Insurance Fraud NEWS

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Insurance Fraud News:
A selection of daily headlines from around the nation

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Couple in Wash. accused of buying life policy on terminal son

June 24, 2019. Oak Harbor, WA-- Washington Office of the Insurance Commissioner : An Oak Harbor couple pleaded not guilty on June 17 in Island County Superior Court to charges that stemmed from a $15,000 life insurance policy they bought for their 12-year-old son who died of cancer. Charles Henry Boyles III was charged with first-degree perjury, conspiracy to commit first-degree theft and conspiracy to file a fraudulent insurance claim. Genia Harris Boyles was charged with conspiracy to commit first-degree theft and conspiracy to file a fraudulent insurance claim. Officials brought charges after the case was investigated by Insurance Commissioner Mike Kreidler’s Criminal Investigations Unit (CIU). A judge in Island County Superior Court set their ...


Texas couple, agent to plead guilty to life insurance murder

June 24, 2019. Columbia, TX-- The Augusta Chronicle : A local insurance agent and a Texas couple accused of an insurance fraud plot that led to murder intend to plead guilty, according to court records. Attorneys for Charles Mercier and Virginia and Mark Buckland advised a judge in Columbia on Friday that the three will plead guilty, but they asked for time to work out the logistics. They have until Sept. 9, according to court documents. Mercier, a North Augusta insurance agent whose license expired in 2004, specialized in writing insurance policies for members of the Irish Traveler community. He and the Bucklands were indicted in federal court in South Carolina ...


Attorneys look for answers to fraud on both sides of Florida's home insurance industry

June 24, 2019. Tallahassee, FL-- Daily Business Review : When Hurricane Sandy pummeled New York and New Jersey in 2012 it drowned financial adviser Doug Quinn’s house in 3 feet of water, and introduced him to a world of fraud and abuse led by flood insurance adjusters and engineers, some of whom even created false reports to underpay storm victims. ...


Court: Man can spend wife's life insurance policy payout on attorney in murder case

June 24, 2019. Denver, CO-- 9 News : The Colorado Supreme Court on Monday ruled that a Denver man accused of killing his wife can use the proceeds of her life insurance policy to fund his defense. Robert Feldman, 55, had his arraignment delayed six times during the fight over approximately $550,000 he plans to use to fight the first-degree murder charge he faces in the 2015 death of his wife, Stacy Feldman. Stacy Feldman’s family had successfully argued in probate court that allowing Robert Feldman to use the life insurance payout violated the state’s so-called “slayer statute,” under which “an individual who feloniously kills the decedent forfeits all benefits ...


OPINION | Let's take the surprise out of medical billing

June 24, 2019. Washington, DC-- Colorado Politics : One of the worst days of any person’s life is having to be rushed to the emergency room. Pain, stress, anxiety are all part of the visit. What can quickly make this crisis worse is the arrival of a surprise medical bill because they unknowingly sought care outside of their insurance company’s network. The good news is that there is a bipartisan solution gaining momentum in Congress based on legislation we passed here, right in our own backyard: The STOP Surprise Medical Bills Act. Studies show that one in four Americans will be hit with a surprise bill. ...


The U.S. gets hundreds of millions from bug Pharma in co-pay settlements

June 24, 2019. Philadelphia, PA-- Barron's : The federal government has secured almost $850 million in settlements from the pharmaceutical industry since a Barron’s investigation revealed how companies used charities in ways that undermined efforts to hold back skyrocketing drug prices. Scrutiny of industry-supported charities is continuing at Medicare, the Internal Revenue Service, and the Senate Finance Committee, so the practice remains a risk factor for drug makers and the charities they continue to underwrite. Just this month, a civil fraud suit was filed by the U.S. Attorney in Philadelphia against Mallinckrodt Pharmaceuticals (ticker: MNK), the seller of the expensive and controversial anti-inflammatory drug H.P. Acthar Gel, whose ...


