News
WA. man on home monitor after disability fraud conviction
March 11, 2010, Seattle, WA -- A West Seattle man has been sentenced to six months of electronic home monitoring and must pay more than $26,000 in restitution for first degree theft in an insurance case, the state Office of the Insurance Commissioner announced.
According to the OIC, Edward Charles Bailey reported an on-the-job back injury to his employer in 2006. He was placed on temporary total disability and received disability pay from his employer's insurer, Alaska National Insurance. Doctors subsequently ruled him unable to return to work.
Five weeks after the injury, investigators working for the insurance company videotaped Bailey working vigorously on his sailboat at a
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W.V. woman accused of claiming Medicaid benefits while working
March 11, 2010, Clarksburg, WV -- A Clarksburg woman pleaded guilty to charges of grand theft and Medicaid fraud Tuesday in front of Common Pleas Judge Scott Nusbaum.
Amanda White, of 10790 Water St., is scheduled to be sentenced on May 5.
Ross County Prosecutor Michael Ater said the fraud occurred from September 2006 to April 2008. White applied for and received $9,171 in food stamps and $9,213 in Medicaid benefits. It was later determined that White was not reporting her income as a self-employed home health care provider working with CareStar.
She falsified three applications for assistance, failing to reveal that she was working.
"We would leave sentencing to
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Former UK police chief torches car for ins. money
March 10, 2010, UK, -- Former West Berkshire police chief Jim Trotman has been arrested over an alleged insurance scam.
A national newspaper said the ex-West Berkshire superintendent, who left the area in 2005, set fire to his car and then alleged arsonists had started the blaze to claim on insurance money.
Thames Valley Police spokesman David Staines said: “A senior police officer from Thames Valley Police was arrested on Thursday, February 11, on suspicion of misconduct in a public office, insurance fraud and perverting the course of justice.
“He has been suspended from duty and bailed pending further enquiries until Thursday, April 8.
“The arrest was made by
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N.J. tech bills for HIV/AIDS meds never dispensed
March 10, 2010, Orange County, NJ -- Two pharmacy technicians received sentences including three years of probation for their role in a scheme to defraud Medicaid by billing for expensive HIV/AIDS prescriptions that were never dispensed.
Jannah Rasheedah Amatul Muid, 26, of East Orange, N.J., and Alicia Stephens, 29, of Newark, N.J., also were barred from working for any Medicaid provider for five years, according to New Jersey Attorney General Paula T. Dow. Muid must also perform 150 hours of community service and Stephens, 100 hours.
The two pleaded guilty Jan. 20 to third-degree Medicaid fraud after their indictment last year by a state grand jury. Through the plea,
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Chicago's medical center agrees to pay $1.5M for fraud
March 10, 2010, Chicago, IL -- Chicago's Rush University Medical Center has agreed to a $1.5 million settlement to resolve allegations it defrauded the federal Medicare program.
The Justice Department accused Rush of submitting false claims to Medicare from 2000 to 2007. The government claims the medical center entered into improper lease agreements with two doctors and three group practices in violation of the so-called "Stark Law."
Stark prohibits a hospital from making money off patient referrals made by a doctor "with whom the hospital has an improper financial arrangement."
The Justice Department learned of Rush's actions after two doctors sued the hospital under the federal False Claims Act,
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Ind. doc accused of issuing fake prescriptions
March 10, 2010, Russiaville, IN -- A Howard County doctor is out of jail on bond after getting arrested on charges she issued fake prescriptions.
Carolyn Greer of Russiaville became the focus of an investigation after a local pharmacy contacted the state.
Investigators say Greer would telephone in prescriptions using the names of co-workers, family and patients and then have the drugs delivered to her.
Prosecutors charged Greer with possession of a controlled substance, obtaining a controlled substance by fraud and insurance fraud.
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President Obama signs order to combat Medicare/Medicaid fraud
March 10, 2010, Jefferson City, MO -- President Barack Obama pays a trip to Missouri to announce a new plan that will be implemented to go after fraud within the Medical and Medicaid Programs. The White House said the president signed an Executive Order Wednesday to implement this program.
