News

Miami man allegedly sells truckers $60K of fake premiums
December 06, 2018, Miami, FL -- Chief Financial Officer (CFO) Jimmy Patronis announced the arrest of Kemny Niebla, owner and operator of Andoba Trucking Company and Sea Trucking in Hialeah, after allegedly selling fraudulent insurance coverage with certificates of insurance totaling nearly $60,000 to three local commercial truckers. CFO Jimmy Patronis said, “Pocketing insurance premiums for your own financial gain is despicable. It puts the victim in the dangerous position of going without proper insurance coverage, and puts unsuspecting drivers in a financially risky position. If you choose to commit fraud to make a quick buck, my office will find you and make sure you pay ...

Man steals IDs, $8K auto-insurance payout in New York
December 06, 2018, Manhattan, NY -- Attorney General Barbara D. Underwood today announced the conviction and sentencing of Sharif King, 32, of Manhattan, for stealing the personal identifying information of employees and prospective employees, and then fraudulently using their identities to steal an $8,000 insurance settlement, buy a $58,000 2015 Mercedes Benz Sprinter passenger van, and attempt to take out a $29,000 loan. An investigation by the Attorney General’s Auto Insurance Fraud Unit revealed that Sharif King engaged in two separate identity theft schemes between 2013 and 2014. King was sentenced to 7 ½ to 15 years in state prison. “Identity thieves continue to find new ...

6 Detroit docs allegedly steal $464M, prescribe 13M pain doses
December 06, 2018, Detroit, MI -- Six doctors were charged in an unsealed indictment Thursday with cheating Medicare and Medicaid out of almost $500 million and fueling the nation's opioid epidemic by illegally prescribing more than 13 million doses of prescription pain medication. The dollars and drugs involved make the alleged health care fraud conspiracy one of the largest in Michigan history, and one of the largest nationwide. The scheme was focused within three pain clinics in Macomb County. They are The Pain Center USA in Warren and Eastpointe, and Interventional Pain Center in Warren. The three clinics were owned and operated by Dr. Rajendra Bothra, 77, of Bloomfield ...

Pennsylvania driver allegely buys insurance after hitting tree
December 06, 2018, Coalport, PA -- A Coalport man accused of insurance fraud in regard to a vehicle accident waived his right to a preliminary hearing yesterday at Centralized Court in front of District Judge James Glass. Jesse J. Finnegan, 54, is charged with one count of theft by deception—false impression and one count of false/fraud/incomplete insurance claim, both of which are felonies of the third degree. In the affidavit of probable cause filed by Special Agent James Kopera of the Attorney General’s office, the investigation was based upon a referral of information by Jessica Kolcun of Safe Auto Insurance Company. The investigation revealed that Finnegan filed a claim ...

Duo stage hit-and-run, inflate injury claim in South Carolina
December 05, 2018, Sumter, SC -- South Carolina Attorney General Alan Wilson announces that Kayla Breann Payne, 26, of Sumter, South Carolina, entered a plea of guilty on November 8, 2018 on an insurance fraud charge. Payne pleaded guilty to one count of Making a False Statement or Misrepresentation $1,000 or More. The Honorable R. Ferrell Cothran accepted the plea and sentenced Payne to three years in prison on the charge. That sentence is suspended to 18 months of probation. As a part of her probation, Payne must repay $800 restitution to USAA. Probation may terminate upon her repayment of the restitution. “Our insurance fraud ...

Payroll firm cheats Ohio comp agency out of $425K
December 05, 2018, Columbus, OH -- The owner of a former payroll services company in Ohio was sentenced to six months in federal prison and fined $10,000 Tuesday for defrauding the Ohio Bureau of Workers' Compensation out of more than $425,000, the bureau announced Tuesday. John R. Cacaro, 59, owner of the now-defunct Employers Choice Plus LLC, was convicted in June on wire fraud and money laundering charges after BWC and Internal Revenue Service investigators discovered a scheme he concocted to short BWC on the insurance premiums he received from employers and pocket the difference, according to a statement. Mr. Cacaro was also sentenced to one year of ...

