News

Brit claim that he 'slipped' by pool to recover 37,00 EURO
June 17, 2019, London, -- A video circulating on social media shows the man crashing through the tree’s crown and landing with a thump on the floor. According to Diario de Mallorca, the man broke his collarbone and various ribs, leaving him with a whopping 37,000 hospital bill. The British holidaymaker then attempted to frame the Magaluf hotel, whose name was not disclosed, by claiming he slipped at the poolside. The hotel passed the claim over to an insurance agency, who promptly discovered the incriminating video on social media networks. The man reportedly received a reply from the hotel saying they would not be footing his bill. ...

Business associate causes a breach for Humana, affecting 5,569
June 17, 2019, Washington, DC -- Humana has notified 5,569 members that a limited amount of their protected health information may have been compromised. Unauthorized third parties posing as physician provider groups registered on one of Humana’s authorized vendors—Availity—the web portal of which providers use to check eligibility and benefits for multiple health plans. The hackers requested eligibility and benefit verification of health plan members by using certain personal information they already had in their possession. Humana executives say they have no reason to believe the information was obtained from Humana or Availity, and the breach was complex in nature and affected other health insurers—suggesting that other payers may ...

Towing firms bilk Alabama insurers, police can’t investigate all
June 17, 2019, Mobile, AL -- You’ve just wrecked your car and a Mobile police officer arranges for your vehicle to be towed, picking a towing company off a list kept by the department. Pretty convenient, right? The company arrives and tows your car to its yard, and you even get to ride shotgun in the front cab. Fun. That tow should cost $125 plus a daily fee of about $20 per day storage for regular vehicles, per Mobile City ordnance laws. But what do you care, an insurance company is picking up the tab. Well, guess what? A small number of towing firms have allegedly been charging insurance ...

Scammer takes fall in massive San Diego patient-referral con
June 17, 2019, San Diego, CA -- The San Diego County District Attorney’s prosecution of Operation Backlash, a large scale, undercover, joint federal and state investigation into multi-million dollar fraud and illegal kickbacks in the California workers compensation has moved forward as another defendant in the state’s case was sentenced. Operation Backlash is the largest healthcare insurance fraud scheme in the history of San Diego County. It resulted in both federal and state charges. Gonzalo Paredes, 63, was sentenced to five years in state prison on June 14, after a jury trial in November resulted in convictions on 51 felony counts. Paredes was the office manager for Advanced Radiology, owned ...

Ambulance firm threatens lives of investigators in New Jersey
June 17, 2019, Delran, NJ -- The former chief of the Delran Emergency Squad from Cinnaminson has been sentenced to 30 days in Burlington County Jail for falsifying patient care reports and then submitting the fabricated records to insurance providers as part of a scheme to collect money for services that were not billable, authorities announced on Monday. Donald Horner, 67 formerly of Cinnaminson, previously pleaded guilty to third-degree insurance fraud and third-degree tampering with public records, Burlington County Prosecutor Scott Coffina said. He also received three years of probation. Coffina called the sentence appropriate, even though the state had been seeking 364 days in jail. "Notwithstanding the ...

Oped in North Dakota: Fraud has many victims
June 17, 2019, Bismark, ND -- Last week in a news release about two North Dakota men accused of insurance fraud, it was brought home to us just how much those kinds of crimes cost the innocent in increased insurance premiums. First of all, the men written about in the news release have not been convicted. They are to be considered innocent, of course. But the schemes they are alleged to have have devised are quite common, we are told. Believe it or not, some people stage accidents so that previously damaged vehicles can yield illegal gain through falsified claims. People involve other drivers in accidents and make it look ...

Do comp insurers know they’re being scammed in California?
June 17, 2019, San Francisco, CA -- It was the overriding message that came out of a “Speed Networking” session held at the WCIRB Annual Conference in San Francisco last week. The session, facilitated by Shaddi Kamiabipour, Sr. Deputy DA for Orange County and Gordon Oard, Sr. Special Investigator for the Berkshire Hathaway Homestate Companies, focused primarily on provider fraud in workers' comp, which in California has been a major issue. But let's not fool ourselves. It is a big issue everywhere else, too. And according to Oard and Kamiabipour, the odds are that workers' compensation carriers don't really have a clue it is happening. Kamiabipour talked about the ...