President Barack Obama is using a stop in Missouri Wednesday morning to announce a new plan to aggressively go after fraud in Medicare and Medicaid programs. The White House said the President will announce a plan to offer auditors a financial incentive to double-check what is known as medical payments from Washington. These checks will be
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Everyone feels the effects when a few commit insurance fraud
March 10, 2010, Columbus, OH -- For many Central Ohioans, the struggling economy has meant hard times.
According to insurance investigators, more and more people are trying to make up lost ground by defrauding insurance companies out of money.
“We’re seeing significant increases across the board in all types, particularly in opportunist fraud situations where people are turned around on their car loans, and it’s easier to give it up than pay the loans,“ says Vickie Neal, director of Area Eight of the National Insurance Crime Bureau, a not-for-profit organization that partners with insurers and enforcement agencies.
She says cases of fraud involving homeowner’s insurance are up as well.
“Ohio
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Maryland whistleblower bill is win-win for state, insurers and consumers
March 10, 2010, Annapolis, MD -- False claims acts empower and reward citizens who blow the whistle on government fraud and uncover schemes that likely would go undetected, the Coalition Against Insurance Fraud said in testimony supporting a state whistleblower bill being debated before a key Maryland House of Delegates committee.
“Without the knowledge and assistance of people on the inside of corporate schemes, the government has little chance of recovering stolen health-insurance money,” Goldblatt told the House Judiciary Committee, which is debating HB 525.
HB 525 allows the state to partner with whistleblowers in bringing bogus health-insurance claims and other scams to light. The proposal is well-crafted,
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GMA: how to protect yourself against medical ID theft
March 09, 2010, Washington, DC -- The phone call was terrifying -- a child protection services worker accused Anndorie Sachs of giving birth to a child that had tested positive for methamphetamine.
Authorities say medical identity theft is becoming more sophisticated.
"Panic, absolute panic," Sachs said.
And then, confusion. Sachs hadn't given birth in more than two years. After investigating the phone call, the Salt Lake City mother of four realized she had been the victim of medical identity theft. Someone gave birth using Sachs' name and her medical insurance to pay for it.
Authorities say that as Americans continue to struggle to pay their bills, more sophisticated thieves are
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N.Y. woman receives workers comp while employed
March 09, 2010, New York, NY -- A New York City woman was sentenced to pay $36,000 in restitution and serve five years probation on Friday for collecting workers' compensation benefits while she was employed as a home health aide.
Alice Jean-Michel, 53, was sentenced in Ulster County Court. She earlier pleaded guilty to third degree insurance fraud and workers' compensation fraud following an investigation by the New York State Insurance Department's Frauds Bureau.
Jean-Michel started collecting benefits from the New York State Insurance Fund in 2004 after suffering a job-related injury. She subsequently reported to the Insurance Fund that she was not working while, in fact, she was
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Colo. House passes bill to limit surveillance
March 09, 2010, Denver, CO -- The House passed a bill on Monday that would tighten the rules on insurance companies that conduct surveillance on workers' compensation claimants.
Sponsored by state Rep. Sal Pace, D-Pueblo, HB1012 passed by a vote of 34-28, with three representatives excused.
"I think it's a simple choice when you're choosing between the people who are covered by an insurer and an insurance company," Pace said. "I choose people every time.
Pace's bill originally aimed to limit spying on workers who claimed they were injured on the job to instances when fraud was suspected and to impose a $1,000 fine compounded daily against insurers who
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Tampa man arrested for role in staged accident
March 08, 2010, Tampa, FL -- His friend asked him whether he wanted to make some quick money. All he would have to do was be a car crash victim and get medical treatment at a specific clinic.
He accepted.
Josue Baez, 23, of Tampa later told investigators he received $500 for playing the role of a crash victim, with the promise of $10,000 more after going through with a lawsuit.