Chiro pleads in $150M bogus-surgery plot in California
December 05, 2018, Los Angeles, CA -- A 56-year-old chiropractor has pleaded guilty for his role in a massive workers’ compensation insurance fraud and conspiracy scheme, the Los Angeles County District Attorney’s Office announced today. Paul Turley (dob 11/12/62) of Granada Hills made a factual basis plea on Monday to one count each of conspiracy to commit insurance fraud, mayhem, insurance fraud and unlawful patient referral. As part of the written plea agreement filed with the court, Turley detailed his involvement in the scheme. He faces up to eight years in state prison. Sentencing is set for June 14. Deputy District Attorneys Dayan Mathai, Catherine Chon, Karen Nishita and Kennes ...

View video: Did senior driver hit man, or was it a Tampa setup?
December 04, 2018, Winn-Dixie, FL -- Surveillance video could make or break the prosecution’s case against John Lee. In January 2017, the vehicle of an elderly couple may have come into contact with Lee as he walked through a Winn-Dixie parking lot. Lee says he was struck and is asking for damages. Lawyers for the elderly couple and their insurance company say Lee targeted them in an attempt to defraud the insurance company. Surveillance video of the incident, from Winn-Dixie, was shown to jurors Tuesday. They will now have to decide if what they saw was an accident or deliberate on the part of Lee, who ways he should get ...

Iowan allegedly hid employment to inflate fed disability payouts
December 04, 2018, Des Moines, IA -- The wife of a former Democratic state Senate candidate who sought the district 15 seat in Jasper and Polk Counties during the 2018 midterm election will stand trial May 6, 2019, for alleged federal social security crimes. Leesa M. Parkhill-Nieland is facing one count each of theft of government funds, social security fraud — concealment and making false statements to a federal agency, according to U.S. court documents. The charges first came to light in September during the height of the Iowa Senate general election campaign for Democrat Dan Nieland, Parkhill-Nieland’s husband. According to court documents, the 47-year-old Altoona woman allegedly received Social ...

Home-health firm pays kickbacks for $8.6M of services in Florida
December 04, 2018, Miami, FL -- Two Miami, Florida residents pleaded guilty today to health care fraud charges for their roles in an $8.6 million health care fraud scheme. Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon R. Richmond of the Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Miami Air and Marine Branch Director Martin G. Wade of the U.S. Customs and Border Protection (CBP) Air ...

Chicago chiro bills insurers for phantom treatment
December 04, 2018, Chicago, IL -- A federal jury has convicted a Chicago doctor on fraud charges for billing insurance companies for purported chiropractic manipulations that were never performed, the U.S. Attorney’s Office for the Northern District of Illinois reported. Dr. Paul Madison, an anesthesiologist and pain management specialist, owned Watertower SurgiCenter LLC, an outpatient surgical center on North Michigan Avenue in Chicago. The U.S. Attorney’s Office reported that from 2005 to 2009, under Dr. Madison’s direction, Watertower’s billing staff submitted false bills to insurers for manipulation-under-anesthesia of body parts that chiropractors at Watertower had not actually performed. Dr. Madison and others falsified patient records to support the fraudulent ...

Survey: Quality of fraud data important to insurers
December 03, 2018, Washington, DC -- With more than $34 billion lost in 2017 to fraudulent insurance claims, one of the insurance industry’s highest priorities is protecting themselves from fraud through innovative technologies. That’s according to the 2018 Insurance Fraud Survey from FRISS, which surveyed 150 insurers. Among the company’s key findings were that the quality of a carrier's data has become increasingly important. Forty-five percent of insurers report a challenge with the quality of fraud data collected, up from 30% in 2016, when only 30% of insurers saw this as a major challenge. Carriers find too little information is available, or poor-quality information is disrupting the ...