NHS staff health secrets leaked in data breach bungle
June 16, 2019, Edinburgh, -- Private medical details of NHS staff were leaked to colleagues in an embarrassing data breach. Intimate details of employees off work with illness were sent in a global email, which made them accessible to all NHS 24 staff instead of just senior executives. It included details of workers who had suffered accidents, had mental health ­problems or were undergoing surgery. A probe was launched by the Information Commissioner’s Office (ICO) in Edinburgh, which is responsible for protecting the ­public’s privacy and personal data. The blunder was made by the employee relations team in the human resources department in Glasgow. When they realised the mistake, they ...

NBI releases co-owner of private clinic in ‘dialysis scam’
June 16, 2019, Phillipines, -- The National Bureau of Investigation (NBI) on Sunday finally released from its custody Bryan Christopher Sy, doctor and co-owner of a private dialysis clinic that had been linked to a scam with the state-run Philippine Health Insurance Corp. (PhilHealth) after posting bail. Counsel Rowell Ilagan said Sy from the WellMed Dialysis Laboratory Center was released at about 10 a.m. Metropolitan Trial Court (MTC) Judge Jerome Jimenez issued the release order after Sy posted a P72,000 cash bail bond. ...

Call centre with 30 staffers ran racket in insurance aggregator's name
June 16, 2019, Delhi, -- An insurance fraud being operated by two men, including a BTech graduate, from Delhi was busted after Policybazaar — an online insurance aggregator — informed police that the duo had cheated several people by issuing fake policy papers in the name of the company. The accused had cheated several customers and had earned at least Rs 50 lakh, police said. Identified as Avinash Kumar Jha (28) and Mahender Singh Rajput (31), the duo had set up a call centre in Delhi’s Tihar village and had around 30 people employed under them, who were told that Policy Bazaar had outsourced their ...

Harris reopens door to insurance industry funding anti-fraud fight
June 15, 2019, London, -- Garda Commissioner Drew Harris has re-opened the door to the insurance industry funding the fight against fraud, as latest figures show six new criminal investigations into false claims are opened every month. A working group set up by the Government three years ago to look at rising insurance premiums recommended a dedicated Garda unit – to be financed by insurers – to deal with fraudulent and exaggerated personal injury claims. The industry last year agreed to the proposal, based on a similar unit in Britain. But Mr Harris ruled it out last December, saying he was not prepared to accept any funding of ...

Former doctor and co-conspirator indicted for diverting Oxycodone
June 15, 2019, Benson, AZ -- Attorney General Mark Brnovich announced a State Grand Jury has indicted Dr. Glenn Gary Robertson and Timothy Arthur Evicci for Illegally Conducting an Enterprise, Conspiracy, Fraud, Transporting a Narcotic Drug for Sale, and Illegally Administering a Narcotic Drug. Robertson was an internal medicine doctor practicing medicine in Benson, Arizona. A joint investigation conducted by the United States Drug Enforcement Administration (DEA) and the Arizona Attorney General’s Office alleges that between January 2, 2017, and June 6, 2018, Robertson wrote 3,516 prescriptions for opioids, totaling 415,665 pills. The indictment alleges that Robertson was administering significant amounts of Oxycodone to Evicci and another ...

Pittsburgh heart doc steals $13M with fake “youth” treatments
June 14, 2019, Pittsburgh, PA -- After deliberating for two hours, a federal jury found Samirkumar J. Shah guilty of two counts of health care fraud, United States Attorney Scott W. Brady announced today. Shah, 56, of Fox Chapel, Pa., was tried before United States District Judge David S. Cercone in Pittsburgh, Pennsylvania. U.S. Attorney Brady stated, "Health care fraud threatens the safety and integrity of our entire health care system. Doctors and medical professionals like Dr. Shah who issue false diagnoses, order unnecessary testing and fraudulently bill Medicare and Medicaid in effect steal from the most vulnerable in our community. Today’s jury verdict sends a clear message ...