Baez was one of the hundreds of people arrested statewide last year in staged crashes. Most of the incidents were in South Florida, but police say staged crashes are increasing in Tampa.
The wrecks are designed to bilk insurance
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Calif. man convicted of falsely reporting motorcyle missing
March 08, 2010, Sacramento, CA -- Sacramento resident Joseph A. Torrez has been convicted and sentenced on March 4 to 240 days in the Sacramento County Jail, five years probation and ordered to pay more than $26,365 in restitution to State Farm Insurance Co., the California Department of Insurance reported.
According to CDI, on April 22, 2009, Torrez, then a sergeant for the California Department of Corrections, was arrested at his place of employment, Folsom State Prison, and booked into the Sacramento County Jail on insurance fraud charges.
On March 9, 2009, the National Insurance Fraud Crime Bureau contacted the Sacramento County Urban Auto Insurance Fraud Task Force
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Conn. man accused of bilking people out of millions
March 08, 2010, Waterbury, CT -- When Thomas Cipriano is sentenced on March 15 in federal court in New Haven, it will mark the end of the road for a lengthy scam that bilked people out of millions of dollars.
In a plea for leniency, Cipriano, who ran an insurance business that turned into a Ponzi scheme, claims that he never meant to hurt anyone. He says he had every intention of paying the money back to his investors. Authorities estimate that $1.3 to $1.8 million was lost during the scheme.
Cipriano says he lost control of his gambling and living expenses, and began diverting customers' money to
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Arkansas woman accused of bilking Medicaid program
March 08, 2010, Little Rock, AR -- Jane W. Duke, United States Attorney for the Eastern District of Arkansas, and Thomas J. Browne, Special Agent in Charge of the Little Rock Field Office of the Federal Bureau Investigation, announced that Patrice Lynae Smith, age 26, of Little Rock, Arkansas, was indicted today by a federal grand jury. The indictment charges one count of health care fraud for attempting to execute a scheme to defraud the Arkansas Medicaid Program by falsely representing at the emergency room of Baptist Health Medical Center in Little Rock that she was an Arkansas Medicaid beneficiary.
Duke stated, “In our ongoing effort to fight
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Pa. woman accused of using sister-in-law’s name for prescription
March 08, 2010, Kingston, PA -- A woman was able to obtain a prescription medication that was billed to her sister-in-law because their first name begins with J, according to charges filed.
Jennifer Lynn Rittel, 37, of Scott Street, Wilkes-Barre, was charged with two counts of insurance fraud and acquire or obtain possession of a controlled substance. She was arraigned by District Judge Paul Roberts in Kingston and released on $7,500 unsecured bail.
According to the criminal complaint:
Agents with the Northeast Insurance Fraud Task Force allege Jennifer Rittel obtained suboxone from CVS Pharmacies in Wilkes-Barre and Kingston from January 2009 to November giving the impression that she was
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Calif. AG says his office recouped $209M last year
March 08, 2010, Sacramento, CA -- Undoubtedly sounding like a candidate for governor, California Attorney General Jerry Brown said Monday that the state is getting a lot of bang out of the taxpayer money going to his office.
In a statement, the Democrat said his office last year recovered $209 million in Medi-Cal fraud cases, or $36 for every $1 expended from the state's general fund.
"In these tough budget times, the state can't afford to lose millions in hard-earned taxpayer dollars from people who try to cheat and steal from the system," Brown said. "Thanks to the tireless work of DOJ investigators, we protected our most vulnerable
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Two docs in Spain sentenced for prescribing illegal drugs
March 08, 2010, Corunna, Spain, -- Two area doctors were sentenced to probation Friday in 35th Circuit Court in connection with a 2009 investigation into the illegal prescribing of various drugs.
Dr. James Howard Park, 75, and Dr. Peter Donald Cotey, 52, both pleaded guilty to misdemeanor charges earlier this year.
In court Friday, Park was placed on two years probation. In addition, he was ordered to pay $25,000 to the prosecutor's asset fund and $2,000 to Blue Cross for investigative costs. He also is responsible for court costs and his driver's license is suspended six months.