Timesheets forged for home-health scam in Pittsburgh
December 03, 2018, Pittsburgh, PA -- A relative of two sisters charged in a home health care ripoff scheme involving millions in false Medicaid billings dating to 2011 became a federal felon Monday when he admitted to a conspiracy count. Travis Moriarty, 37, of Pittsburgh, is the first of 16 people charged in the case to enter a plea. Federal prosecutors say the scheme was led by Arlinda Moriarty, Travis's sister-in-law, who ran Moriarty Consultants on Perrysville Avenue, and her sister, Daynelle Dickens, who controlled a related company. The sisters were named in a 22-count indictment handed up last week charging them with billing Medicaid for services that were ...

Revealed: Hidden history of failures fake medic’s
December 03, 2018, London, -- Our investigation has uncovered an astonishing litany of formal complaints were lodged against the fraudster, with allegations ranging from inappropriate prescribing, making insensitive comments to patients, and rudeness, to falsifying her CV, illegally detaining patients, and bullying. She was also investigated for alleged prescription fraud and failing to disclose she was accused of assaulting a police officer. Despite the scale and severity of the allegations - dating back to 1998 - the strongest sanctions she received until her arrest in 2016 were conditions and a warning. She was suspended only after police in west Cumbria arrested her for fraud and theft. The failure ...

New avenues opening to combat home health care fraud
December 03, 2018, Washington, DC -- Even though the Center for Medicare and Medicaid Services has imposed new rules and regulations in an effort to combat home health care fraud, there are still going to be individuals who take advantage of loopholes, flaws in the system, and other opportunities to fraudulently acquire money for services not required, necessary, or even provided. The answer in helping to combat home health care fraud moving forward may lie in artificial intelligence. Researchers at Florida Atlantic University created programs that were intended to detect potential fraudulent activity in Medicare Part B claims. The focus of this research study was to determine ...

Felon pleads guilty to over $464,000 in supplemental nutrition assistance program
December 03, 2018, Raleigh, NC -- United States Attorney Robert J. Higdon, Jr. announced that today in federal court, FERNAN SANCHEZ, 51, waived indictment and pleaded guilty to SNAP fraud and conspiracy to commit money laundering charges. SNAP, formerly known as the Food Stamp Program, is a federally funded, national program established by the United States Government to alleviate hunger and malnutrition among lower income families. The United States Department of Agriculture administers the SNAP through its agency, the Food and Nutrition Service (FNS). FNS is responsible for the authorization and disqualification of retail food establishments participating in the redemption of SNAP benefits. Social ...

Pennsylvanian allegedly lies that water wrecks his computer
December 03, 2018, Erie, PA -- State investigators charged him in two incidents from earlier this year. An Erie man charged by state investigators in a pair of insurance fraud cases is facing trial after waiving the felony charges filed against him to court. Richard E. Weber, 29, waived his preliminary hearings before Erie 1st Ward District Judge Sue Mack Monday morning on third-degree felony counts of false or fraudulent insurance claim and theft by deception in one case; and on third-degree felony counts of false or fraudulent insurance claim, theft by deception and insurance fraud in the second case. Weber, who represented himself in court Monday, is free ...

Connecticut man tricks insurers into policies for seniors
December 03, 2018, Simsbury, CT -- A Simsbury resident was sentenced Monday to 30 months of imprisonment for his role in a life insurance scam, according to John H. Durham, United States Attorney for the District of Connecticut. Daniel Carpenter, 64, was sentenced by U.S. District Judge Robert N. Chatigny in Hartford. The sentence includes three years of supervised release. Carpenter was accused of defrauding insurance companies into issuing insurance policies on the lives of elderly people for the financial benefit of Carpenter and other investors in the scheme, Durham said. On June 9, 2016, Judge Chatigny found Carpenter guilty of 57 counts of conspiracy, mail and wire fraud, ...

Home-health firm allegedly forges doc’s signatures in Virginia
December 03, 2018, Fairfax County, VA -- The owner of a Fairfax County home health care company is behind bars accused of billing the state for millions in fraudulent claims. The case emerges just as Virginia is poised to expand its Medicaid program. John Ndunguru, the president of home health care company Mercy Services of Health, was indicted on 12 charges. He's accused of fraudulently charging Virginia's Medicaid program $4.5 million. Court documents show that the agency that oversees Medicaid has already paid Ndunguru $3.6 million. Investigators allege Ndunguru made false Medicaid claims on behalf of 59 patients who were not approved for long-term care. Trina Greene, the Mercy Services office manager, ...