Former Somerset caregiver pleads guilty to abusing, neglecting adult

June 24, 2019. Pulaski County, KY-- Berea Online : Attorney General Andy Beshear and his Office of Medicaid Fraud and Abuse today announced the guilty plea of a Pulaski County woman on one count of knowingly abusing or neglecting an adult, a Class C felony. Ashley Grimes, 23, of Somerset, pleaded guilty in Pulaski Circuit Court June 20, acknowledging the abuse of a resident at the CAKY Somerset in Pulaski County, where she worked as a direct care professional. On July 28, 2018, Grimes sat on the victim while the victim was on the floor. Grimes will be sentenced to a term of seven years with 30 days incarceration with ...


Massive DHS data breach raises questions about Oregon’s cybersecurity protocols

June 24, 2019. Salem, OR-- The Oregonian : A January data breach at the Department of Human Services exposed the confidential information of an eye-popping 645,000 Oregonians. Those people whose personal data was compromised were left with many questions. But the massive breach raised an even bigger question for everyone else: What are state officials doing to protect the information stored on government computers about virtually everyone in Oregon? State officials say they are working to address the problem, in particular with a new agency that provides data tracking and training, among other cybersecurity initiatives. Yet despite that work -- and procedures in place within individual agencies -- the security lapses ...


Insurer Dominion national reports server hack that began August 2010

June 24, 2019. Richmond, VA-- HealthIT Security : Virginia-based Dominion National is notifying patients that their personal and medical data was potentially breached during a nearly nine-year hack on its servers. Dominion is an insurer and administrator of dental and vision benefits and also serves as a health plan administrator. Officials received an internal alert about unauthorized access and launched an investigation. They discovered an unauthorized party accessed some of Dominion National’s computer servers, beginning as early as August 25, 2010 – nearly nine years before the investigation concluded on April 24, 2019. The notice did not explain what spurred the internal alert, nor when they first discovered the hack. ...


Disgraced businessman who filed false insurance claims for farming equipment banned from running company for 12 years

June 24, 2019. Spalding, -- Lincolnshire Live : A businessman has been banned from running any company for 12 years after submitting fraudulent insurance claims. Christopher Dawson from Spalding was found to have submitted false claims for what he told insurers was stolen agricultural equipment, when in fact it had been seized by creditors in lieu of a debt payment. Despite offering to pay back the money, the 36-year-old failed to return the full amount and was declared bankrupt. Now he has had his bankruptcy restrictions extended until May 2031 as a result of his conduct. As part of the bankruptcy restrictions Dawson is not allowed to act as a company ...


Four in Calif. charged with crash/auto give-up schemes

June 23, 2019. Sacramento, CA-- The Sacramento Bee : Detectives from the California Department of Insurance last week arrested four men in connection with an auto insurance fraud ring that allegedly collected $22,000 by filing false insurance claims. The ring consisted of owners and associates of Habib Auto Sales, Ocean Auto Sales and Rusul Auto Sales who purchased already-damaged vehicles from auctions and staged collisions or other incidents to collect fraudulent insurance payments, according to a news release. Arrested last Tuesday were Ameer Almassou, 29, Bariq Aleyada, 33, and Ziad Jaber, 31. A fourth man, Muhamed El Gererey, 38, surrendered to authorities two days later According to the news release, one suspect ...


Contractor in Ohio pleads guilty to $57K comp fraud scheme

June 23, 2019. Toledo, OH-- WorkersCompensation.com : A Toledo-area contractor owes the Ohio Bureau of Workers' Compensation (BWC) nearly $57,000 in restitution after pleading guilty to workers' compensation fraud in a Toledo courtroom last month. Eric L. Hughes, 53, of Holland, pleaded guilty to a fourth-degree felony charge of workers' compensation fraud May 19 after failing to renew his BWC policy despite repeated attempts by the agency to bring him into compliance. A Lucas County judge ordered Holland to pay BWC $56,959 in restitution and serve three years of community control (probation). “Ducking his legal obligation to protect his workers clearly didn't pay for Mr. Hughes,” said BWC Administrator/CEO ...


