News

Congress advances legislation against surprise medical billing
July 27, 2019, Washington, DC -- Legislation against surprise medical billing and high health care costs for patients is advancing in the U.S. House of Representatives and the Senate. The Lower Health Care Costs Act passed the Senate Health Committee Wednesday by a 20-3 vote. Committee Chairman Sen. Lamar Alexander, R-Tennessee, said the legislation aims to end surprise medical billing, create more transparency with the medical billing process for patients and increase prescription drug competition through bipartisan provisions that aim to expand patient access to cheaper medications. “Altogether, this legislation will help to lower the cost of health care, which has become a tax on family budgets and ...

Fed employee allegedly pockets kickbacks for treating spines
July 19, 2019, Richmond, VA -- A Department of Veterans Affairs employee used a network of shell companies to steal millions of dollars from a VA program to provide health services to children of veterans who are suffering from a debilitating spinal condition, federal prosecutors say. The Justice Department lodged 23 federal criminal charges late last year against Joseph Prince, a former Veterans Affairs employee who prosecutors say used his position to steer almost $20 million in taxpayer money to companies run by family members and associates. Those companies then provided huge kickbacks to Prince, his wife, and other family members, the government alleges. ...

Health insurance make scamming too easy
July 19, 2019, Washington, DC -- Ever since her 14-year marriage imploded in financial chaos and a protective order, Amy Lankford had kept a wary eye on her ex, David Williams. Williams, then 51, with the beefy body of a former wrestler gone slightly to seed, was always working the angles, looking for shortcuts to success and mostly stumbling. During their marriage, Lankford had been forced to work overtime as a physical therapist when his personal training business couldn’t pay his share of the bills. So, when Williams gave their three kids iPad Minis for Christmas in 2013, she was immediately suspicious. Where did he get that kind ...

One in seven people guilty of committing fraud without even knowing it
July 18, 2019, London, -- Fraud figures are soaring - and last year, the illegal practice cost the economy £190billion pounds, with many losing their identities and life savings as a result. However, new figures show the practice of it could be a lot more common than you think with one in seven people admitting their guilty of such scams. New figures from Cifas - the UK's largest fraud database - show 'fronting' is now the most common type of consumer fraud in the UK - where a car owner intentionally lies about the main driver on their vehicle for a cheaper car insurance quote. The impact of ...

Searches carried out over insurance fraud in Dublin
July 18, 2019, Dublin, -- A number of searches have been carried out in Dublin by Gardaí investigating insurance fraud. The Special Investigations Unit (SIU) has been conducting an investigation into ghost brokering activities. Ghost brokers sell forged or invalid discounted insurance policies to unsuspecting consumers. They usually advertise their services online or within local communities, typically claiming to be able to secure a cheap motor insurance policy. Members of the SIU carried out two searches in the Dublin area on Wednesday. A number of items were seized including smart phones, laptops, desktop computers, hard drives and two imitation guns. Three bank accounts were also frozen under Section 17(1) of the ...

Richard Curran: 'Doing time for perjury would help insurance fraud battle
July 18, 2019, Dublin, -- Swearing on a Bible when taking the stand in a court case is probably the oldest way of 'ensuring' the witness tells the truth, the whole truth and nothing but the truth. It seems we may need something a little more robust than the individual's conscience and, depending on their beliefs, the idea they may face an eternity in hell. Punishment in this life, rather than the next, seems to be the way to go. The question of telling lies in court cases, tribunals of inquiry or other investigations has been around for many years. But more recently, the issue has grabbed ...

Fake guns, smartphones, computers seized during driving insurance scam raids
July 18, 2019, Dublin, -- Smartphones, computers and imitation guns have been seized by Gardaí investigating an insurance scam operating around Ireland. The Garda Síochána' Special Investigations Unit attached to DMR Roads Policing Unit in Dublin Castle, has been conducting an investigation into fraud related insurance ghost brokering activities throughout the State. SIU gardaí carried out two searches within the Dublin area as part of Operation PUCA on Wednesday, July 17. A number of items were seized at both locations including smartphones, laptops, desktop computers, hard drives and two imitation firearms (imitation pistol and imitation assault rifle). Three bank accounts were also frozen under the provisions of Section ...

