News
Comp claimant in Conn. charged with working side job
September 01, 2010, Watertown, CT -- MOURAD "Mike" GUIRGUIS, age 54, of 29 Crestview Drive, Watertown, was arrested today on a warrant charging him with one count each of Workers' Compensation Fraud and Perjury.
The charges are felonies carrying a maximum possible sentence totaling 25 years in prison.
According to the arrest warrant affidavit, Mr. Guirguis reported a work-related injury in June 2004 while employed as a food service manager for the Wild Oats Market in Westport.
Between 2004 and 2009 he received $168,935 in temporary and total disability benefits and an additional $69,148 in medical benefits, the warrant states.
The warrant alleges that while collecting benefits, Mr.
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Conn. arson investigator charged with torching her car
September 01, 2010, Bridgeport, CT -- A Bridgeport police detective was arrested on charges of insurance fraud and conspiracy at first-degree arson after police say she conspired with a felon to torch her own Mercedes in 2008.
Detective Kimberly Biehn, 41, of Bridgeport, surrendered to police over the weekend after city investigators concluded she conspired with Samuel Encarnacion, 35, of 53 Fernwood Ave., to set fire to her car.
Biehn reported her car stolen in December 2008. The charred remains of the luxury vehicle were found ditched on River Street in Waterbury less than 24 hours later, police said.
Capt. Christopher Corbett, a Waterbury police spokesman, said although it
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Business couple in Calif. accused of forging comp docs
September 01, 2010, Loma Linda, CA -- Insurance Commissioner Poizner today announced the arrests of two Loma Linda residents. On August 31, 2010, CDI detectives arrested Sir Isaac Lindsay, 61, and his wife Veronica Lindsay, 57. They are charged with felony forgery after allegedly presenting fake documents to demonstrate that their business had workers' compensation insurance, when they were not insured. The Lindsays were booked at the Central Detention Center in San Bernardino County with bail set at $25,000 each. If convicted, the Lindsays could face a prison sentence of up to 18 years.
"When employers refuse to purchase mandatory workers' compensation insurance, they are not only breaking
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Driver in Philly arrested for buying fake auto policy
September 01, 2010, Philadelphia, PA -- Agents from the Attorney General's Insurance Fraud Section have arrested a Philadelphia man who allegedly purchased fraudulent insurance off the streets of Philadelphia and used the fake cards in paperwork submitted to PennDOT for vehicle tags and registration.
Attorney General Tom Corbett identified the defendant as Vincent Wingate, 28, 2128 Morris St., Philadelphia.
According to the criminal complaint, the investigation began following an October 2009 accident near 17th and Wharton Streets in Philadelphia. A man, riding his bicycle, allegedly struck a Ford Pickup truck that was parked unattended with a large pieces of lumber and logs protruding from the back and
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Owner of transport service in Md. sentenced for fraud
September 01, 2010, Laurel, MD -- Lois Diane Fant, owner of a now defunct transportation company, was sentenced today to three years’ probation and 180 days of home detention for billing D.C. Medicaid for non-existent transportation services. The sentence, in U.S. District Court for the District of Columbia, was announced by U.S. Attorney Ronald C. Machen Jr.; Shawn Henry, Assistant Director in Charge of the FBI’s Washington Field Office; Nicholas DiGiulio Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General (HHS - OIG) Philadelphia Region; and Charles J. Willoughby, D.C. Inspector General.
Fant, 61, of Laurel, Maryland, pled guilty
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Penn. mom arrested for lying about son on auto policy
September 01, 2010, York, PA -- York County detectives have arrested two women in separate incidents, charging both with committing insurance fraud.
On Aug. 19, Judith A. Sinclair, 62, of 11 Griffith Road in Peach Bottom Township, was charged with insurance fraud and released on recognizance bail, according to Detective Rick Magee, insurance-fraud investigator with the York County Detectives Office.
According to Magee, Sinclair had an insurance policy with Donegal Insurance Co. in which she'd signed a document that her son would not drive her vehicle and would not reside at her home.
