Arrest - InsuranceFraud.org

A Pitkin man is accused of setting fire to his home to commit insurance fraud.

Justin Scott Ware II, 37, was arrested Friday in connection with a house fire on Hopewell Road in February.

The Plainview Fire Department responded to the fire around 3 a.m. on Feb. 24, officials with the Office of State Fire Marshal said. After examining the scene, analyzing digital evidence and interviewing witnesses, investigators determined the fire had been intentionally set as part of an insurance fraud scheme involving the home and a vehicle.

Ware faces two counts of insurance fraud and one count of arson with the intent to defraud. He was booked into the Rapides Parish jail.

A complex auto insurance fraud ring led to an array of charges including insurance fraud, grand theft by trick, and false impersonation, investigators say.

A dozen Southern California residents are reported to have conspired to create fraudulent insurance claims to illegally collect more than $350,000.

They were arrested last week after an investigation reportedly discovered a large-scale organized auto insurance fraud ring engaged in multiple schemes, including holding vehicles hostage and collusive collisions.

Three additional people were charged for their alleged involvement in the organized ring. The charges involve 19 fraudulent claims resulting in a loss of $353,035.

The Inland Empire Automobile Insurance Task Force began an investigation in 2022 after reportedly discovering a California Highway Patrol non-sworn employee, Rosa Isela Santistevan, 55, of Irvine, was unlawfully selling traffic collision report face pages with personal information of people who had been involved in collisions throughout the region.

Searches reportedly led to the seizure of more than 3,500 CHP traffic collision report face pages from the residence of Esmeralda Parga, 26, of Pomona, who the task force determined was connected to Santistevan through the organized ring’s ringleader, Andre Angelo Reyes, 36, of Corona.

The alleged conspiracy began after Reyes befriended Santistevan and other CHP employees by donating to various CHP events and parties. Santistevan printed and unlawfully sold thousands of traffic collision face pages to Reyes, who reportedly would then provide the reports to Parga. Parga would then pretend to be from the insurance company of involved parties and coordinate having the vehicle towed to a repair center, according to investigators.

Tow trucks were then sent to pick up the vehicles and take them to CA Collision, owned by Anthony Gomez, 35, of Jurupa Valley. Once at there, the repair shop held the vehicle hostage and demand cash payment from the insurers to have the vehicles released.

This investigation resulted in 15 suspects being charged with insurance fraud, grand theft by trick, and false impersonation.

The investigating task force included the California Department of Insurance, California Highway Patrol, San Bernardino County District Attorney’s Office, and the Riverside County District Attorney’s Office. The San Bernardino County District Attorney’s Office is prosecuting the case.

Defendants include:

Andre Angelo Reyes, 36, of Corona;
Rosa Isela Santistevan, 55, of Irvine;
Esmeralda Parga, 26, of Pomona;
Anthony Gomez, 35, of Jurupa Valley;
Ezequiel Baltazar Orozco, 30, of Los Angeles;
Antonio Terrazas Perez Jr., 19, of Los Angeles;
Erika Garcia, 31, of Los Angeles;
Israel Avila Sandoval, 45, of Pomona;
Luis Alberto Ramirez Jr., 32, of San Bernardino;
Robert Arzac, 49, of West Covina;
Antonio Ramirez Perez, 44, of Los Angeles;
Brian Anthony Lopez, 25, of Anaheim
Emily Marie Boatman, 26, of Ontario;
Ricardo Parga Jr., 23, of Pomona;
Steven Anthony Alfaro, 38, of Buena Park.

A former El Paso County woman is accused of filing fake insurance claims for her pets, potentially pocketing thousands of dollars.

The Colorado Attorney General’s Office announced Wednesday that 45-year-old Leah Valentine is facing charges of allegedly submitting five false and altered invoices to her pet insurance company to the tune of $5,000.

“Valentine, who now lives in Oklahoma, is accused of submitting multiple false claims to Nationwide Mutual Insurance Company in 2021 for veterinary care for her dog, Pepper, and her cat, Janet. While her pets received some veterinary care from clinics in Colorado Springs, Valentine allegedly submitted invoices in support of her claims, some altered and some completely fabricated, with inflated amounts,” the attorney general’s office said.

