crying out for rescue nearby.
And surprise surprise, the code being transmitted belonged to a black 240SX Nissan coupe.
Then for some odd reason, the signal led police to a local towing company. The police drove away when the owner said no black Nissan was stashed there, but sped back when they realized the Lo-Jack signal was growing weaker.
The unlucky Lewin just happened to be standing out front when the police returned. This final coincidence was too much. After discovering Lewin worked at the tow yard, the police checked the premise in more detail. They discovered the Nissan out back, completely stripped.
His luck continued free-falling. The police drove Lewin back to his apartment so he could get his ID. Inside the apartment, they found two door panels, one bucket seat and the rear seat to the "stolen" Nissan.
Thanks to that Lo-Jack transmitter, Lewin stands charged with filing a false report and attempting to defraud an insurance company. Police haven’t charged his girlfriend so far.
Poor Lewin had no idea his car carried a tracking device when he made that insurance claim. Though Lewin hasn't been convicted, prosecutors will undoubtedly ask him many times in court, "How Lo can you go?"
Fraud victim gets mad — and even
When Sherri Holder found herself on the losing end of an insurance scam, she decided citizen action was the best revenge. After two people stole her Lexus by paying for it with a fake insurance check, the UPS worker dogged them all over the county and led police right to her stolen car.
Holder got mad, and even.
Her adventure began when she placed a newspaper ad to sell her 1992 gold Lexus. A nice, chatty couple responded. They all met in a local Steak n Shake parking lot by a mall. The couple seemed respectable enough. They test-drove Holder's car, asked a lot of questions, then handed her a $6,000 check from an insurance company.
The wife had totaled her car in an accident recently, and this was a settlement check the couple's insurance agent would endorse over to Holder, assured the man who called himself Bob Jones.
That check seemed official. It had the right look, and bore the name of an agent and insurance company. Holder deposited it without incident, confident she'd made a good deal.
But the bank called back a week later. The insurer had noticed a faulty claim number and notified the bank.
Holder's $6,000 check was a fake. She had no car or money.
But then "Jones" wasn't an especially astute crook. He picked the wrong woman to scam, left a trail of clues, and paid a price for sloppiness.
Incredibly, he'd given Holder his cell phone number during their earlier talks, and it never occurred to him that she might trace that number after cheating her so brazenly.
Holder jumped all over his gaffe. She realized she'd forgotten to give the couple a spare car key, and called him to ask for his mailing address. Even more incredibly, he took the bait and gave it to her.
Holder and a couple of friends then made two trips to the couple's home before they finally found her Lexus parked in the driveway. She called county police on her cell phone, but the couple took off in the car before police arrived.
So Holder then followed her stolen car, relaying every turn to a DeKalb police dispatcher while the pursuit was broadcast on a police scanner. Before long, police caught up with the Lexus, cornered it and arrested the couple.
James Riley (his real name) is now stewing in DeKalb County Jail, unable to post $15,000 bond. Fabarage Washington posted bond. They face a number of charges, including forgery. Naturally, Riley and Washington will have a chance to convince the court they're innocent and that the forged check is all an innocent mistake.
Whether regular, everyday people like Holder should personally chase down possibly dangerous fraud schemers is another question. But at least this time, Holder showed that decisive citizen action can help the cause of justice.
For all her pluck and sleuthing skills, however, maybe the best thing Holder gained is a new attitude. It's better to head off a scheme before it hatches than to chase cons all over town afterward.
"You don't want to be skeptical of all people, but that's what this did for me," Holder said.
Cleaning woman comes clean
Wanda Leonard knew she’d done something wrong when she saw the ominous billboard by a Pennsylvania roadside. The towering sign pictured a cold and gloomy jail cell with the message, "Commit Insurance Fraud, Enjoy Luxury Living."
Wracked by guilt, Leonard called her insurance company right away and withdrew an illegal claim she’d made four days earlier through her cleaning business, Ms. Detail.
Apparently Leonard had spilled coffee while cleaning the master bedroom of a client. Upset and agitated, she tried to scrub the carpet with bleach but turned the carpet yellow instead. Leonard had just taken out an insurance policy, and filed a claim to cover the spill even though the accident had happened before she’d obtained the coverage.
"I was nervous. I got the bleach bottle out. I was more afraid of losing a customer," she said.
But then came that big and scary billboard, just promising doom, gloom and despair for any poor schlep caught committing insurance fraud. It was all too much for Leonard, who changed her mind about crime, on the spot.
The billboard was part of a statewide public awareness campaign by the Pennsylvania Insurance Prevention Authority. The folks at the authority knew they had a strong message, but even they didn’t realize the mere sight of their billboard could send insurance cheats running for cover.
Leonard was charged with insurance fraud despite her epiphany, and readily pleaded guilty to filing a false insurance claim. But instead of being fined or thrown in the slammer, an understanding judge handed Leonard only 12 months of unsupervised punishment.
So the case of the Cleaning Woman Who Came Clean ended well for all, thanks to the crime-busting billboard: The insurer cracked the case, the authority got its point across, the judge doled out justice — and Wanda Leonard has a clean conscience.
