News

Agents charged with stealing client premiums in California
March 28, 2019, Los Angeles, CA -- Two recent California Department of Insurance investigations have led to the arrests of insurance agents who allegedly stole tens of thousands of dollars from clients and failed to place insurance coverage for those clients, exposing them to significant financial risk. “California consumers should be able to trust that their insurance agents are looking out for them and ensuring they are protected,” said Insurance Commissioner Ricardo Lara. “These agents not only allegedly stole from their clients, they put their clients at great financial risk.” Maria Aquino, 34, of South Gate, was charged with multiple felony counts of embezzlement and theft for allegedly pocketing ...

Office manager allegedly files fake surgery claims in New York
March 28, 2019, Suffolk County, NY -- Suffolk County District Attorney Timothy D. Sini today announced the unsealing of a 70-count indictment against a former health care worker for allegedly fraudulently receiving more than $400,000 through a health care insurance fraud scheme. “This was an act of pure greed,” District Attorney Sini said. “He used his knowledge of the health care insurance system to illegally pocket hundreds of thousands of dollars, money that would have otherwise been used to care for people who were sick and in need. Our office will continue to work with our partners in law enforcement and in the private sector to investigate and ...

7 accused of $50M compound con in New Jersey
March 19, 2019, Trenton, NJ -- Seven people could face up to 20 years in prison for their alleged role in an elaborate compound medication scheme that defrauded New Jersey health insurers out of $50 million, federal prosecutors said. The U.S. Attorney for New Jersey announced Friday that a grand jury had returned the indictments after an investigation showed that the seven were involved in a plan to recruit patients who had insurance that covered the expensive compound creams and other medications. The scheme then found physicians to prescribe the compounds without seeing the patients and without determining medical necessity, the prosecutor's office said in a bulletin. ...

Officials warn: Bogus, low-cost auto policies sold in Texas
March 18, 2019, Hidalgo, TX -- Fraud investigators are warning residents about fraudulent insurance claims and fake car titles. Hidalgo County fraud investigator, Cesar Solis, says people are using their tax refunds to buy new cars. Solis says he is seeing an increase in claims where people unknowingly buy new cars with false titles. “Just don't do it, we recommend not to do it, I know that is a cheap price to pay but if it's too cheap it’s not true,” he says. Solis urges residents to be aware of low-cost car sales as well as insurance policies. He adds that residents caught buying or selling fraudulent insurance policies or titles ...

Electronic health records proving vulnerable to scammers
March 18, 2019, Washington, DC -- A decade ago, the U.S. government claimed that ditching paper medical charts for electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, the digital revolution has gone awry, an investigation by Kaiser Health News and Fortune magazine has found. Veteran reporters Fred Schulte of KHN and Erika Fry of Fortune spent months digging into what has happened as a result. (You can read the cover story here.) Here are five takeaways from the investigation. Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses ...

Oped: Seniors regular prey for varied insurance scams
March 18, 2019, Washington, DC -- Spring is coming, and with it comes phony home improvement “experts” who prey on the unsuspecting … and they’re among an array of frauds out there. The home improvement fraud involves people telling you they can repair whatever you need fixed. They’re working in your neighborhood and are cheaper than the others. Beware. They may run off with your deposit and never make the repairs or do shoddy repairs and then disappear. Check with people you trust for recommendations. Get written estimates. Ask for references and be sure to ask for copies of licenses and insurance before you let anyone start working ...

Davenport doctor settles health care fraud lawsuit for $2.2M
March 17, 2019, Davenport, FL -- A Davenport doctor and his vascular surgery practice paid more than $2.2 million to settle allegations of health care fraud for filing false claims to federal health programs. According to U.S. Attorney Maria Chapa Lopez in a media release issued by the United States Attorney’s Office Middle District of Florida, Dr. Irfan Siddiqui and the Heart & Vascular Institute of Florida in Davenport violated the False Claims Act by submitting claims from Jan. 2, 2011 to June 30, 2018 for medically unnecessary and non-Medicare reimbursable vein ablations that were up-coded to reflect they were medically necessary so the doctor and the ...