One of the claims ultimately raised suspicions, leading Nationwide to look again at the other claims.

“Nationwide found other suspicious claims and flagged them for further investigation. After conducting their own internal review, Nationwide referred the case to the Financial Fraud Unit in the Criminal Justice Section of the Colorado Department of Law under suspicion of fraud. A subsequent investigation by the department determined there was cause to charge Valentine,” the attorney general’s office said.

Valentine faces 10 counts of insurance fraud and five counts of forgery.

“When people engage in insurance fraud, we all pay the price through higher premiums and increased enforcement costs to taxpayers,” said Colorado Attorney General Phil Weiser. “Everyone should know that insurance fraud is a crime. Whether it’s a false claim about your dog or anything else, if you attempt to defraud your insurance company, you are barking up the wrong tree.”

After refusing to recuse himself, a Loudoun Circuit Court judge denied bond to a woman accused of insurance fraud in the wake of a fatal fire allegedly set by a man living with her at her Lowes Island home.

Valeria Gunkova, 48, now of Adamstown, Maryland, was arrested on July 16 after being indicted on charges of attempting to obtain money by false pretenses, and conspiring to obtain money by false pretense.

She is accused of filing an insurance claim listing items valued at $182,500 as destroyed in the fire, when in fact the items were in a storage unit and not destroyed. The total insurance claim was $1 million.

In denying bond, Judge James P. Fisher said Gunkova posed a danger to the community and was a flight risk.

He cited the “nature of the scheme” and the “high level of apparent malevolent intent” and said federal and state courts have accused Gunkova of destroying evidence in bankruptcy cases.

Fisher noted that Gunkova’s mother recently returned to Russia and said Gunkova doesn’t have strong ties to the U.S.

Jacob G. Bogatin, who lived with Gunkova in the townhome on Riptide Square townhome off Lowes Island Boulevard, is accused of setting the fire that killed their next-door neighbor, Madelaine Samantha Akers, 36.

Bogatin, 78, is set to stand trial on first-degree murder and arson charges on Aug. 24 and was also indicted on fraud charges in July.

Bogatin and Gunkova faced eviction shortly before the fire and a prosecutor said they were seen on video moving belongings to a storage unit before the blaze.

Authorities said Gunkova told investigators she was in Ocean City, Maryland, when the fire occurred. She is not accused of setting the fire and hasn’t been charged in Akers’ death.

In seeking bond for her client, defense attorney Michele L. Burton noted Gunkova has no prior criminal record and said she isn’t a flight risk or a danger to the community. She said Gunkova would have turned herself in rather than being arrested if she was aware she had been indicted.

“Ms. Gunkova only went to the storage unit once before the fire,” Burton said. “She has never been implicated in the fire or homicide and firmly maintains her innocence in both cases.”

Gunkova, who appeared by video from the Loudoun County Adult Detention Center, asked through Burton that Fisher recuse himself because he granted a default judgment in September 2024 against Bogatin and Gunkova in a civil lawsuit involving a Countryside spa they operated.

In court filings in the civil case, Gunkova accused Fisher of mishandling the case.

“This is just a ploy by Ms, Gunkova and I’m not going to recuse myself,” Fisher said.

A man who had staged his own death by allegedly burning alive a youth from his own village in a bid to claim life insurance money was arrested in Churu district on Sunday.

Police said the arrested man, Rajesh Jat, had brought Dinesh Meghwal in his truck, given him too much liquor to drink, and then set him ablaze in the truck on June 7. Jat aimed at passing it off as his own death so that he could get the life insurance money. Churu SP Jay Yadav said Jat had lured Meghwal with the promise of employment, and on June 6 night, he took him from the village in his truck and gave him alcohol to drink during the journey.

Under the influence, Meghwal fell asleep in the truck’s cabin. The following morning, around 4am, Jat parked the truck on the roadside near Hisar Bypass Rajgarh on National Highway 52, doused the cabin with petrol, shut the cabin from the outside, leaving Meghwal trapped inside, and set the truck ablaze.

