News

Tipton County woman charged with TennCare drug fraud
April 25, 2019, Tipton County, TN -- A Tipton County woman is charged with TennCare fraud in connection with the sale of prescription drugs paid for by the state’s health care insurance program. The Office of Inspector General (OIG), with the assistance of the Tipton County Sheriff’s Office, today announced the arrest of Ursula Patrice Adams also known as Ursula Patrice Ponder, 51, of Covington, Tenn. She is accused of obtaining the dangerous opiate Fentanyl, and on two separate occasions she allegedly sold a portion of the drugs during an undercover investigation. According to the U.S. Drug Enforcement Agency, fentanyl is 80 to 100 times more potent than ...

Washington legislature passes 30-day data breach notification law
April 24, 2019, Olympia, WA -- The Washington legislature unanimously passed new legislation that effectively truncates the time organizations in the state must begin notifying victims of a data breach to just 30 days. For healthcare organizations, the breach notification timeframe has been effectively cut in half, as HIPAA gives providers 60 days to report a breach from time of discovery. Further, the Washington Attorney General must also be notified within 30 days and without reasonable delay. In addition to modifying notification requirements, the bill expands the definition of consumer information. Currently, the state’s law defines a breach as the combination of an individual’s name with their Social ...

Study blames medical claims for high auto insurance rates in Michigan
April 24, 2019, Lansing, MI -- A new study into the high cost of auto insurance in Michigan points the finger at no-fault insurance and blames the system for soaring medical claims and an explosion in accident-related lawsuits. But at least one consumer advocate faults the report for not scrutinizing insurance companies and their role in setting the prices that motorists actually pay for coverage. The study, released this month by the national Insurance Research Council, an insurance industry-funded group, says that the frequency of auto accidents and motor vehicle fatalities in Michigan are below nationwide averages. Yet Michiganders still pay some of the highest auto insurance premiums ...

Man dies after using $33,000 insurance check to go on binge
April 24, 2019, Raleigh, NC -- Jennifer Alba sifts through the boxes of photographs and documents. It's a collection of what once was, and what her life has become. A mother sorting through pain. There's her son, Joseph, as an infant, smiling, dressed in a onesie with his bright blue eyes matching the blue backdrop. He was her firstborn, a gift who came into her life when she was just 17. Not too far away lies the document from a middle school recommending that he be suspended for the last few weeks of school after being caught with marijuana. He was 13. It was the start of a lifelong ...

New Albany doctor charged with drug trafficking, theft, fraud and more
April 24, 2019, Albany, NY -- A New Albany doctor was arrested Wednesday on charges of drug trafficking, aggravated funding, theft, and multiple other charges. A 28-count indictment was announced against Khaled Amr, 56, for corrupt activity that occurred from 2012-2019, Franklin County Prosecutor Ron O’Brien said. Dr. Amr, who ran Columbus Pain Specialists pain management facility, is accused of over prescribing pills in order to get cash as a kick back for providing the prescriptions. “The Doctor came to the attention of the local DEA task force because of alleged over prescription of opioid medication,” O’Brien stated. “This doctor was involved in over a half dozen different ...

Feds to sue Sen. Steve Dickerson and other pain clinic owners over fraud, forgery allegations
April 24, 2019, Nashville, TN -- Federal and state prosecutors are moving to file lawsuits accusing Tennessee Sen. Steve Dickerson and other owners of a massive pain management company of defrauding the government with years of unjustified tests, dishonest billing and forged documents. Their company, Comprehensive Pain Specialists, or CPS, allegedly profited so much from questionable drug tests that a corporate executive once said urine samples "smelled like money," according to newly unsealed federal court records. Prosecutors revealed in those court records they plan to sue CPS by incorporating allegations from seven whistleblowers who filed secret complaints against the company over the past three years. Five of ...

Cars torched at California dealership in suspected scam
April 24, 2019, Carlsbad, CA -- Police say a fire that erupted at a North County car dealership in March was a part of an insurance scam by the suspect. Carlsbad Police arrested Charleston Octavius McGhee, 29, on April 20 and charged him with multiple felony counts, including insurance fraud and arson. He was also charged in association with the theft of a 2018 Dodge Charger Hellcat on April 4 from the dealership. His bail has been set at $185,000. The fire broke out early March 26 at Carlsbad's Bob Baker Chrysler Jeep Dodge RAM Fiat on Car Country Dr. Police say a caller reported several vehicles on fire ...