Eyecare centers report data breach

June 23, 2019. Swansea, IL-- Invision Mag : JFJ Eyecare Ltd., doing business as Quantum Vision Centers and Eye Surgery Center LLC, announced that some of its systems were accessed by an unauthorized person. “While there is no evidence that suggests that any data was actually taken, Quantum Vision Centers and Eye Surgery Center have mailed letters to individuals whose information may have been affected,” the company stated in a press release. On April 18, Quantum Vision Centers and Eye Surgery Center “became aware of an incident in which malware was introduced by an unauthorized person into some of their systems,” according to the release. The malware encrypted certain files, including ...


Car insurance: Shocking lies drivers are telling to get cheaper cover putting them at risk

June 23, 2019. London, -- Express : New data has revealed that motorists are telling lies and making errors which could land them in trouble or invalidate their cover. A study by LexisNexis Risk Solutions found that some motorists are willing to massively stretch the truth to try and secure cheaper overall cover. In some cases, deliberately providing inaccurate information could result in insurance cover being cancelled or a claim not being paid. It could also result in it being difficult for you being able to secure insurance cover in the future. The research found that drivers are telling lies both big and small which could put them ...


What role does big data play in the insurance industry?

June 23, 2019. Washington, DC-- e27 : A cloud-based infrastructure is now the norm for most insurance companies. In 2019, seven in 10 carriers incorporated the cloud in their business operations, with increased speed, flexibility, and scalability being some of the key benefits. And this widespread cloud adoption has meant one thing – a massive volume of data. When harnessed correctly, this data can lead to profound insights within the insurance industry, helping providers become more efficient and deliver a better customer experience. With that said, here’s the role big data plays in the insurance industry, and how to capitalize on it. Why it’s being used in the insurance ...


Clinic owner in Texas convicted of providing unlicensed care

June 21, 2019. San Antonio, TX-- My San Antonio : A jury on Friday quickly convicted the operator of San Antonio-based physical therapy clinics of charges that he defrauded workers comp out of millions of dollars. Jurors deliberated about an hour after a two-week trial before unanimously finding Rafael Enrique Rodriguez, 51, guilty of six counts of healthcare fraud and five counts of wire fraud, for claiming physical therapy sessions at his 210Workers clinics were provided by licensed healthcare professionals — when unlicensed physical therapy technicians actually conducted the services. According to authorities, the federal workers compensation program administered by the U.S. Department of Labor does not pay claims for physical therapy ...


Woman in NC accused of using fake estimate on crash claim

June 21, 2019. Walhalla, NC-- FOX Carolina : Agents with the S.C. Law Enforcement Division said Friday a Walhalla woman was arrested after she was accused of creating a fake company in order to file an insurance claim for auto repairs. SLED agents charged Robbie Leigh Eades, 29, with presenting a false claim for insurance benefit According to the arrest warrant, Eades filed a fake estimate with State Farm for $6,508.40 back in February. The case will be prosecuted by the S.C. Attorney General’s Office, who SLED said requested the investigation ...


Supreme Court turns down bid of life insurance killer

June 21, 2019. Phoenix, AZ-- Tucson.com : The U.S. Supreme Court has rebuffed the efforts of a man who married and then killed a Pinal County woman for her life insurance to escape the death penalty. In a brief order, the justices rejected arguments by attorneys for Michael Apelt that his counsel at his trial had been deficient and that required a new sentencing. The high court did not disturb the conclusion of the 9th Circuit Court of Appeals that the attorney may have botched the job of representing Apelt at sentencing and finding evidence to urge a trial judge to spare his life. But they also left intact ...


Did you hire one of these contractors? They just got busted

June 21, 2019. Manatee County, FL-- Bradenton Herald : A sting targeting unlicensed contractors and workers compensation fraud in Manatee County netted nine arrests in two days, according to the Manatee County Sheriff’s Office. The sheriff’s office organized the operation with the help of Manatee County Code Enforcement and the Florida Department of Business and Professional Regulation. In addition to targeting contractors working without a required license, the sting went after those engaging in construction-class work without workers’ compensation insurance or workers’ compensation insurance exemptions. The operation resulted in the arrest of nine men for unlicensed contracting, which is a first-degree misdemeanor on the first offense. Six of the men were ...