The charred body in the truck’s cabin was discovered by Rajgarh police on June 8. Following media coverage of the incident, Omprakash Meghwal, a resident of Barwala village in Hisar district of Haryana, approached police, alleging that Rajesh Jat, also from the same village, had taken his younger brother, Dinesh, from his home by offering him work. He alleged that Jat killed Dinesh and burned his body in the truck to destroy evidence. Dinesh, also known as Desi, used to work odd jobs to make ends meet, he said. Police registered a case and started a probe.

Investigations found that Jat wanted to settle debts incurred from his online gambling addiction, and he wanted to get his life insurance money by staging his own death. So he lured Dinesh Meghwal into his truck and burnt him alive. After investigating the murder for 17 days, police cracked the case and arrested Jat.

“A dedicated team worked on this case. During interrogation, we learnt that Rajesh had amassed significant debts due to his addiction to online gambling. Faced with constant pressure from creditors demanding repayment, he drew inspiration from a similar incident in his locality and devised a plan to claim insurance by faking his own death. He killed Dinesh in the process,” said the SP.

It’s the melting pot of all scams.

Russian gangsters, MS-13 members, and a cadre of corrupt surgeons, lawyers and lenders are pulling off the latest big con in the city: bogus personal-injury lawsuits where immigrants go under the knife to help their twisted ruse.

Migrants and other desperate New Yorkers are pressured into getting unneeded spinal fusion surgery and other operations to boost the value of their fake-accident claims, according to court records, insurance investigators and law-enforcement sources.

Doctors cash in on the sick swindle by performing back and neck fusions, allowing fraudsters to swipe billions through bogus insurance filings, according to court filings and sources.

The racket typically involves a healthy person taking a seemingly minor tumble on the street or at a construction site, then claiming a devastating injury that requires multiple surgeries. A crooked surgeon fuses healthy vertebrae with screws and plates, leading to a lawsuit against a business or landlord or both. Settlements start at $1 million each but can go much higher.

“One-five is now on the cheap side,” said an insurance industry lawyer who asked for anonymity.

These scams rely on law firms that take on hundreds of such cases, along with high-profile doctors, sketchy lending firms that hard-sell migrants into borrowing to cover the costs, and an army of “runners” who recruit victims and orchestrate their falls, according to legal papers and sources familiar with the mix of schemes.

The set-up is fed by a seemingly endless supply of low-income dupes willing to risk their health for a quick score.

“They’re regularly recruiting migrants and homeless people and in some cases are proactively arranging for them to come to New York,” a private investigator told The Post.

So-called “shot callers” pocket most of the windfall settlements, while those who pose as injured receive as little as $1,000 each, according to testimony in one case. Their share gets shriveled by sky-high interest on loans they’re told they need for medical and legal expenses. Others can collect up to six figures.

Russian hoodlums are suspected of running lending firms that fund trip-and-fall lawsuits and surgeries — often at hugely inflated rates to goose settlement figures, sources told The Post. “They’re well-versed in this kind of thing,” said a recently retired NYPD supervisor.

MS-13 leaders provide a pipeline of Hispanic migrants, some who are brought to New York specifically to fake injuries, sources said. They said the gang ropes in unsuspecting border crossers with offers to drive them to the city, pay for meals and provide spending cash before pressuring them into phony accidents.

A private investigator said an MS-13 informant at a construction company revealed plans for a worker to fall off a ladder — and it happened just as the tipster said it would, said the sleuth, who declined to say where or when the fraud occurred to protect the identity of his source.

Setting up fake falls is “so successful for MS-13,” he said. “Rival gangs are now trying it.”

But MS-13 leaders are not experienced in white collar crime and don’t know how to pull off phony injury fraud, according to gang expert Lou Savelli, who founded the NYPD gang unit and now consults for police and other law enforcement agencies. “That’s where the Russians come in,” he said. “They have the lawyers.”

NYPD investigators found one integrated Russian-led operation — with doctors, lawyers, lenders and physical therapists all in the same office building, said a former police supervisor who declined to give further details. “It was one-stop shopping. Everyone was in the same place,” he said, adding that authorities were unable to build a case against the group.