Two Pennsylvania physicians acquitted of drug charges in WV
June 14, 2019, Wheeling, WV -- After an eight-day trial, Dr. Krishan Kumar Aggarwal, of Moon Township, Pennsylvania, and Dr. Cherian John, of Coraopolis, Pennsylvania, were found not guilty of drug charges, United States Attorney Bill Powell announced. “The jury returned not guilty verdicts against Dr. Aggarwal and Dr. John. Notwithstanding the verdict, we remain steadfast in our intention to prosecute matters which we believe, based upon the evidence, support prosecution. Jury trials are an adversarial process and do not provide guaranteed results. Though we disagree with the jury in this case, the jury has spoken and that is part of the process, which ...

Medicaid billing upcharges prompts Oklahoma nurse to blow the whistle on hospital
June 14, 2019, Oklahoma City, OK -- Oklahoma Heart Hospital (OHH) has agreed to pay $2.8 Million to settle U.S. and Oklahoma government claims that the hospital committed Medicaid Fraud. Jennifferr Baird, a retired registered nurse, filed the complaint, which reported that her former employer, OHH was consistently billing Oklahoma’s Medicaid insurance program inpatient rates for outpatient procedures – regardless of whether a doctor ordered inpatient care or not. Ms. Baird’s 2015 complaint, filed under the False Claims Act (FCA) and a similar Oklahoma law because Oklahoma administers its Medicaid program with federal funds. The practice of billing inpatient rates for outpatient service is more commonly known ...

People are intentionally crashing their cars to commit insurance fraud, investigators say
June 14, 2019, Charlotte, NC -- An NBC Charlotte Defenders investigation is uncovering a dangerous and alarming trend that drivers will have to see to believe. The team found people intentionally staging car crashes to collect insurance money, and it’s happening in the Queen City. Now, North Carolina is dramatically beefing up resources to combat insurance fraud. The Defenders went to a Charlotte home to talk to a 29-year-old woman who, according to court documents, admitted to staging a crash. However, the woman’s brother was at the home, and he told NBC Charlotte she doesn’t live there. According to the traffic accident report, the crash happened around 5:30 ...

Sharon man to trial for alleged home improvement fraud in Crawford County
June 14, 2019, Crawford County, PA -- A Mercer County man will stand trial on home improvement fraud and theft charges for allegedly bilking a Woodcock Township woman out of almost $1,200. Mathew Scott Kerr, 27, of 365 E. Connelly Blvd., Sharon, failed to appear for a preliminary hearing Wednesday before Magisterial District Judge Lincoln Zilhaver and was ordered held for court on the charges filed by Pennsylvania State Police. Police allege Kerr took $1,194.53 from a Woodcock Township woman for cement work, telling the woman that he worked for Miller Concrete and was fully insured when he does not work for the firm nor have insurance. Kerr had been ...

Man found dead in burning car after buying life policy in Michigan
June 14, 2019, Farmington Hills, MI -- Relatives spent a good decade warning Darvin Tennyson his life was in danger. Tennyson and his wife were known to have serious conflicts over such things as bank accounts. When Darvin Tennyson shared that he had a half-million-dollar life insurance policy, “we told him he had just signed his death certificate,” his nephew Donald Tennyson said Thursday in 36th District Court. Detroit police and firefighters found a deceased Darvin Tennyson, 60, of Farmington Hills in a burning vehicle in Detroit on March 20, 2016. In April, more than three years later, Wayne County prosecutors charged his wife, Beatrice Flint-Tennyson, 68, of ...

Delaware woman fakes being her dying mother to buy life policy
June 14, 2019, Dover, DE -- Arlene Belfield, 51, of Lincoln DE, was arrested on Thursday, June 13th, 2019 by Capital Police, following an investigation by the Delaware Department of Insurance Fraud Prevention Bureau. The charges allege that in November, 2017, Arlene Belfield, pretending to be her terminally ill mother, contacted AAA Insurance by phone to obtain a $50,000 Life Insurance policy with the intent to defraud. To facilitate this fraud, the charges allege that Arlene Belfield used her mother’s personal identifying information without her consent. Arlene Belfield attempted to collect on the policy two days after her mother’s death, with the sole beneficiary of the policy ...