Judge finds insufficient evidence to try accused Cedar City arsonist

June 21, 2019. Cedar City, UT-- St. George News : A man accused of aggravated arson and filing a fraudulent insurance claim will not stand trial after a judge ruled that prosecutors failed to show sufficient probable cause to support the charges. Clare Eugene Prisbrey had been suspected by investigators of deliberately starting a fire at his Cedar City residence on Dec. 31, 2017. Firefighters were dispatched to 1074 Mill Hollow Way shortly after 10:20 p.m. and spent the next several hours battling a blaze that severely damaged the interior of the structure. The two-story, 2,782-square-foot residence was deemed a total loss. Prisbrey was charged with first-degree felony aggravated arson, along with filing ...


New Louisiana law aims to protect policyholder choice of auto repair shop

June 21, 2019. Baton Rogue, LA-- Insurance Journal : A new law in Louisiana aims to ensure that auto insurance policyholders have the option to choose a particular motor vehicle repair shop. Under Act 317 (House Bill 411), which has been signed by Gov. Jon Bel Edwards, insurers are prohibited from recommending specific auto repair shops unless their insureds are clearly informed that they are not required to use the recommended shop. According to the Coalition Against Insurance Fraud, insurers are allowed inform consumers about reputable repair facilities and warn against body shops suspected of committing fraud. However, the bill states: “An insurer shall not engage in any act or practice of ...


North Carolina woman fakes cancer and gets $230,000; now it's costing you

June 21, 2019. Raleigh, NC-- ABC 11 : Insurance fraud is becoming a massive issue in North Carolina and it's costing you a lot of money, according to state officials. The Department of Insurance says up to 20 percent of what you pay for insurance is going to fraudulent claims. The department is working to crack down on those scammers by doubling the number of special agents investigating cases statewide. "This industry is so creative because they are so creative and imaginative," said Frank Rodriguez, Deputy Commissioner of the Criminal Investigation Division. Rodriguez oversees 40 agents stationed throughout North Carolina. On average, he says each agent handles about 100 cases a month. The ...


More false DNA tests dog consumers, this time in Louisiana

June 20, 2019. Lake Charles, LA-- KALB : A genetic testing fraud scheme is targeting Medicare beneficiaries, according to James Donelon, Louisiana’s Commissioner of Insurance. Beneficiaries are being targeted through phone calls, booths at health fairs, tables at grocery stores and pharmacies, and door-to-door visits to participate in free genetic testing and cancer screenings. Donelon said the screenings are a fraudulent means for scammers to obtain Medicare information for identity theft or fake billing purposes. The Better Business Bureau is reporting several states, including Kentucky, Nebraska and South Carolina, have issued warnings about the screenings, which involve collecting DNA cells swabbed from inside a person’s cheek. Donelon said beneficiaries can avoid ...


Missouri woman suspected in death of friend's wife for $150K

June 20, 2019. St. Louis, MO-- Fox4kc.com : A Missouri woman will spend the rest of her life in prison after admitting that prosecutors had evidence to convict her of killing a mentally disabled man in what authorities believe was part of a complicated plot to divert attention from another homicide case. Pamela Hupp, 60, of O’Fallon, entered an Alford plea Wednesday that calls for life in prison without the possibility of parole at sentencing in August. Hupp could have faced the death penalty if convicted of first-degree murder in the August 2016 death of 33-year-old Louis Gumpenberger. St. Charles County prosecutor Tim Lohmar said after the hearing that the ...


Eyes injected for bogus maladies in alleged $16M con in Texas

June 20, 2019. Houston, TX-- United States Department of Justice : A medical director and two operators of a Houston, Texas, medical clinic were charged in an indictment unsealed today for their alleged participation in a multimillion-dollar health care fraud scheme. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge Kristie K. Osswald of the Railroad Retirement Board Office ...