Publications

In 2004 more than 100 insurers in America offered such products, now the number is about one dozen. The average annual long-term care insurance premium increased from $1,071 to $2,772 between 1990 and 2015. Both of these shocking statistics come from the NAIC. “It’s an unfortunate position that we find ourselves in,” NAIC President Dean Cameron of Idaho notes in a recent article addressing the myriad issues surrounding long-term care insurance. He spoke of more insurers going insolvent and consumers being left with higher premiums and decreasing coverage. Little action has taken place, despite promises and some efforts. In 2021, President Biden proposed $400 million in funding for long-term care programs. But his proposal lacked details about how the funds would be allocated, and ultimately died in the Senate with little support from either party. The NAIC has also proposed federal intervention, such as adding a homecare benefit to Medicare, Medicare Supplements and Medicare Advantage plans; creating long-term care savings accounts; and allowing retirement plan participants to make distributions from their savings without paying penalties.

Florida CFO Jimmy Patronis is highlighting and urging expansion of the Florida Fraud Fighter Reward Program to increase fraud tips and crack down on insurance fraud in the Sunshine State. The program was founded more than 20 years ago to encourage fraud reporting. It rewards up to $25,000 to persons who report information leading to an arrest and conviction. The Coalition supports the CFO’s efforts to expand the program. “To bolster this program, I intend to pursue a law change to make the Florida Fraud Fighter reward eligible for tips that lead to a fraud arrest, not only an arrest that leads to a conviction,” Patronis says. “This will give even more incentive for Floridians to report insurance fraud and protect your friends, family and loved ones from becoming a victim.” The Coalition is hopeful the change will be approved soon during the special legislative session set to convene later this month in Tallahassee. 

Out-of-state insurers engaging in improper insurance activities in New Jersey are now subject to a direct action by the state’s insurance commissioner based on a decision released this week by the state Appellate Court. Applied Underwriters argued the state’s Non-Admitted Insurers Act mandated only the Attorney General to act following concerns raised by Commissioner Marlene Caride of the New Jersey Department of Banking and Insurance over several of its workers compensation programs. The insurer further asserted any claims for violations by non-admitted foreign insurers must be filed in the state Superior Court, claiming the state’s non-admitted insurers law also disallows the commissioner from bringing faster and less-expensive administrative actions. The court disagreed: “Based on the text, legislative history, and public policies of the statute as a whole, as well as principles of primary jurisdiction, the Commissioner has the authority to choose to pursue an administrative complaint against the companies instead of a lawsuit brought by the Attorney General.” 

Iowa Insurance Commissioner Doug Ommen is promoting a newly expanded state law that grants financial advisors immunity for reporting suspected fraud cases to the state DOI. “It’s put the advisers in the position of being the bird dog that calls out the problems,” Ommen said at a recent meeting. Financial advisers are key to fighting fraud because ”so many of the consumers that are getting ripped off don’t realize they’re getting ripped off,” Ommen told the advisors. “If you see something, report it to us in confidence.” The commissioner also advised consumers: “The door-knocking agents that come around put a lot of pressure on people. Don’t give in to that pressure. Don’t make a decision alone. Talk to someone you trust,” Omen warned. He urged citizens to contact the Iowa Insurance Division to determine if a financial adviser is properly licensed, and if there are any complaints or disciplinary actions involving that adviser.

Note: Texts of anti-fraud bills are available on the Coalition’s website here.

Deepfakes: The rapid rise of touchless claims creates a potentially messy fraud exposure for scammers trying to slip proliferating deepfake photos past insurers. “While there is some movement from insurance organizations to close the gap of deepfake fraud, the pace of touchless automation, in the form of self-service transactions and straight-through processing (STP), has been far faster and a bit more furious,” says an article in Property-Casualty 360. “No doubt, COVID may have aided the transition to self-service transactions, as it was a natural fit for claims reporting during lockdowns. At the same time, this mostly welcome digital transformation increases dependency on customer-supplied photos for settling claims … The deeper implication of this relatively torrid pace of automation is that with customer-provided photos and virtually no human interaction on the claim processing side, the risk of fraud from altered, manipulated or synthetic photos significantly increases.”