Fake motor insurance policies more than double in last two years
July 18, 2019, Chenna, -- Chennai: Fake motor insurance policies have more than double from 498 cases to 1,192 cases, with more than Rs 53.7 crore worth fake policies sold in India in the last two years, data from IRDAI’s fraud monitoring cell showed. For the year 2016-17 498 fake policies were sold, which rose to 823 in 2017-18, which further increased to 1192 in 2018-19, finance minister Nirmala Sitharaman told the parliament in a written reply earlier this month. Most of the duplicate policies have been sold to truck users and two wheeler owners, who buy them to avoid police scrutiny when vehicular checks ...

Fake motor insurance policies more than double in last two years
July 18, 2019, Chenna, -- Chennai: Fake motor insurance policies have more than double from 498 cases to 1,192 cases, with more than Rs 53.7 crore worth fake policies sold in India in the last two years, data from IRDAI’s fraud monitoring cell showed. For the year 2016-17 498 fake policies were sold, which rose to 823 in 2017-18, which further increased to 1192 in 2018-19, finance minister Nirmala Sitharaman told the parliament in a written reply earlier this month. Most of the duplicate policies have been sold to truck users and two wheeler owners, who buy them to avoid police scrutiny when vehicular checks ...

SIU says its toll-free number being used in fraudulent calls asking for SIN
July 18, 2019, Ontario, -- Ontario's police watchdog says its toll-free number is being used in fraudulent calls that ask people for their social insurance number. The Special Investigations Unit says that in some cases the person answering the call is told that there is something wrong with their social insurance number. The SIU says the person is then told they will be charged or jailed if they don't continue with the call. The agency says it does not contact people over the phone for such personal information. It is asking anyone receiving such calls to report them to the Canadian Anti-Fraud Centre and Canada's Do Not Call List. The ...

Office of Insurance Commissioner says reports 49 fraud arrests in first half of 2019
July 18, 2019, Baldwin County, GA -- Agents in the Fraud Investigations Division of the Georgia Insurance Commissioner’s Office have made 49 arrests in the first half of 2019 and are set to pass the total number of arrests from last year (60) in just the third calendar quarter. “Insurance Fraud is a very serious and widely-practiced crime. The schemes are elaborate and well-planned,” said Insurance Commissioner John F. King. “I am very proud of the success our agents have had this year in bringing these criminals to justice. I look forward to building on our success in the second half of the year.” In February, Baldwin County Business ...

Wausau doctor convicted of prescription fraud
July 18, 2019, Wausau, WI -- Thomas Strick, a former doctor with Aspirus in Wausau, pleaded guilty to five counts of prescription fraud in federal court Thursday. Prosecutors say Strick wrote prescriptions for fentanyl patches to patients who didn’t need them with the intention they would return to him for personal use. He them allegedly offered those patients at home care. The fraud happened between 2015 and 2018. Sentencing is scheduled for October 9. He faces a maximum penalty of four years in prison. ...

20 New York towing firms suspected of widespread fraud
July 18, 2019, Albany, NY -- Tow truck operations are taking New Yorkers for a ride, according to the city Department of Consumer and Worker Protection. The watchdog agency is currently in the process of notifying 20 tow truck company licensees in Queens that they are among 130 operations citywide that are suspected of widespread fraud in the industry. None of the companies have been identified publicly by the department. An in-depth investigation suggests that a quarter of all licensees in the five boroughs may have engaged in widespread insurance and workers’ compensation fraud and the agency expects to name the operations in the coming days. “The tow truck ...