The Russian-MS-13 partnership “is a perfect marriage for them,” said a second ex-NYPD source.

Insurance insiders claim losses have tripled since the pandemic, with payouts so massive they’re driving up the cost of living for all New Yorkers.

One insurer, Tradesman Program Managers insurance firm of Poughkeepsie, a carrier covering contractors and construction companies in the city, says it forked over $142 million in 2022, three times the $36 million it paid out in 2018. It claims it has been hit with 650 allegedly fraudulent suits over the last four years.

“We’re talking billions collectively across the city,” said an insurance executive who asked not to be identified.

Tradesman and the Roosevelt Road insurance carrier sued eight doctors and two law firms — Gorayeb Associates and Fogelgaren, Forman & Bergman — along with 36 lawyers, healthcare providers and companies in Brooklyn Federal Court in March, citing RICO conspiracy laws used to prosecute Mafia dons, in its civil action.

“They train the migrants how to act at some of these staged accidents,” Tradesman lawyer Kirk Willis told ABC 7. “And then when the people are hurt — allegedly hurt — they go to the lawyer first, not the doctor, and the lawyer then starts a course that sets up these fraudulent lawsuits.”

New York’s Scaffold Law says builders are considered fully at fault for any accident involving a fallen worker, and that empowers criminals, said Rygo Foss, former general counsel for Andromeda Advantage Inc. of Long Island City, a construction consultant.

“We have 59 cases that we’ve identified as fraudulent,” said Foss, who projects those claims will cost as much as $100 million to settle or reach a verdict. “And that’s if it all stops now. It’s a huge issue. Everyone’s getting hit.”

The scams are ballooning costs for insurance, housing, construction, food, utilities, and basic living expenses, sources say.

New York already has the third highest average car insurance rate in the country, with minimum liability costing $1,472 per year; the fifth highest rates for individual health insurance at $736 per month; and the second highest workers compensation costs.

“Every contractor is affected because their rates go up every year and they pass along the costs,” said restoration company owner Steven Katz. “It affects every single building. It’s an undisclosed tax.”

Rumors of a potential federal probe have circulated among lawsuit litigants for weeks. One confidential source told The Post he has shared information with the FBI.

Law-enforcement has done little to stop the scams, but one case brought by the feds revealed details on how they work.

A whistleblower in the prosecution of Dr. Sady Ribeiro, the Manhattan surgeon sentenced to three years in prison last March for doing unnecessary back operations as part of an insurance scam, said those procedures were the key to getting top-dollar payouts.

“It was always a back injury,” testified Peter Kalkanis, a former chiropractor who pocketed $2 million for orchestrating more than 200 accidents over four years. And if someone balked at having fusion, “the case would be dropped,” he said.

Among the accused is “Dr. Bo,” Gbolahan Okubadejo, a Johns Hopkins-trained spinal surgeon from Nigeria with offices in Manhattan and New Jersey who allegedly performed unnecessary fusion operations on patients to pump up payouts for them and make money for himself, according to papers filed in Manhattan Supreme Court in May.

The filing alleges that purportedly injured construction worker Edvaldo Nunes Oliveira, who emigrated from Brazil in 2013, didn’t require surgery, but that Okubadejo performed neck and back fusions on him anyway — as well as on other plaintiffs also repped by the midtown Manhattan firm Wingate Russotti Shapiro Moses & Halperin, stated lawyer Scott Brody, who represents the defendant landlord and construction company, in his court papers.

Okubadejo was “fully aware that by…recommending surgery on those referrals from the Wingate firm, that their cases significantly increased in value,” the filing claims. “[He] knew that if he operated on [them], and thus increased the value of their cases, he would obtain more referrals.”

An assistant to the doctor, who has not been criminally charged in any case, said his office was unaware of the filing. Wingate did not return calls seeking comment.

Among immigrants who allegedly participated is Lesly Ortiz, a native of the Dominican Republic who came to New York in 2018 at the age of 20 and found work as a hotel housekeeper, and hoped to own a home and start a family in the city.

A year later she tripped on the sidewalk on West 158th Street in Manhattan, landing on her backside in a seated position. Passersby asked if she wanted someone to call 911. She declined and went home, according to court documents.