Coalition: Florida reforms a victory over abusive claim takeovers
April 24, 2019, Washington, DC -- New reforms of widely abused assignments of insurance benefits will rein in contractors and attorneys who preyed on Florida homeowners and insurers for years, the Coalition Against Insurance Fraud said today. “Passage is a great victory that will go far in curbing insurance fraud and abuses that have driven up homeowner premiums and subjected honest homeowners to shoddy repair practices with seeming impunity,” said Dennis Jay, Coalition executive director. The state Senate today passed urgently needed reforms of so-called Assignment of Benefits. The bill mirrors a House-passed version, and Gov. Ron DeSantis has promised to sign. “The Coalition applauds the Senate and House ...

Californian torches dental spa, flood home for insurance
April 24, 2019, Corona, CA -- A Corona man has been sentenced to 17 years in prison for flooding a business, setting his home on fire and filing false insurance claims, the Corona Fire Department said Wednesday, April 24. Cornel Lucaci, 58, was sentenced April 15 after being convicted in March of nine charges related to false insurance claims, two counts of grand theft, arson, forgery and burglary, according to Riverside County Superior Court records. He was also ordered to pay more than $900,000 restitution. The charges were borne out of a January 2014 insurance claim for water damage at Parkridge Dental Spa, 520 E. Parkridge Ave., Corona, ...

Tree trimmer treed after claiming comp injury in Ohio
April 24, 2019, Lisbon, OH -- Kevin E. Kirby, 44, North Market Street, Lisbon, was sentenced to nine months in prison and ordered to pay restitution to the Bureau of Workers’ Compensation in the amount of $26,222 once he is released from prison. Kirby had pleaded guilty in February to workers compensation fraud, theft and 11 counts of tampering with records. Beginning on Dec. 1, 2016 and continuing through Nov. 20, 2017, Kirby had received about $10,338 in temporary total disability benefits through the Bureau of Workers’ Compensation, while he was also receiving cash payments for unreported employment through Harter’s Tree Service in Lisbon. He falsified ...

California construction firm alters payroll records, steals $6M
April 24, 2019, Paramount, CA -- A brother and sister who run a construction company in Paramount have admitted to their roles in a $6 million workers' compensation fraud and labor theft scheme, the Los Angeles County District Attorney's Office announced today. Enrique Vera, 49, of Tarzana, who owns Ultimate, Inc., pleaded no contest yesterday to one felony count each of workers' compensation fraud and grand theft of labor, according to Deputy District Attorney Christopher Hartman of the Healthcare Fraud Division. Gloria Vera, 58, who is the company's office manager, pleaded no contest to one felony count each of workers' compensation fraud and insurance fraud. They both admitted ...

'Bad dentist' avoids prison in Medicaid fraud scheme
April 23, 2019, Springfield, MO -- Federal prosecutors say it was a symbiotic relationship. Dental clinic owner Pamela Van Drie needed a dentist who would go along with her plan to defraud Medicaid without asking too many questions. And dentist James Dye needed a dental office willing to hire him despite the multiple complaints brought against him for shoddy care. The U.S. Attorney's Office for the Western District of Missouri says Dye and Van Drie teamed up to defraud the government of more than $165,000 in a scheme involving mouthpieces between 2010 and 2015. Prosecutors say Dye would provide patients with $50 Ortho-Tain devices that look similar to football mouth ...

New whistleblower seeks to disqualify "parasitic" relations in $235M Texas/Xerox Medicaid fraud settlement
April 23, 2019, Travis County, TX -- Linda Reed, the former Xerox/Conduent employee who recently brought a lawsuit to be recognized as the original whistleblower in the $235 million Texas/Xerox/Conduent Medicaid fraud settlement, has filed further motions with the District Court in Travis County to have other latecomer joint relators disqualified from any award and to strike their motion for it. Claim to be original whistleblower Ms. Reed worked for Xerox/Conduent in their orthodontic prior authorization department and blew the whistle on the allegedly fraudulent nature of the process in early 2007. Close ties to OAG The other relators, represented by lawyers from the Dallas law firm Waters & Kraus, Houston ...