But her son was living there, according to Magee, and when he was badly hurt
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Heart doc in Md. accused of implanting unneeded stents
September 01, 2010, Salisbury, MD -- A Salisbury cardiologist who allegedly implanted unnecessary stents in the arteries of his patients has been indicted on health care fraud charges.
Dr. John McLean is not charged with a crime for the actual surgeries he performed but for the alleged fraud that went along with them. Federal prosecutors say McLean submitted insurance claims for the unnecessary stents, ordered needless tests and falsified patients' medical records.
According to the indictment, McLean recorded in patients' records that their coronary arteries were 70 percent blocked when they were not. Patients must have a 70 percent blockage before stents are considered medically necessary.
McLean is
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Pair in N.J. charged with medical ID theft and fraud
August 31, 2010, West New York, NJ -- Two West New York men were indicted Friday for alleged identity theft and insurance fraud, state Attorney General Paula Dow announced yesterday.
Remny Gomez, 23, was charged with theft of identity, as well as trafficking in personal identifying information, insurance fraud, attempted theft by deception, receiving stolen property and two counts of theft by deception.
William Collado, 27, was charged with insurance fraud.
If convicted of the most serious charges, Gomez could face up to 10 years in prison, while Collado would likely face probation, but could receive up to five years in prison.
The Union County grand jury indictment alleges that in
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Audit in W.V. finds 10,000 stealing insurance benefits
August 31, 2010, Charleston, WV -- A recently completed audit of the state’s Public Employees Insurance Agency (PEIA) shows that nearly 10,000 — yes, 10,000 — people were receiving the benefit of health coverage or life insurance who shouldn’t have been. And the annual tab these illegally claimed dependents are costing the program figures out to be approximately $10 million.
That’s fraud, no matter how you dice it.
Taxpayers are footing about 80 percent of the bill for the PEIA program; they’re getting gypped.
Subscribers legitimately on the PEIA plan are suffering as well — certainly in the form of higher premiums/deductibles — since the program is costing
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Florida man admits $5.6M Medicaid scam in Georgia
August 31, 2010, Savannah, GA -- A Miami-area resident Monday pleaded guilty in federal court to scheming to defraud Medicare of more than $5 million through a Broughton Street clinic.
Alfredo Rasco, 51, of Pembroke Pines, Fla., admitted to a conspiracy to commit health care fraud and a separate charge of aggravated identify theft by unlawfully using a doctor's identification in April 2006 in connection with the scheme.
Two others - Rasco's wife, 49-year-old Niurka Rasco, and Iris Oswald, 53, of St. Simons Island - also entered guilty pleas to lesser charges in the scheme.
In return for their pleas, prosecutors agreed to dismiss the 60-count indictment.
The pleas
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Hospital CEO in Calif. gets 2 years for patient dumping
August 31, 2010, Brentwood, CA -- The former chief executive of City of Angels Medical Center was ordered today to spend two years in prison and pay more than $4.1 million in restitution to Medicare and Medi-Cal for paying illegal kickbacks for patient referrals skimmed from Skid Row.
Dr. Rudra Sabaratnam, a 66-year-old Sri Lankan-born Brentwood physician, pleaded guilty in 2008 in U.S. District Court to two counts of health care fraud for his role in a scheme to defraud public health insurance programs by recruiting transients from downtown Los Angeles.
"This is an extremely serious offense,' U.S. District Judge George H. King said before handing down
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Dentist in California convicted of Medicaid fraud
August 31, 2010, Pasadena, CA -- A 47-year-old Pasadena dentist could face up to 10 years in prison for defrauding Medicaid, a US Attorney announced Monday.
Dr. David Lloyd Gonzales Jr. was convicted on 22 counts of health care fraud after a jury determined he knowingly billed Medicaid for unperformed services, such as root canals, fillings and wisdom teeth extractions, according to a U.S. Department of Justice statement.
The jury took about one day to deliberate in his trial.
Gonzales began working with Medicaid in 1994, but he was suspended in 2005, according to the statement.
Gonzalez had been released on bond and will remain free until his sentencing
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Agent in Louisiana arrested for stealing client premiums
August 31, 2010, West Monroe, LA -- Michael Evans Ryan, 26, of 218 Standard Reed Road in West Monroe, has been arrested on eight counts of insurance fraud.