Suspect tries to fill dead person’s prescription
March 17, 2019, Normandy, TN -- A Normandy woman attempted to obtain drugs prescribed to a now-deceased woman Thursday at a Shelbyville pharmacy, police were told. The date and quantity of Lortab pills listed on the prescription had been modified, a pharmacist said. Tiffany Dawn Anderson, 35, of Center Street in Normandy told officer Sam Campbell her boyfriend, who has the same last name as the woman on the prescription, sent her to the pharmacy. But an employee of another pharmacy told police Anderson had enquired about obtaining Lortabs. Anderson told police she chose the particular store because the deceased woman had obtained her prescriptions there. She had presented ...

Murder of Brandon Horst by Aaron Allen, involving his wife spotlighted on Heart of Darkness
March 16, 2019, St. Paul, MN -- The latest episode of Heart of Darkness on Investigation Discovery spotlights the murder of Brandon Horst, whose wife, Heather Horst, persuaded Aaron Allen to kill him. At around 1:00 am on August 5, 2013, Heather called 911 and told an operator that she had just found her husband in bed at the home they shared in the 400 block of Bellows Street in St. Paul, Minnesota, with blood coming from his head. When officers arrived at the scene, they found Brandon in the upstairs bedroom with a single gunshot wound to the head. A 9mm casing was found on the bed. An investigation revealed ...

Kelvin Collins: Use caution when hiring repair contractors
March 16, 2019, Washington, DC -- In the aftermath of recent tornadoes, the Better Business Bureau urges the public to exercise caution when hiring contractors to repair damages. Natural disasters can bring out the best in people; unfortunately, it also brings out con artists. Unscrupulous contractors can take advantage of post-disaster chaos to scam unsuspecting property owners by providing shoddy materials and sub-standard work. The BBB offers these tips for selecting a contractor: • Check with your insurance company about policy coverages and any specific filing requirements. • Don’t act in haste and never sign anything you do not understand. If someone insists you sign immediately, this is a red ...

Ohioan claims injury, earns $185K as general contractor
March 16, 2019, Cleveland, OH -- A Cleveland-area man was sentenced to seven months in prison Wednesday and ordered to repay nearly $246,000 in disability benefits he fraudulently received from the Ohio Bureau of Workers' Compensation (BWC) and the Social Security Administration. Louis C. Cooper, 57, of North Royalton, previously pleaded guilty to wire fraud and theft of government property after investigators discovered him concealing his work as a general contractor. He was sentenced Wednesday in the U.S. District Court for the Northern District of Ohio in Cleveland. “Acting on an anonymous tip, our investigators discovered Mr. Cooper earned at least $185,000 over the last eight years as ...

600,000 affected by huge data breach in Michigan
March 15, 2019, Lansing, MI -- The effects of a September 2018 ransomware attack are still reverberating for Wolverine Solutions Group, which serves both health insurers and provider organizations. More than six months after the attack, Michigan’s Attorney General Dana Nessel and Anita Fox, director of the Department of Insurance and Financial Services, are now urging residents of Michigan affected by the data breach to take extra precautions to safeguard their personal health information ...

Long Island chiro pleads guilty to multi-million dollar health care fraud
March 15, 2019, Long Island, NY -- Earlier today, at the federal courthouse in Central Islip, Raymond R. Pellegrino, a chiropractor, pleaded guilty to health care fraud. Today’s plea took place before United States District Judge Joseph F. Bianco. When sentenced, Pellegrino faces up to 10 years in prison, as well as restitution of $2,110,000, forfeiture of $504,444 and a fine to be determined. Richard P. Donoghue, United States Attorney for the Eastern District of New York, announced the guilty plea. “Pellegrino abused his position of trust as a health care provider by billing millions of dollars in fraudulent claims for services that doctors never provided,” stated ...