3 charged with trying to buy prescription cough syrup with false information
April 23, 2019, Troy, GA -- Three Georgia residents have been arrested in Troy for reportedly trying to buy cough syrup with forged prescriptions. According to the Troy Police Department, 24-year-old Jameel Marquis Davis of Atlanta, 23-year-old Malik Bobby Rowe of Decatur, and 19-year-old Megan Korea Davis of Jonesboro were taken into custody after a failed attempt to buy promethazine-codeine cough syrup at Walmart Pharmacy. Police say they had tried to buy the controlled medication at three other pharmacies before Walmart and were successful at one of them. According to the National Institute on Drug Abuse, promethazine-codeine cough syrup contains codeine, an opioid that acts as a cough ...

Man allegedly fakes tumble in water at Wendy’s in Carolina
April 23, 2019, Raleigh, NC -- A Georgia man faces felony charges after being accused of intentionally falling at the Wendy’s fast-food restaurant in Murphy last summer. North Carolina Insurance Commissioner Mike Causey today announced the arrest of Cedric Shropshire, 42, of Calhoun, Ga. He is charged with felony insurance fraud. Special Agents with the Department of Insurance’s Criminal Investigations Division accuse Shropshire of trying to deceive Employers Mutual Casualty Insurance Co. by claiming he slipped on the restaurant’s floor near the bathroom. According to the arrest warrant, the restaurant’s surveillance video shows Shropshire initially looking down at water on the floor, stepping over the water and ...

Psychotherapist to pay $82K, cardiac care providers to pay over $80K for alleged Medicaid fraud
April 23, 2019, Baltimore, MD -- Maryland Attorney General Brian Frosh announced two settlements over Medicaid fraud with cardiac and psychotherapy care providers. Five cardiac care providers have agreed to pay $81,234.80 to resolve allegations that they submitted false claims for Medicaid services. The following cardiac care providers will pay: Cardiac Associates, P.C., a practice with offices in Rockville, Olney, Laurel and Germantown, paid $30,143.20; Horizon Vascular Specialists, with locations in Olney, Rockville, Frederick and Germantown, paid $26,113.50; St. Agnes Healthcare, Inc. of Baltimore paid $19,868.10; Riverside Medical Associates of Riverdale paid $3,152; Maryland Specialty Group, a Glenn Dale-based practice, paid $1,958. The Attorney General’s Medicaid Fraud Control Unit alleged the providers submitted false ...

Michigan congratulations you are #1 when it comes to auto insurance rates
April 23, 2019, Lansing, MI -- Great job Michigan you have topped the charts for 6 years in a row. What exactly did you do to top the charts, well you have the country’s highest auto insurance rates. You get to pay more money than anywhere else in our country for the privilege of insuring and driving your vehicle in this great state. Insure.com performs an annual ranking of the most and least expensive states for vehicle insurance in the United States. The press release stated: For the sixth year in a row, Michigan took the top spot as the most expensive state to insure a ...

Sentencing in June for prescription fraudster
April 23, 2019, Douglas, -- A man who forged a prescription using a stolen form will be sentenced in June. Twenty-four-year-old Dean Thomas John Costain-Quirk pleaded guilty to three charges when he appeared before magistrates. The hearing at Douglas courthouse was told Costain-Quirk had an appointment with a community mental health service psychologist on 21 January. He stole a blank prescription form, and later filled it in himself. Prosecutor Richard Butters told the court Costain-Quirk, of Demesne Road, tried to have the prescription filled at Lloyds Pharmacy in Douglas. However, he'd made so many mistakes on the form staff became suspicious and called police. During the hearing, he admitted theft, fraud ...

Allstate lodges RICO suit against alleged Michigan no-fault ring
April 23, 2019, Detroit, MI -- Auto insurance giant Allstate claims in a new federal lawsuit that it fell victim to a racketeering conspiracy involving six metro Detroit patient treatment clinics, an MRI center and a medical transportation company that Allstate says acted together and made millions by abusing Michigan's no-fault insurance system. Some of the clinics received help, the lawsuit says, from tow truck drivers and auto repair shop workers, who were supposedly offered kickbacks by middlemen such as $500 per patient referral. Other patients were illegally solicited to visit clinics just days after their car crashes, according to Allstate, by individuals who called up ...