But the next day Ortiz went to the Columbia Presbyterian ER, where medics X-rayed her left wrist and left knee and found nothing wrong, hospital records show. Doctors prescribed ibuprofen and sent her home.

What Ortiz didn’t realize was that her aunt’s ex-boyfriend was part of a ring of notorious runners, according to sources familiar with the case. He suggested she contact the Subin law firm, Ortiz told The Post, and she signed on as a client just 24 hours after leaving the hospital, court papers show.

She said Subin then directed her to Dr. Michael Gerling, an orthopedic surgeon and former NYU Langone director in Brooklyn who describes himself as New York’s “top spine surgeon” and operated on Ortiz, according to court papers. Gerling performed two surgeries: a lumbar and a cervical fusion, she added, though court papers say he did one fusion on her back. Neither procedure did anything but create more pain, according to Ortiz.

“The pain is unbearable since the operation on my lower back,” she told The Post. “I feel like a 60-year-old woman in the situation I find myself in. I don’t know how I will continue working.”

Her case was going forward until defense lawyers filed a motion alleging that Ortiz and 11 other family members, including her aunt, had engaged in fraud.

The filing stated that all 12 members resided at 2011 Amsterdam Avenue or had ties to the building, and each allegedly suffered injuries there or nearby that required fusions, according to the firm Weiner, Millo, Morgan and Bonanno, which reps a landlord sued by them.

“The idea that this was mere coincidence is arguably statistically impossible,” the firm claimed in court papers.

Subin, whose lead attorney Herbert Subin represented Ortiz, relied on All Boro Medical Rehabilitation for doctor referrals, according to the filing.

All Boro co-founder Dr. Kevin Weiner had his medical license suspended by the state last year and was banned from prescribing medicine and doing surgeries after it found he was guilty of “negligence” and “incompetence” and performed “unwarranted test/treatments” on patients between 2013 and 2017, according to agency records and court papers.

Ortiz said she was unaware of the allegation, and that she’s lost touch with her aunt. “I don’t know anything because I haven’t lived with her in years,” she said.

Subin, which handled 11 of the 12 family lawsuits, asked to be relieved from those cases, and a judge agreed. Ortiz said she never got any money, and now owes thousands of dollars to a lending firm that fronted her the funds for her filing and her operations.

On May 16, a litigator for Subin Associates told a judge in Manhattan Supreme Court that the firm likely would need to step away from 200 to 300 cases brought in from an outside individual on advice of its ethics counsel.

“We have questions about the reliability of this referral source,” said lawyer Mark Meleka. He didn’t name the source.

Subin has already walked away from 170 lawsuits, allegedly engaged in a decade-long pattern of using “problematic sources” and in one case relied on a “runner or runners who either staged or otherwise induced the firm’s clients to manufacture bodily injury” claims, according to a June 12 filing by Exo industries, a Queens construction firm.

Subin did not return calls seeking comment.

Gerling, who last year was named in a suit brought by Geico in which the insurance company alleged he performed unnecessary surgeries, denied he was involved in any fraud.

The United States Attorney’s Office accused a Thibodaux health care worker of defrauding health insurance companies of millions of dollars.

John Christopher Barrilleaux, a clinical social worker and owner of Clinical Consultants LLC and founder of Outpatient Alternatives, used the two companies to charge health insurance companies for work that was not done, the U.S. Attorney’s Office said in an eight-page filing at the United States Eastern District Court of New Orleans.

The filing states that Barrilleaux defrauded health insurance companies of $6,087,758, of which he was paid $4,592,650. This fraud, prosecutors said, took place from June 2008 through March 2024.

“Specifically, Barrilleaux created treatment plans for patients that falsely and fraudulently indicated that they would receive mental health treatment on certain days of the week, and then submitted false and fraudulent claims to the Insurance Companies for purported services provided on those dates, even when no services were provided,” the documents state. “In order to conceal the fraud, Barrilleaux fabricated patient notes and submitted the falsified notes to auditors for the Insurance Companies in order to falsely make it appear as if he had provided services to patients.”