$84K Maine home burns, insurer pays out $350K
July 18, 2019, New Portland, ME -- The State Fire Marshal’s Office says a western Massachusetts man was arrested this week charged in connection with a fire that destroyed his second home in New Portland Maine two and half years ago. William Carabetta, 49, of Monson, Mass., was arrested at his home Tuesday evening by the Massachusetts State Police. Carabetta faces four counts of insurance deception and a fifth charge of conspiracy to commit insurance fraud. They said the charges stem from a January 2017 fire that destroyed his home at 38 Carrabassett Road in New Portland. Although investigators said the cause of the fire was never determined, Carabetta had ...

“Free” DNA test could cost consumers thousands
July 18, 2019, Washington, DC -- As the old saying goes: There’s no such thing as a free DNA test. Do-it-yourself DNA tests have taken off across the United States in recent years, but now officials are warning of scammers who promise free kits to steal victims’ private information and defraud health plans in California, Kentucky, Nebraska and beyond. Oregon Attorney General Ellen Rosenblum was the latest to warn the public of the scam on Thursday, saying multiple Medicare beneficiaries in the state have reported scammers victimizing them through telemarketing, health fairs and door-to-door pitches. Oregon officials also warned that the scam provides its perpetrators with “personal genetic information ...

Puerto Rico faces tougher scrutiny over federal Medicaid funding
July 17, 2019, San Juan, PR -- U.S. lawmakers on Wednesday called for heightened scrutiny of Puerto Rico’s Medicaid program as the bankrupt territory seeks increased federal healthcare funding while it deals with repercussions from a government corruption scandal. The House Committee on Energy and Commerce agreed to several accountability measures linked to a $12 billion funding boost over four years for the low-income healthcare program in Puerto Rico. A group of Republican U.S. senators, meanwhile, sought information on whether any safeguards are in place to deter misuse of the island’s federal Medicaid dollars. Last week, Angela Avila-Marrero, former executive director of Puerto Rico’s Health Insurance Administration, pleaded not ...

4 Cass County residents sentenced in federal Oxycodone case
July 17, 2019, Cass County, IA -- Four Cass County residents were sentenced in federal court for the distribution of Oxycodone. U.S. Attorney Marc Krickbaum says 50-year-old Mary Mayo, 34-year-old Tony Martin Mayo, Jr., 31-year-old Jessica Lynn Gross and 25-year-old Alex Lee Pleis were sentenced for conspiracy to distribute Oxycodone. Mary Mayo received 24 months in prison, Tony Mayo, Jr. received 12 months in prison, while the other two defendants were sentenced to time served, plus probation. The sentences stem from a lengthy investigation by the Drug Enforcement Agency using a confidential informant. Undercover DEA agents purchased prescription pills from Mary Mayo — which she fraudulently obtained using false ...

Hospitals, clinics in Los Angeles hit by data breach
July 17, 2019, Los Angeles, CA -- Phishing attacks strike again. Last week, Nemadji Research Corp., which does patient eligibility and billing services work for the Los Angeles County Department of Health Services, discovered that they’d been breached by a phishing attack. The attack enabled the criminals to gain access to the medical records of nearly 15,000 patients. According to Nemadji, on March 28, 2019, Nemadji identified unusual activity in an employee’s email account. They then contracted a security expert to determine what systems and data may have been compromised. That investigation concluded that the attacker behind the phishing attack gained access to an employee’s email account for ...

Trussville woman convicted on charges of health care fraud and money laundering
July 17, 2019, Trussville, AL -- A federal jury today convicted Dr. Patrick Emeka Ifediba, 60, of Shelby County, and Ifediba’s sister, Ngozi Justina Ozuligbo, 49, of Trussville, of numerous crimes stemming from their involvement with Care Complete Medical Clinic, located in Birmingham, Alabama, announced U.S. Attorney Jay E. Town, FBI Special Agent in Charge Johnnie Sharp Jr., and Drug Enforcement Administration Assistant Special Agent in Charge Clay Morris. The U.S. Department of Justice said that following a four-week trial before Judge David R. Proctor, the jury convicted Ifediba of 35 counts involving unlawful drug distribution, health care fraud and money laundering. Specifically, Ifediba was convicted ...