An arrest affidavit said West Monroe and state police investigated Ryan, an insurance agent.
He is accused of accepting, but failing to remit insurance premiums for customers on eight occasions, which caused their policies to be canceled even though they made payments to him.
The affidavit said Ryan failed to remit premiums between Sept. 23, 2009 and June 14, 2010 for several clients.
Ryan was booked into Ouachita Correctional Center. His total bond is $80,000.
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Doc, clinic owner, 5 nurses plead guilty to $37M scam
August 31, 2010, Miami, FL -- A South Florida doctor, clinic owner and five nurses pleaded guilty on Tuesday to participating in a multimillion-dollar Medicare fraud scheme.
They were among a group of South Floridians rounded up in December during a health care fraud sweep.
Dr. Fred Dweck admitted to referring 858 Medicare recipients for unnecessary home health care services. As a result, Miami-area home health care agencies billed the Medicare program for more than $37 million in false and fraudulent claims. Medicare paid more than $22 million of the fraudulent claims.
Yudel Cayro owned and operated Courtesy Medical Group in Miami, which employed Dweck. He admitted to
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Referrals for workers comp fraud in Missouri up sharply
August 31, 2010, Jefferson City, MO -- The Missouri Department of Labor's Division of Workers' Compensation recently reported that it referred 184 cases of fraud and noncompliance to the attorney general for prosecution during the first six months of the year -- an increase of 80 cases during the same period in 2009. The department also noted that there have been 1,369 cases of work-related injuries that weren't reported by an employer or insurer to the DWC this year. This is slightly above pace to surpass 2009's overall total of 2,669 unreported injuries.
Officials said the increase in referrals is likely the result of a combination of the
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CVS to pay Mass. $2.65M for comp drug overcharges
August 30, 2010, Boston, MA -- Attorney General Martha Coakley’s Office has entered into an agreement with pharmacy chain CVS Pharmacy, Inc., after an investigation revealed that the company was overcharging public entities for various prescription drugs under the workers compensation insurance system.
Under the terms of the settlement, filed late last week in Suffolk Superior Court, CVS will make a payment to the Commonwealth and to approximately 200 cities and towns in Massachusetts totaling $2.65 Million.
The city of Boston will receive $60,000 in restitution, and the cities of Brockton, Lowell, Fall River, and Springfield will each receive refunds in excess of $10,000. Other
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Agent in Minnesota accused of life commission scam
August 30, 2010, Eden Prairie, MN -- An Eden Prairie insurance producer lost his license and agreed to a fine after he bilked his employer out of $8,370 in commissions on fraudulent life insurance applications, according to a Department of Commerce order signed this month.
Primerica Life Insurance Co. fired Wesley Allen King in February after an internal review found that all 39 of the applications he submitted in the second half of 2009 contained fraudulent signatures, phone numbers and other information, the order stated.
King admitted that he wrote the false policies and said he was caught up in a competition with other salespeople.
King was ordered to
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Doc, clinic owner in Detroit convicted in Medicare scam
August 30, 2010, Detroit, MI -- The owner of a Detroit-area medical clinic, Juan De Oleo, and a doctor who helped falsify files at the clinic, Dr. Rosa Genao, were convicted today by a federal jury in Detroit for their roles in a $2.3 million Medicare fraud scheme.
According to evidence presented during the two-week trial, Juan De Oleo owned a company called Xpress Center, Inc. (XPC), which was based in Livonia, Mich. Evidence showed that De Oleo and others established XPC for the sole purpose of defrauding Medicare. XPC was an outpatient clinic that purported to specialize in infusion and injection therapy.
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La. couple accused of faking storm damage to BMW
August 30, 2010, New Orleans, LA -- SEAN HUNTER, 44, and SHAUNA CROWDEN HUNTER, 31, both of New Orleans, Louisiana, were charged in a one count Bill of Information today for conspiracy to commit mail fraud and making false statements to the FBI, announced U.S. Attorney Jim Letten and Special Agent in Charge, David Welker, of the FBI New Orleans Division.