Multiple vehicle scammers convicted in California
March 15, 2019, Ventura, CA -- Four people pleaded guilty to auto insurance fraud charges in multiple cases on Thursday, the Ventura County District Attorney’s Office said Friday. One case involved Raymond Merkley, 40, of Woodland Hills, who pleaded guilty to filing a fraudulent claim after driving his truck off-road in November 2016 at Hungry Valley State Park. Merkley’s truck sustained major damage, but throughout the insurance process, Merkley lied to his carrier about how the damage occurred, prosecutors said. He is due to be sentenced May 29 and faces up to 10 years in custody due to two prior convictions for which he served prison time. In ...

Georgia driver allegedly claims crashes after being paid
March 15, 2019, Augusta, GA -- An Augusta woman was arrested Thursday on seven counts of insurance fraud by the Georgia Department of Insurance Fraud Unit, with assistance from the Richmond County Sheriff’s Office. According to a news release from the Georgia Insurance Commissioner’s office, April Nashonda Alston, 34, is accused of making fraudulent claims to her insurer by stating she was involved in various one and two-car accidents after she allegedly already received payment for the damages to her vehicle. Insurance fraud is a felony punishable by imprisonment for two to ten years, or by a fine of up to $10,000, or both. Suspected fraud can be reported ...

Mississippi pair charged with faking ATV theft
March 15, 2019, Wilkinson, MS -- Wilkinson County Deputy Sheriff Christopher James, 43, and Kelvin Tolliver, 54, both residents of Woodville, Mississippi, have been indicted on conspiracy and wire fraud charges, announced U.S. Attorney Mike Hurst and FBI Special Agent in Charge Christopher Freeze. James and Tolliver are charged with one count of conspiracy and one count of wire fraud involving a scheme and artifice to defraud Mississippi Farm Bureau. The indictment alleges that James and Tolliver conspired to fraudulently obtain insurance proceeds by creating and submitting a false offense report with the Wilkinson County Sheriff’s Department stating that Tolliver’s ATV had been stolen when, in fact, the ...

Agent lifts Colorado churchgoer IDs to create fake policies
March 15, 2019, Larimer County, CO -- A Larimer County life insurance agent who investigators said used his fellow church-goers' information to create fraudulent life insurance policies was sentenced to probation. Michael Nebeker, 38, pleaded guilty to four counts Jan. 14: theft between $100,000 and $1 million, a Class 3 felony; identity theft, a Class 4 felony; insurance fraud, a Class 5 felony; and forgery, a Class 5 felony. He pleaded guilty as part of an agreement from the Larimer County District Attorney's Office, according to court records. As part of that agreement, the district attorney dismissed 72 other charges. On Monday, Nebeker was sentenced to 30 days in ...

Kentucky woman allegedly has husband shot in face
March 15, 2019, Alton, KY -- An Alton woman police say wanted her husband murdered and the man they suspect of shooting him are both behind bars. Amanda Renea Rogers, 36, of 1140 Alton Road, Lot 24, is charged with solicitation of murder for allegedly conspiring with Jason Patrick Downs, 28, of 214 East Court St., Lawrenceburg to have her husband, Christopher Rogers, killed. Christopher Rogers was shot in the face Wednesday morning at his home, according to reports on file in the Anderson County Courthouse. He was transported to an area hospital and has reportedly undergone surgery. His condition was not available as of this report. A report ...

Spectrum Health Lakeland affected by healthcare data breach
March 14, 2019, Lansing, MI -- Around 60,000 patients who have been treated by Spectrum Health Lakeland and its various services in southwest Michigan are being notified of a data breach. Spectrum Health Chief Privacy Officer Leah Voigt tells WSJM News the hack happened at Wolverine Services Group, a vendor that handles mailing services with healthcare groups all over the state. “Patients should know that if they have been impacted, if their information was encrypted at Wolverine, that they should be receiving a letter within the next seven to ten days,” Voigt said. “That letter will explain the situation in more detail. It will also provide patients ...