The money, prosecutors said, was spent on real estate, fine art and gambling.

A hearing has been rescheduled for Oct. 10. Barrilleaux is expected to plead guilty, court documents state.

Former CFO Charged with Fraud.

Detectives of the Financial Crime Unit have charged the former Chief Financial Officer of the National Health Insurance Plan (NHIP).

TESSA BEEN MALCOLM, 41, faces the following charges:

One count of Theft;
One count of False Accounting;
One count of the Use of Criminal Property.

Mrs Malcolm was charged today and granted $50,000 bail. She is scheduled to appear in the Magistrate’s Court on October 8, 2024.

The charges against Mrs Malcolm stem from a report lodged in August 2022.

An unnamed number of stolen vehicles from Cheltenham Township have been found at Allentown Auto Works & Recycling, the Lehigh County District Attorney’s Office announced today.

The company is owned by Cesar Garcia-Martinez, 34, of Easton, and was identified as a “chop shop”, an illegal business typically disguised as an auto body shop. Garcia-Martinez has been accused of dismantling stolen vehicles and selling their parts.

The investigation included detectives from the Lehigh County Auto Theft and Insurance Fraud Task Force, Allentown Police Department, Bethlehem Police Department and an agent with the National Insurance Crime Bureau. It began when the task force was contacted by Allentown police regarding a stolen Honda Accord seen in the area of North 5th and Washington streets on Wednesday, September 18.

Detectives searched the shop and found 10 stolen vehicles.

Each vehicle was found in a different state of disassembly, and none of the vehicles had titles or other paperwork. In addition to Cheltenham, they were stolen from New Jersey, New York City, and Philadelphia, officials said.

Garcia-Martinez is charged with two counts each of owning, operating or conducting a chop shop, disposition of a vehicle or vehicle part with an altered VIN number, and receiving stolen property.

Federal court documents reveal that investigators believe Wayne County resident Angela Frase intentionally blew up her home in an elaborate fabricated hate crime scheme to defraud an insurance company.

The seven-page court filing shows that Frase and her husband devised the scheme to defraud and obtain money and property by means of false pretenses. She has been charged with four counts of mail fraud.

Community members raised thousands for the couple, who claimed they were victims of a series of hate crimes.

In one incident, Frase reported to police that a stuffed doll was left in her mailbox with a noose tied around its neck.

The Sterling Fire Department responded to a fire on Spruce Street in Sterling, Ohio, on Aug. 7, 2019, shortly after midnight.

“I got a call last night, it was 12:47 and I remember thinking ‘who’s calling me at one in the morning?’ It was my neighbor and he thought lightning had struck the house,” Frase told 3News in an interview after the explosion. You can watch her conversation with us below.

Documents show that the Sterling Fire Department had also responded to the home on Aug. 6, for a reported natural gas leak.

Investigators determined that Frase left the hotel she was staying at and drove to the home on Aug. 6, just about an hour before the house exploded.

The documents show that the Ohio State Fire Marshall’s Office found racist graffiti and a swastika symbol painted on the garage of the home.

Investigators revealed that Frase did not tell law enforcement that she was at the home just before the explosion. She told them that she did not leave her hotel that evening, according to the documents.

Frase reported to investigators that days later, on August 11, she went to the home to check on her cats and discovered two individuals near her garage, according to the documents.

Investigators then discovered “white power” written on the side of the garage. A neighbor allegedly told police that they did not see anyone in the area.

Days later on August 14, Frase reported to police that she found a doll with a noose tied around it’s neck in her mailbox.

About a week later on August 23, Frase reported to police that they located an envelope with the word “DIE” written on the inside of it along with an unknown white substance.

In March 2020, Frase and her husband claimed the fire was caused by an “apparent explosion” of “origin unknown,” with no witnesses to the insurance company, according to the documents.

The documents show the insurance company paid the couple more than a quarter of a million dollars. The documents also show Frase made other reports to the Sterling Fire Department and reported another fire in the home, about a month before the explosion.

Our team has reached out to Frase’s attorney for comment. You can read the court filing below.

Pitkin man accused of burning home, vehicle in insurance fraud scheme