Consumers with fake health coverage can cancel plans
June 14, 2019, Washington, DC -- Tens of thousands of consumers still making monthly payments for “practically worthless” health insurance plans purchased from a shuttered Hollywood-based agency will be allowed to cancel those plans, a federal judge has ordered. Thursday’s ruling by U.S. District Judge Darrin P. Gayles marks the latest courtroom defeat in Steven J. Dorfman’s fight to prevent the Federal Trade Commission from permanently closing his company, Simple Health Plans LLC, and distributing its remaining assets to victims of what the FTC calls a sophisticated scam. Dorfman’s customers will be contacted within days by the distributor of their plans, Health Insurance Innovations, and given the option ...

Clay County doc prescribed opioids to people who didn't need them
June 14, 2019, Clay County, TN -- A Clay County doctor who was arrested by federal agents last month for opioid-related crimes has been indicted by a grand jury. Gilbert Ghearing, a family practice physician with an office in Celina, was indicted on more than 60 counts which include prescribing opioids without a legitimate medical purpose, and then fraudulently billing claims for those prescriptions to Medicare and TennCare. Ghearing was arrested last month for opioid-related crimes after federal agents believed he posed a flight risk. He was released with conditions following a hearing on May 22. The indictment reiterates allegations previously made against Ghearing: Prescribing controlled substances ...

Opioid crisis: Sales reps turned blind eye to Tennessee's pill mills
June 13, 2019, Morristown, TN -- The line at Dr. Abdelrahman Mohamed's pain clinic snaked down the hall, out the door and sometimes into the parking lot, full of patients with cash in fists. Federal agents knew Mohamed, the owner of Hamblen Neuroscience Center in Morristown, as the "drive-through doctor" who signed an average of 60 prewritten prescriptions for pain pills per day. Sales reps for Endo Pharmaceuticals knew him as a Grade A customer and saw nothing wrong. When suspicious local pharmacists stopped filling the prescriptions, Mohamed's Endo rep stepped in to help. "This is my top writer," the rep wrote in an email. "He is having a ...

Three physicians and five marketers charged for violations to federal anti-kickback statute
June 13, 2019, Tulsa, OK -- Three physicians and five marketers have been charged in U.S. District Court with violations of the federal anti-kickback statute and other criminal offenses, announced U.S. Attorney Trent Shores. The men allegedly caused federal health care insurance programs to pay reimbursement costs for fraudulent and expensive compounding drug prescriptions written by recruited doctors in return for kickback payments. The defendants would then use the reimbursed funds for their own financial gain. “Sadly, the American taxpayer ends up paying the price when unscrupulous medical professionals fraudulently bill federal health insurance. In these cases, patients believed they were receiving a compounded cream that fit ...

St. Louis City man sentenced for fraudulently cashing another's Social Security disability check
June 13, 2019, St. Louis, MO -- Christopher Lamar Smith, 34, of St. Louis, was sentenced to 26 months in prison for bank fraud, misuse of a social security number, and fraudulent use of identification documents. Smith appeared before U.S. District Court Judge Rodney W. Sippel who ordered him to pay $24,852 in restitution to the victim. According to court records, Smith fraudulently obtained a Social Security Administration check properly payable to another individual related to disability insurance benefits. Smith then used the victim’s name and other personal information to create a fictitious Missouri non-driver’s license and open a bank account in the ...

Chicago Mayor Lori Lightfoot says city will hire outside firm to oversee workers' comp program
June 13, 2019, Chicago, IL -- Chicago will transfer day-to-day control of its $100 million-per-year city workers’ compensation program, which for decades was largely handled in secret under the auspices of now-indicted Ald. Edward Burke, to a private company, Mayor Lori Lightfoot announced Thursday. A recent audit, performed by outside auditing firm Grant Thornton, found that the program did not operate according to industry best practices, staff members were inadequately trained, and it lacked “comprehensive policies and procedures governing claim handling, which can lead to inconsistent claim outcomes for workers,” according to the mayor’s office. Chicago’s workers’ comp program also lacks key protections against fraud, though auditors did ...