Arrest - InsuranceFraud.org

Angelica Maria Holst, 54, of Fullerton, was arraigned this week on four felony counts of theft after an investigation by the California Department of Insurance found she allegedly embezzled over $35,000 from several clients while working as a licensed insurance agent and operating her own business.

The investigation began after receiving a complaint against Holst alleging that while working as a licensed insurance agent and operating her business, Highway & Environmental Services, Inc., she failed to remit commercial insurance policy payments from several victims. Instead of submitting the collected funds to her managing general agent for the policies, Holst pocketed the payments for personal use.

The investigation found that between July 2018 and December 2018, Holst embezzled a total of $35,789 in premium commercial insurance policy payments from multiple victims meant to secure policies. Holst’s managing general agency stepped in to cover the losses so that no client had a lapse in coverage and were left uninsured.

The Department of Insurance has filed an accusation against Holst and is seeking to revoke her insurance license.

Holst is scheduled to return to court on January 19, 2023. This case is being prosecuted by the Orange County District Attorney’s Office.

A Harare man is in trouble for insurance fraud after he allegedly swindled Old Mutual Insurance Company of US$2000 through a false claim for his motor vehicle which had been involved in an accident.

Onward Dewa (48) appeared before Harare magistrate Dennis Mangosi charged with fraud.

Dewa was granted $50000 bail, and was remanded to February 13 next year.

The complainant is Old Mutual Insurance Company represented by Kudakwashe Rufudza, a claims manager.

It is the state’s case that on the dates unknown to the prosecutor but during in May this year, , Dewa approached Henrics Providence Dhonga, who is already on remand on the some charge, at his garage in Willowvale, Industrial Site, Harare and informed him that his Toyota Mark 2 motor vehicle had been involved in a road accident and wanted it repaired.

It is alleged that Dhonga and Tinevimbo Clarence Marufu, who is also on remand on the same charge, hatched a plan to defraud Old Mutual insurance Company through fake insurance claims.

On May 5, the trio staged a road traffic accident along Prince Edward Road, Harare involving the accused’s motor vehicle as the first party and Marufu’s as the second party.

It is alleged that on June 2,Dewa made a false insurance claim for his vehicle to the sum of US$2 000-00.

Acting on misrepresentation, Old Mutual Insurance Company paid the claim.

According to sources, the mastermind, identified as Latifur Rahman, along with his two aides, identified as Baharul Islam and Gafur Ali were remanded in custody for questioning.

Notably, last Thursday, the Crime Branch conducted raid at several places in the concrete city of Guwahati along with Nalbari and Barpeta.

The branch, during the raid, had arrested a gang who provided fake death certificates.

The raid was carried out at the city’s Paltan Bazar, Hatigaon and Mukalmua in Nalbari.

The gang committed fraud in several banks including ICIC and Axis Bank.

At first, they apply for insurance and then they provide fake death certificates to extort money.

So far, the branch has arrested at least nine persons, including a woman, in connection to the scam of extorting money.

A 59-year-old registered nurse practitioner from Spokane, accused of defrauding Medicaid of $5 million, faces 68 criminal charges.

Paul B. Means, registered owner of the firm Abilia Healthcare based on Spokane’s South Hill, was formally charged Thursday with felonies including leading organized crime, theft, use of proceeds of criminal profiteering, money laundering, false Medicaid statements and witness tampering. Means is scheduled to appear before a judge in Spokane on Jan. 4, according to court records, following a three-year investigation by the Washington Attorney General Office’s Medicaid Fraud Control Division.

A message left at a phone number Means used to register Abilia Healthcare with the state was not immediately returned Friday. Phone and email messages left with an attorney representing Means in his civil case on Friday also were not returned.

According to a 247-page complaint filed by Scott Tollackson, a supervising special agent with the AG’s fraud division, the investigation into Means and Abilia began with an audit of Medicaid billing in 2019. Investigators discovered that certain codes the firm used in billing the government health program designed to help the poor far exceeded other institutions in the state, including major hospitals and service providers, beginning in 2017, and that there was no documentation to support the billing.

Review of records obtained during a November 2020 search of Means’ homes on the South Hill and subsequent interviews with patients and staff at American Behavioral Health Systems, where Means and his employees provided services, showed that Means would bill Medicaid for face-to-face services as described in Medicaid codes lasting up to an hour or more. Those services were instead provided via videoconferencing and often lasted less than 15 minutes.

Means met with investigators in November 2020, according to the complaint, and described his billing processes. During that interview, Means said “he did not know much about the specific codes that he billed,” according to Tollackson’s report. He also told investigators he’d hired contract workers, whom he referred to as “back office” staff, in the Philippines for data entry.