Washington man claims disabled, allegedly harvests shellfish
April 23, 2019, Shelton, WA -- A Shelton man faces a felony theft charge accusing him of commercially harvesting and delivering shellfish while claiming he was disabled from a back injury and couldn't work. Jose Cruz Contreras Alvarez, 39, is scheduled for arraignment on Tuesday, April 23, on one count of first-degree theft in Thurston County Superior Court in Olympia. He's charged with stealing more than $70,000 in workers' compensation benefits from late 2016 through July 2017. The amount includes medical and vocational benefits and more than $32,000 in payments to replace his wages. The Washington Attorney General is prosecuting the case based on a yearlong investigation by the ...

Jersey judge dismisses med charges, case goes to grand jury
April 23, 2019, Passaic County, NJ -- A Passaic County judge has dismissed healthcare insurance fraud charges against a doctor and two of her employees. However, prosecutors plan to present the case to a grand jury. Judge Justine Niccollai dismissed the charges against the three women – doctor Lisa Ferraro, Yvonne Jeannotte-Rodriguez, and Marta Galvan – “without prejudice” on Apr. 3, according to court documents. “I was falsely accused and charged with insurance related crimes along with my office manager, Mrs. Marta Galvan and a former medical assistant,” said Ferraro in a letter to the Paterson Times last week. “The entire case was dismissed and all of the charges ...

Michigan cracking down on payroll scams, misclassifying
April 22, 2019, Lansing, MI -- Michigan Attorney general Dana Nessle is creating a new unit to recover $107 million in tax revenue lost each year from businesses illegally misclassifying workers or paying them off the books. At a Monday press conference, Nessel announced the creation of a task force to aggressively investigate new complaints of payroll fraud. Senate Minority Leader Jim Ananiach, D-Flint, said Democrats are bolstering the effort with a package of bills aimed at increasing civil and criminal penalties for payroll theft, strengthening protections for whistleblowers and auditing companies that commit violations. “Companies that cheat and steal are committing crimes, plain and simple,” Nessel said. ...

EmCare says February email breach exposed some patient, contractor and employee data
April 22, 2019, Washington, DC -- Physician staffing company EmCare is alerting patients, employees and contractors about a Feb. 19 data breach that exposed their personal data, according to the Dallas Morning News. An unauthorized third party gained access to Social Security numbers and clinical information of some patients through employee email accounts. EmCare also found the security breach exposed names, dates of birth and drivers license numbers. It is unclear how many people were affected by the data breach. EmCare is unsure if the personal information was taken, but there has been no indication of fraud or identity theft. EmCare has since taken additional steps to ensure similar ...

Medical data of patients leaked in new breach
April 22, 2019, Washington, DC -- Data breaches come in all shapes and sizes and what's worse, they're much more commonplace than ever before. While they're all inherently bad, what varies is the severity of the exposure and the impact it could have on you. You could have a breach involving millions of records, but if it's just a bunch of email addresses, that's a manageable issue. There are also those breaches that affect a smaller group of people, but the number doesn't matter if that exposed data is full of your most sensitive information -- like medical records. Sometimes the word "sensitive" doesn't do a situation justice, and ...

Statewide helplines set up for patients affected by arrests of doctors and nurses
April 22, 2019, Nashville, TN -- Tennessee is activating substance abuse resources and statewide call lines to help patients affected by the arrests of doctors and nurses in a crackdown on prescription opioid abuse. Indictments were unsealed last week charging more than 30 medical professionals in Tennessee with illegally prescribing and distributing millions of painkillers. A federal grand jury indicted Dr. Harrison Yang, 75, of Manchester, Tennessee, with healthcare fraud violations. In a separate case, Nurse Practitioner Jonathan White, 49, of Tullahoma, Tennessee, was indicted on three counts of healthcare fraud and one count of conspiracy to commit healthcare fraud. According to a news release, TennCare members receiving services from ...