Delhi farmer Dickerson pleads guilty in $17-million fraud
July 17, 2019, Monore, LA -- Delhi farmer Thomas “Tommy” Dickerson pleaded guilty Monday to making false statements to the U.S. government in crop loan applications to fraudulently obtain some $998,000. At the U.S. District Courthouse in Monroe, Dickerson signed a plea agreement acknowledging his guilt to two counts of making false statements to the U.S. Department of Agriculture’s Commodity Credit Corporation. U.S. District Court Judge Terry Doughty, of Rayville, accepted Dickerson’s guilty plea. The government estimated Dickerson fraudulently obtained a total of at least $17 million from the government, local banks and other agricultural lending entities in northeastern Louisiana and southern Arkansas. The government did not move to detain ...

Scammers make good contractors look bad in West Virginia
July 17, 2019, Huntington, WV -- After a devastating storm hits and leaves behind a path of destruction, often swindlers are eager to pounce. People who work on repairing homes after storm damage say scammers are harming their ability to do their jobs. "It dramatically affects us," Brandon Madden said. Madden owns Aftermath Storm Consultants in Barboursville and says scammers damage the credibility of those legitimately trying to do the work. "Trust is a huge thing," Madden said. Madden says 90 percent of their business comes from going door to door, but con artists have made it much harder to earn potential clients' trust. "We go door to door because that's where ...

Why 70% of healthcare orgs have suffered data breaches
July 17, 2019, Washington, DC -- Digital transformation initiatives bring a slew of data privacy concerns to US health organizations, according to a Thales report. With digital transformation initiatives pervading the healthcare industry, many are facing data breaches as a result, according to the 2019 Thales Data Threat Report—Healthcare Edition. The majority (70%) of US healthcare organizations surveyed said they've experienced a data breach, with a third reporting one occurring in the past year alone. All healthcare organizations (100%) reported collecting, storing, or sharing sensitive data with digital transformation technologies, the report found, but 38% or less are successfully encrypting their data along the way. Healthcare companies ...

Bangor-area health network warns 13,000 patients of potential data breach
July 17, 2019, Bangor, NY -- Penobscot Community Health Care, a nonprofit primary care network serving the Bangor area, Belfast and Jackman, has notified patients that some of their personal records — including credit card information — may have been inappropriately accessed in a data breach. An unauthorized person may have obtained data about 13,000 patients, stored by a billing collection contractor between August 2018 and March 2019, PCHC said on its website. American Medical Collection Agency, based in Elmsford, N.Y., notified PCHC on May 15 of the potential breach. PCHC began sending letters about the incident to affected patients on July 12. Information that may have been accessed ...

2.2M clinical pathology patients included in AMCA data breach
July 17, 2019, Augusta, ME -- Clinical Pathology Laboratories (CPL) in Texas has been added to the victims of the massive breach of billing services vendor American Medical Collection Agency, which already includes Quest Diagnostics, LabCorp, BioReference, and Penobscot Community Health Center in Maine. In early June, AMCA began notifying up to 11.9 million patients of testing giant Quest Diagnostics that their financial data, Social Security numbers, and medical information was potentially breached during an eight-month hack on its web payment system. Days later, LabCorp reported up to 7.7 million of its patient records were also compromised during the AMCA security incident. The breached data included demographic details, ...

Kentucky lab owner admits to defrauding Humana, Aetna, Anthem
July 17, 2019, Owensboro, KY -- The owner of a toxicology lab in Kentucky pleaded guilty for his role in a conspiracy that defrauded health insurers of more than $1.3 million, according to the Department of Justice. Dinesh Goyal, owner of Owensboro, Ky.-based Tristate Medical Laboratory, falsely submitted billing information to Kentucky's Medicaid program that made it look like urine drug tests completed outside of his facility were performed at Tristate. Mr. Goyal was falsely billing tests for two co-conspirators, who were restricted from filing claims due to concern over their legitimacy. Through the scheme, Mr. Goyal received 40 percent of the fraudulent claims. The fraudulent claims were ...