Investigators allege nurses working for Means would prepare notes based on the services they provided a patient, and that Means would then access those notes and alter them to increase the billing amount from Medicaid using an automated system. Authorities recovered videos believed to be used to train those working in the Philippines how to use the automated text system to prepare falsified patient reports for billing.

Nurses working for Means later told investigators when reviewing their notes they did not enter text that appeared to be created by the automated system and increased the billing amounts for Medicaid. Investigators concluded that the nurses were “generally not able to see their prior encounter notes so they were not aware that Means was altering the notes.”

A day after authorities served a search warrant at Means’ residences, he emailed a contact in the Philippines informing them that “we have been shut down” and requesting that they not speak to “anyone trying to contact you.” Those emails, and internal messages, were later obtained by investigators.

Investigators allege the proceeds of the fraud were used to purchase several vehicles and two homes, one on the South Hill and one in Cheney. A separate civil case filed in November 2020 in Spokane County Superior Court has been placed on hold while the criminal charges are resolved.

Abilia ceased operations and Medicaid billing following the November 2020 search of Means’ home, according to court records. Means remains a licensed nurse practitioner in the state, according to the Washington Department of Health, and there are no disciplinary actions on his record.

The charges Means faces are all felonies, the most serious of which – leading organized crime – carries a potential life prison sentence and a fine of up to $50,000. The Attorney General’s Office, in a news release Friday, indicated it would seek a sentence above what is known as the standard range, a calculation of time of imprisonment based on a person’s criminal history, citing “the high degree of sophistication, lengthy period of time, and scale of the monetary loss.”

Dr. David J. Smith, a pain management physician, and his office manager, Julia Ann Oertle, are charged in a federal grand-jury indictment with perpetuating a long-running scheme to commit healthcare fraud and to manufacture and distribute adulterated fentanyl.

Smith made his initial appearance today before U.S. Magistrate Judge Bernard G. Skomal. Smith’s bond was set at $1 million, secured by real property, with a limitation on his ability to practice medicine. Oertle was still at large.

According to allegations in the indictment, Smith purports to specialize in the installation and maintenance of intrathecal pain pumps which are surgically placed in a patient’s stomach with two catheters implanted on the spine; pain medicine is then infused into a reservoir in the pump periodically and meted out directly into the spine.

Beginning in December 2017, Smith and Oertle began compounding fentanyl citrate into vials, in a room at Smith’s principal medical practice, San Diego Comprehensive Pain Management Center. According to the indictment, this compounding practice was grossly improper and resulted in the production of adulterated fentanyl. Smith nevertheless directed administration of this fentanyl to patients repeatedly.

The indictment alleges that beyond providing patients with adulterated fentanyl, Smith violated the applicable standards of care by, among other things, prescribing materially excessive quantities of fentanyl, prescribing unnecessary oral opioid medications in conjunction with pain-pump medication, and installing pain pumps in patients without proper assessments for patient need. Smith then had false and fraudulent reimbursement claims submitted to Medicare for these administrations. Among other things, the claims were inflated by nearly 60 percent; they sought reimbursement for large volumes of unnecessarily manufactured fentanyl; they falsely represented that excess fentanyl had been discarded, when in fact it was used; and they did not disclose that the fentanyl was adulterated.

According to the indictment, Oertle illegally ordered fentanyl citrate for compounding; compounded fentanyl with Smith; and helped direct the illegal billing practices.

“The DEA is committed to bringing to justice doctors that take the public’s trust and abuse it for their own purposes,” said DEA Special Agent in Charge Shelly S. Howe. “We are grateful for our relationships with the U.S. Attorney’s Office, the FBI and the other agencies who worked to bring these defendants to justice.”

“We are supposed to be able to trust our doctors with our lives,” said U.S. Attorney Randy Grossman. “This office will use all its resources to protect vulnerable patients from doctors who use them to make money, with no regard for their safety.”

“Criminal misconduct within the healthcare system is not only deceitful, but also destructive,” said Special Agent in Charge Stacey Moy of the FBI’s San Diego Field Office. “David Smith and Julia Oertle allegedly abused their positions of trust by manufacturing and propagating this toxic poison to patients over an extended period of time, further unraveling the fentanyl crisis our country is experiencing. This investigation clearly demonstrates that the threat of the opioid crisis extends far beyond street level dealing. The FBI will continue to work with our law enforcement partners to protect our communities and ensure justice is served.”

“U.S. consumers must be able to trust that their medicines meet FDA’s required standards of safety and effectiveness,” said Acting Special Agent in Charge Christopher M. Alston, FDA Office of Criminal Investigations Los Angeles Field Office. “Our office will continue to pursue and bring to justice those who jeopardize the public’s health and the public’s trust.”