Iowans warned to watch for robocalls selling fake health plans
December 03, 2018, Des Moines, IA -- Health insurance continues to change, and that can confuse consumers. Unfortunately, scammers will exploit that confusion. The Iowa Attorney General’s Office and the Iowa Insurance Division remind Iowans to “double check” before they sign up for health insurance. Research your options by finding a licensed agent at doublecheck.iowa.gov. “Don’t be fooled by telemarketers spreading misinformation or seeking your personal data,” said Attorney General Tom Miller. “A licensed agent or assister can direct you to the right options for you and your family.” Iowans planning to sign up for an Affordable Care Act plan must act quickly. The open enrollment period ends Dec. 15, ...

After Garner woman's experience, expert offers advice for dodging 'catfish' schemes
December 03, 2018, Garner, NC -- A Garner woman's online love connection became a deadly plot thwarted by law enforcement. Roxanne Reed was arrested earlier this year for planning for kill her mother and sending the life insurance claim to a mystery man she met online. Experts say "catfishing," or online romance scams like this one, are becoming more and more common. "I guess they was gonna kill me," said Emma Hammontree, Reed's mother. Reed made headlines this year when she was arrested for conspiracy to commit murder. According to warrants, Reed and a man she met online, but never in person, cooked up a plan to kill her mother so ...

Commonwealth Bank customers' medical data exposed in potential privacy breach
December 02, 2018, Sydney, -- The Commonwealth Bank is urgently investigating a potential data breach that may have given its staff access to customers' sensitive medical information. Key points: Sensitive medical data held by CommInsure was accessible to other staff members, including those making decisions on loan applications The bank says it has not found evidence any data was accessed from outside the insurance arm, but it is still investigating A former staff member says there was the potential for the data to be misused The issue was discovered around late July as the bank made preparations for the $3.8 billion sale of its insurance arm, CommInsure, to the AIA ...

Phony prescriptions: Health professionals must be on guard for fraud
December 02, 2018, Leechburg, PA -- The opioid epidemic being what it is, health professionals should be ever vigilant for people trying to get prescriptions under false pretenses. So when the state attorney general’s office last week announced the arrests of four people for using fake prescriptions, the most remarkable detail was that two of them allegedly used prescription blanks taken from the doctors’ offices where they worked. One, Sylvia Marino, a nurse at a local neurology practice, was charged with writing about 118 prescriptions for 12,000 pills over about four years. The Leechburg resident allegedly wrote the prescriptions for herself; for Melissa Riggle, a medical office co-worker ...

Three charged in health care fraud scam
December 01, 2018, Tuscaloosa, OK -- A Tuscaloosa sales representative is among three defendants accused of committing a $10.5 million health care fraud scam. Brett Taft, 45, along with a Birmingham doctor and a Demopolis pharmacist, are accused of fraudulently billing for compounded drugs and defrauding third-party administrators of health insurance plans of more than $10.5 million. The indictments were announced Thursday by the U.S. Attorney’s Office in Birmingham. The release focused on the announcement of a 103-count indictment against a Fultondale doctor who is accused of dispensing controlled substances without a legitimate purpose. According to the charges, Dr. Paul Roberts, 46, is accused of prescribing Adderall, Suboxone ...

Ivanhoe man charged with wounding deputy, assaulting two others
December 01, 2018, Ivanhoe, VA -- Accused of assaulting two individuals on Nov. 21, an Ivanhoe man is facing more charges after being accused of hurting the deputy trying to arrest him. Lewis Edward Newkirk, 25, was arrested on Nov. 22 and charged with maliciously wounding Wythe County Sheriff’s Office Sgt. R. Coleman. The Sheriff’s Office also charged him with obstructing justice and fleeing law enforcement, both misdemeanors. Police said Newkirk slammed a door while running into a residence, and the officer was struck by the door and his hands went through the glass. Coleman was treated in the emergency room and released. Newkirk was also accused of assaulting ...