Park agreed to voluntarily give up his medical license and his Drug
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N.Y. dentist accused of filing bogus billing claims
March 05, 2010, Newfane, NY -- Scott D. Geise, a well-known Niagara County dentist and civic leader, is on trial in federal court on charges that he used bogus billing procedures to cheat insurance companies and dental benefit plans.
Geise, 48, of West Creek Drive, Newfane, denies the allegations.
His jury trial began Wednesday before U. S. District Judge Richard J. Arcara.
“[Geise] engaged in a scheme to defraud insurance companies and dental benefit plans by submitting claim forms for dental services he did not provide, and for dental products the patient did not receive or need,” Assistant U. S. Attorneys Timothy C. Lynch and Jack Rogowski said in
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Tampa is ranked #2 in the nation for staged accidents
March 05, 2010, Tampa, FL -- Staged auto accidents are on the rise in Tampa, officials say, and it's affecting car insurance premiums.
Tampa ranked No. 2 in the nation for questionable auto claims, according to National Insurance Crime Bureau statistics for the first half of 2009. Only Brooklyn ranked higher.
In past years, most of Florida's staged accidents occurred in South Florida, but in part because of a crackdown there, Tampa has seen a recent spike, said Florida Chief Financial Officer Alex Sink. In 2009, there were 190 questionable claims in Tampa and 136 in Miami.
An Allstate spokeswoman estimated that fraud causes the average policy holder to
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$4 billion recovered in 2009 from Medicare fraud
March 05, 2010, Brentwood, TN -- The Office of Inspector General recovered $4 billion in fraudulent Medicare charges last year, but that sum is "just the tip of the iceberg" in the amount of corrupt practices overcharging taxpayers, Daniel Levinson, the agency's chief, testified Thursday.
"More disturbing, even if the rate of fraud remains constant, as healthcare expenditures continue to rise, the financial impact of healthcare fraud will continue to increase," he said.
Levinson made his remarks on efforts to combat healthcare fraud, waste, and abuse before the Subcommittee on Labor, Health and Human Services, Education, and related agencies of the House Committee on Appropriations.
His talk was indicative
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Calif. worker falsely collected $278K in workers comp
March 05, 2010, Sacramento, CA -- Nicki Lee Buxmann, 46, of Sacramento, who has been a letter carrier for the U.S. Postal Service, has been indicted by a federal grand jury on 15 counts of falsely claiming to have been injured on the job and falsely denying that she had outside employment and income.
Prosecutors say she illegally got $278,000 in workers’ compensation benefits.
The indictment alleges that Ms. Buxmann defrauded the United States Postal Service by first claiming that she had injured her back, neck, and shoulder while on the job, and then falsely denying that she had outside employment and income in order to continue receiving
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Texas worker files false claims with stolen records
March 05, 2010, Dallas, TX -- The University of Texas Southwestern Medical Center has sent letters to 12,000 patients advising them to guard against possible fraud, after a former employee allegedly stole a limited amount of patient billing and insurance information last year.
Authorities in September discovered that a worker in the hospital's financial services department had taken billing or insurance information from 21 patients. Police made the discovery after executing a search warrant on another matter, hospital officials said.
The employee may have compromised the billing or insurance information of as many as 200 patients, hospital officials said. The employee did not have access to medical records,
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La. woman stole $600K from insurers to buy boats
March 04, 2010, Lake Charles, LA -- A 45-year-old Lake Charles woman has pleaded guilty in U.S. District Court to three counts of health care fraud that involved the theft of more than $600,000.
From June 2005 to September 2007, prosecutors say Nikkie A. LeFleur stole the money by billing various insurance companies for treatments that never took place.
LeFleur worked as an account manager for Medical Provider Services in Lake Charles.
She allegedly used the money to buy two Yamaha personal watercraft, a 31-foot Fleetwood Prowler trailer, and a 22-foot Cape Horn offshore series motorboat with a Mercury outboard motor.
LeFleur will be sentenced on May 27.
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