“According to allegations in the indictment, these defendants were trusted with the medical care of their patients but instead used treatments that were not medically necessary in order to gain financially,” stated Special Agent in Charge Tyler Hatcher of the IRS Criminal Investigation’s Los Angeles Field Office. “We will continue to serve the public and help put a stop to schemes like this that take advantage of our medical system and put patients’ care at risk.”

AGENCIES

Federal Bureau of Investigation, United States Attorney’s Office, Food and Drug Administration, U.S. Department of Health and Human Services, U.S. Marshal Service, and the Internal Revenue Service

Workers’ compensation funds are meant to help injured workers by partially replacing lost wages and covering medical expenses. But state investigators observed Patrick Dean Farthing walking on roofs, removing roof tiles, and moving construction equipment and heavy materials – the same kinds of tasks he did when working as a roofer before his injury.

Farthing, 63, is scheduled to be arraigned on one count of first-degree theft, a felony offense, in Thurston County Superior Court in Olympia on Dec. 27.

The Lakewood man is charged with wrongfully taking the thousands of dollars in wage replacement payments from the Washington State Department of Labor & Industries (L&I) from mid-2014 to January 2021.

Farthing, who was caught working as an unregistered contractor, also used the alias Adam Lay and sometimes did business as Pat Farthing Roofing.

“When we hear about fraud, we investigate,” said Celeste Monahan, assistant director for L&I’s Fraud Prevention and Labor Standards division. “Cheaters seem to think that stealing workers’ comp benefits doesn’t hurt anyone.

“But it’s taking money from legitimately injured workers, and everyone whose hard-earned dollars support the workers’ compensation system.”

The Washington State Attorney General’s Office is prosecuting the case based on L&I’s investigation of Farthing.

Tip leads to two-year investigation
Farthing injured his shoulder in 2010 while repairing a roof. His medical provider determined the injury was so serious he couldn’t work as a roofer. That assessment, coupled with Farthing’s declarations that he wasn’t working in any job, allowed him to qualify first for wage replacement payments, which are temporary, and then for a pension.

In 2018, L&I launched a two-year investigation into Farthing after receiving a tip he was working as a roofer. A team of L&I investigators determined Farthing had been running his own business that performed roofing jobs throughout the South Sound.

Investigators photographed Farthing remove and install roofs, direct work crews, and move equipment and materials on and off job sites, according to charging papers. They obtained Farthing’s bank records, and building supply invoices showing he was buying roofing materials starting in 2014, sometimes using the name Adam Lay.

Cited for unregistered contracting
As part of the investigation, construction compliance inspectors caught Farthing and his work crews roofing houses in Spanaway and Olympia in 2018, according to inspection records. They issued him civil infractions for unregistered contracting, with penalties totaling $5,000 that remain unpaid.

When the inspector at the Spanaway site asked Farthing if he wanted to register as a contractor, Farthing responded, “he was not interested,” the inspector’s statement said.

L&I oversees the state workers’ compensation system, which helps employees injured on the job heal and get back to work. Employees who can’t work because of their injury and who meet certain conditions can receive payments for part of their lost wages.

STATE OF VERMONT

DEPARTMENT OF PUBLIC SAFETY

VERMONT STATE POLICE

NEWS RELEASE

CASE#: 22A2005816

RANK / TROOPER FULL NAME: Trooper Justin Wagner

STATION: St. Albans

CONTACT#: 802-524-5993

DATE/TIME: 10/12/2022 at approximately 10:21 AM

INCIDENT LOCATION: Carpenter Hill, Georgia

VIOLATION: Home Improvement Fraud

ACCUSED: David Johnson

AGE: 46

CITY, STATE OF RESIDENCE: Sheldon, VT

SUMMARY OF INCIDENT: On October 12, 2022 at approximately 10:21 AM Vermont State Police – St. Albans was contacted in regard to possible home improvement fraud occurring on Carpenter Hill Rd. in the Town of Georgia.

Through investigation, probable cause was found to charge 46-year-old David Johnson with Home Improvement Fraud. On 12/22/22 Johnson was issued a criminal citation to appear in Franklin County Superior Court to answer to the charge.

COURT ACTION: Yes

COURT DATE / TIME: 2/14/23 at 8:30 AM

COURT: Franklin County Superior Court

LODGED: No LOCATION: N/A

BAIL: N/A

MUG SHOT: No

A retired Massachusetts schoolteacher was charged with murder last week after being accused of poisoning her boyfriend’s coffee shakes with antifreeze.

Judy Church, 64, of Salisbury, appeared briefly in court on Friday, one day after she was arrested on suspicion of poisoning Leroy Fowler, 55, with ethylene glycol, WCVB reported.