2 Atlanta medical group execs sentenced to prison for $8.5M blood work scheme
March 14, 2019, Atlanta, GA -- The chief executive officer and the chief operating officer of a defunct Atlanta medical group were sentenced to prison Thursday after being convicted of conspiracy to commit healthcare fraud and aggravated identity theft. Shailesh Kothari, who also goes by Shue Kothari, was the CEO of Atlanta-based Primera Medical Group, Inc., and he was sentenced alongside his former COO Timothy McMenamin, U.S. Attorney Byung J. “BJay” Pak said in a news release. The duo was found guilty of participating in an allergy testing scheme, where they sought more than $8.5 million in insurance payments for more than 4,500 fraudulent claims, the release said. ...

Sacramento area pain clinic and its owner to Pay $860k to settle allegations of improper Medi Cal billings
March 14, 2019, Sacramento, CA -- Advanced Pain Diagnostic & Solutions Inc. and owner Kayvan Haddadan, M.D. have agreed to pay $860,000 to resolve allegations that the clinics violated the federal False Claims Act by knowingly submitting claims for reimbursement to California’s Medi‑Cal program for services rendered by a provider who was excluded from participation in the Medi-Cal program, U.S. Attorney McGregor W. Scott announced today. At the time of the alleged conduct, Advanced Pain operated pain management clinics in Sacramento, Roseville, and Rocklin. The clinics employed staff physicians and nurse practitioners (NP) who provided medical treatment to patients, including drug therapy and injections. Today’s settlement resolves ...

Nationwide medical scam could drive up health insurance costs
March 14, 2019, Pittsburgh, PA -- Over the holidays, Diane Depalma got a surprise in the mail. “I received a box. I put it aside because I thought it was Christmas stuff,” she says. “When I opened it, it was all this lidocaine, it was spray that was like Bioflex, or Biofreeze spray, and two liquids that are like an anti-inflammatory.” She didn’t know why she received it. Then she got a call from the fraud division of Highmark. “She told me the expense of the medication that they sent to me was $6,000,” she said. It’s a medical scam that’s sweeping the country. Surveys pop up in social media feeds, ...

Medical director of substance abuse treatment facility sentenced to prison for unlawfully distributing Opioids
March 14, 2019, Wellington, FL -- The Medical Director of a substance abuse treatment center in Wellington, Florida, was sentenced to prison today after having previously pled guilty today to unlawfully distributing controlled substances (opioids, barbiturates, and benzodiazepines). Ariana Fajardo Orshan, U.S. Attorney for the Southern District of Florida; George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Michael J. De Palma, Special Agent in Charge, Internal Revenue Service, Criminal Investigation (IRS-CI); Jimmy Patronis, Florida Chief Financial Officer; Michael J. Waters, Special Agent in Charge, Amtrak Office of Inspector General (Amtrak-OIG); Isabel Colon, Regional Director, United States Department of Labor, ...

Two owners of pharmacy who made millions illegally distributing prescription drugs sentenced to over a decade in prison
March 14, 2019, Los Angeles, CA -- Two brothers who owned a West Los Angeles pharmacy and were convicted of illegally selling prescription opioids and other narcotics to black market customers across the United States were sentenced late Wednesday, with each man being ordered to serve 121 months in federal prison. Berry Kabov, 48, and his brother Dalibor “Dabo” Kabov, 35, both residents of Brentwood, were sentenced by United States District Judge Dolly M. Gee. The Kabov brothers operated Global Compounding Pharmacy, a pharmacy that was located in West Los Angeles. Following a three-week jury trial in early 2017, the brothers were convicted of illegally selling the opioid narcotics ...

Lehigh County woman stole Social Security, Medicare benefits, feds allege
March 14, 2019, Lehigh County, NJ -- A South Whitehall Township woman allegedly lied about being disabled for more than a decade to collect hundreds of thousands of dollars in federal and state disability and unemployment benefits, federal prosecutors in New Jersey said. Martha Aguilar, 57, of the 1900 block of Pope Road, was indicted in August on charges of theft of government funds, Social Security fraud, and making false statements in furtherance of Social Security fraud. The U.S. attorney’s office in Newark announced a second indictment Thursday, charging Aguilar with three counts of health care fraud. Aguilar, formerly of Middletown, N.J., allegedly concealed her employment as a paralegal ...