According to the bill, on September 27, 2005, SHAUNA CROWDEN HUNTER contacted the AAA insurance company and fraudulently claimed that her 2005 BMW 525i, with a retail value of $53,377.27, was completely destroyed during Hurricane Katrina. Subsequently, SHAUNA CROWDEN HUNTER falsely completed and mailed to the
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Military families sue life insurer over death benefits
August 30, 2010, New York, NY -- Six military families are suing Prudential Insurance Co. of America, accusing it of profiting off dead service members by keeping their life insurance benefits in the company's own general account to earn interest for itself, instead of immediately handing them over to the families.
The lawsuit, which was first reported by Bloomberg News last month, was filed in federal court in Springfield, Mass., on July 29. An amended version of the suit, a draft of which was obtained by The New York Times, will be filed in federal court today, lawyers say. It has additional plaintiffs and also accuses Prudential
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Court reinstates Fed case against crop insurance agent
August 30, 2010, St. Louis, MO -- The 8th Circuit reinstated the government's claim that an insurance agent helped farmers commit crop insurance fraud by submitting false applications to a private insurer that got reimbursed by the federal government.
The government sued Russell Hawley and his company, Hawley Insurance, claiming he signed and submitted crop insurance applications for farmers who weren't eligible for federal coverage because they had no "insurable interest" in the crops.
The applications were sent to North Central Crop Insurance (NCCI), a private insurer that then requested reimbursement from the Federal Crop Insurance Corporation (FCIC).
The government said it relied on the information Hawley submitted when
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Virginia man gets 10 years for prescription drug fraud
August 30, 2010, Alexandria, VA --
After Joseph G. Ecker was apprehended in a Medicare fraud scheme, he told his wife to hide $10,000 worth of wine he had purchased and to burn or abandon their home to prevent authorities from obtaining their possessions.
But she didn't destroy the home, and authorities found the wine.
And Ecker, 53, now must forfeit his property, repay the government and serve prison time for distributing more than $200,000 of prescription drugs through the scheme.
In federal court in Alexandria, U.S. District Judge Leonie Brinkema sentenced him to 10 years in prison. Ecker must also repay Medicare the $201,465 he defrauded
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Roofer in Ga. accused to stealing homeowners’ claims $
August 30, 2010, Sedgwick County, GA -- A Georgia sheriff's office is planning to file criminal charges against the operators of a company alleged to have bilked homeowners — including at least 80 in Sedgwick County — out of insurance money to fix hail- and wind-damaged roofs.
A Wichita lawmaker who serves on the Kansas House Judiciary Committee said the state may need to change its laws to be more like Georgia's to protect homeowners from unscrupulous operators who might try to take advantage of victims of damaging weather.
At issue is the case of American Shingle, a now-closed company that specialized in door-to-door sales of new roofs in
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Virginia man gets 10 years for diverting pain pills
August 27, 2010, Middleburg, VA -- A 53-year-old Middleburg man will spend 10 years in federal prison for illegally distributing prescription drugs he obtained while on Medicare.
Joseph George Ecker was sentenced Aug. 27 for conspiracy to distribute Schedule II prescription narcotic drugs and health care fraud, charges he plead guilty to June 1, said Peter Carr, U.S. Department of Justice spokesman.
In addition to his prison time, Ecker was ordered to repay Medicare $201,465, the amount he defrauded from it. Ecker will also be required to repay $200,000 in profits from his illegal prescription drug sales. Ecker also consented to the forfeiture of his house as
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New Calif. law aids state and insurer fraud cooperation
August 27, 2010, Sacramento, CA -- The California Legislature has approved a bill to allow the Department of Insurance to help better monitor insurance fraud trends.
To help prevent, detect and investigate insurance fraud, existing law requires insurers to disclose to an authorized governmental agency information relative to incidents of workers' compensation fraud.
If SB 156 is signed by the governor, it would authorize the DOI to convene meetings with insurance companies to discuss specific information concerning suspected, anticipated, or completed acts of insurance fraud and would protect a person sharing information pursuant to that authorization from civil liability for libel, slande or any other relevant cause
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