Church called emergency services shortly after 8 p.m. Nov. 11 to report that Fowler was in “medical distress,” according to records obtained by NBC Boston. Explaining to dispatchers that her boyfriend “must have ingested something,” Church alleged that he was “pulling the bedroom apart, and had a bloody nose.”

Fowler was transferred to three different hospitals for care, where doctors eventually determined his kidneys were failing due to antifreeze poisoning. The discovery prompted Fowler’s family to contact police.

Fowler was pronounced dead on Nov. 13. Investigators eventually discovered unidentified containers on surveillance footage around Church’s apartment.

Fowler’s stepson, Michael Hawkins, told investigators that Fowler suggested “out of the blue” that Church was poisoning him just two weeks before. Fowler allegedly said he “‘felt better’” when he left Church’s home, but he still relied on her for most of his meals.

Fowler’s sister, Tammy Carbone, reported similar suspicions, telling police that her brother claimed Church might be contaminating the coffee shakes she frequently made for him.

Although Church’s motive remains unclear, Hawkins divulged to authorities that Fowler was known to “go back and forth” between Church and a second girlfriend.

Citing court documents, NBC Boston alleged that Hawkins claimed to have overheard Church saying she “wanted to murder” the other girlfriend. Church also reportedly took out a life insurance policy on Fowler one year before his death.

A common ingredient in antifreeze, ethylene glycol can be unknowingly ingested because of its syrupy texture and sweet flavor. Though symptoms of antifreeze poisoning can appear anywhere from 30 minutes to 12 hours after ingestion, even small amounts can be fatal.

In a brief statement to the Daily Beast, Fowler’s son, also called Leroy, described his father as “a good guy.”

“Not perfect but he was a good guy,” he said, noting that Fowler was especially close to his 8-year-old grandson.

Church was denied bail on Friday. She is due back in court on Jan. 23 for a probable cause hearing.

In a comment on Church’s Facebook page, Carbone expressed outrage over her brother’s fate.

“I can’t wait to see [Church’s] face tomorrow when she can’t walk out [of jail],” the grieving sister wrote before Church’s arraignment. “To think she thought she could get away with it.”

A man from St. Louis was arrested Thursday on an indictment that accuses him of manufacturing and selling fake temporary vehicle license tags.

Mario C. Cooks, 34, was indicted in U.S. District Court in St. Louis Wednesday on six felony counts of fraudulent transfer of an authentication feature. The indictment says Cooks used a fake watermark and seal of the Missouri Department of Revenue on temporary motor vehicle license tags produced between June 28 and December 6.

In a court-approved search, Thursday morning of Cooks’ home in the 5300 block of Claxton Avenue, the United States Secret Service, St. Louis Metropolitan Police Department, St. Charles Police Department, and the Missouri Department of Revenue seized computer equipment, counterfeit temporary motor vehicle documents, and counterfeit motor vehicle titles.Geographic Reference

In an affidavit filed to obtain the search warrant, an agent of the U.S. Secret Service said the investigation began when police in St. Charles learned that Cooks was offering fraudulent temporary motor vehicle tags as well as a fraudulent license plate that appeared to have been issued by the State of Missouri to a licensed car dealership. An undercover police officer then purchased a series of fraudulent temporary motor vehicle tags and automobile insurance cards from Cooks, the affidavit says.

Cook’s federal charge carries a penalty of up to five years in prison, a $250,000 fine, or both.

The case was investigated by the St. Charles Police Department, the St. Louis Metropolitan Police Department, the U.S. Secret Service, and the Missouri Department of Revenue. Assistant U.S. Attorney Tracy Berry is prosecuting the case.

A doctor from Brookline was indicted on Tuesday for money laundering and healthcare fraud, according to U.S. Attorney Rachael Rollins.

Pankaj Merchia, 49, a sleep medicine physician of Brookline and of Boca Raton, Florida, was indicted on three counts of money laundering and one count of health care fraud, Rollins said. Merchia self-surrendered and was in federal court at 3 p.m. on Tuesday in Boston, according to the attorney.

The indictment stated Merchia committed two different healthcare fraud schemes. The first was that Merchia had allegedly continued to bill former patients’ insurance companies for the use of sleep apnea machines (the CPAP and BiPap machines) for years after the former patients had stopped using the machines or returned them to Merchia’s office.

According to the attorney, Merchia allegedly used the money he received from the fraud to buy an expensive house in Brookline.

The second scheme Merchia allegedly committed was against a family member of a patient — the doctor allegedly billed the family member over $400,000 for a monthly CPAP machine rental, even though he knew the insurance carrier wouldn’t pay for treatment through a patient’s family member. The attorney said Merchia used the money from this scheme to wire transfer $250,000, and purchase at least $140,000 in securities, or stock.

Fullerton insurance agent arraigned after allegedly embezzling over $35,000 in premium payments from clients