Healthcare AI: Auto, home and comp insurers may find familiar AI insights with healthcare’s struggles to thwart fraudsters: “… healthcare leaders are quickly learning that even so-called ‘advanced’ tools aren’t capable of keeping up with today’s fraud. Only top-grade AI solutions are able to find all types of payment errors and identify suspicious and anomalous activity that might have been missed through traditional means,” writes Dr. Musheer  Ahmed, CEO of Codoxo. “These solutions have been built to include faster, earlier, more comprehensive detection of exposure. With a more complete and accurate view of provider performance, providers can act before they see impacts on their bottom line. An example of this in action is a system that can ingest and analyze all claim types, including professional, facility, and pharmacy claims through AI rules. Excluding one claim type from the analysis will create a gap in the view of provider practice patterns and create missed opportunities to promote coding best practices and reduce costs pre-claim.”
 

A ditzy scammer chose the wrong person to ping with a bogus offer of COVID-19 “insurance.” The scammy text went to the personal cell of Maryland Insurance Commissioner Kathleen A. Birrane: “This is the Novel Coronavirus insurance service based on the current outbreak. The premium for COVID-19 insurance is $1,000. If you are diagnosed with COVID-19, you can get a lump sum of $30,000. In the case of home isolation or hospital isolation, you can get $300 per day for up to 21 days.” The message also gave a “contact us” number. Be wary of unsolicited offers of COVID-19 insurance via text, email or cold calls, the insurance department warns residents. Contact the department to confirm the insurance is legit and authorized in Maryland, Birrane urges. HHS shares these consumer resources.

Then along came contractor Salvador Chiaromonte. He took more than $1 million of victims’ money and left them unrepaired homes. The fire wrecked 4,600 homes. Victims signed about 40 construction contracts with Chiaramonte. He took money for work that was shoddily performed or not done at all. Chiaramonte missed deadlines, and broke promises on construction start dates. Victims saw their rebuilds drag on with no progress. One victim was D.M. Kelley, who lost his house. He met with Chiaramonte who repeatedly mentioned his Christian values. Chiaramonte took over $100,000 from Kelley and did almost no work. Kelley demanded his money back. Chiaramonte said he needed the money to save his own home. “I said, ‘What about us? We have no houses!” Kelley retorted. Chiaramonte pled no contest and faces a six-year jail term, including 18 months of probation. Meanwhile, some of Chiaramonte’s victims still haven’t rebuilt their homes with their insurance money stolen. “A lot of them are still very emotionally raw,” says attorney Rich Freeman, who represents 14 homeowners in a lawsuit. “The horror of what they went through, losing everything in the fires, the emotional trauma of that, coupled with battling with their insurance companies to find out what their coverage was, only to have this guy run off with or squander their money and leave them scrambling — there’s almost nothing that could make them whole again.”

Knocking on doors after Hurricane Florence in 2018, contractor Dennis Daugherty lined up homeowners for home repairs in North Carolina. His firm Green Lantern took advance payments from insurance claims, yet provided shoddy work and didn’t pay subcontractors, the state AG says in a lawsuit. The contentions: Daugherty promised he could repair all hurricane damages, including roof, siding, windows and ceilings. Yet he and his crew didn’t have the expertise. They left several homes unrepaired and exposed to the elements. And because customers had signed over their insurance payments to Daugherty, they couldn’t obtain additional relief from their insurers to complete the repairs. The victims were forced to pay out of their own pockets. The state received nine complaints from customers who paid Daugherty $250,000 total. He also lied that he was state-licensed. The AG seeks a preliminary injunction to prevent Daugherty from doing business in North Carolina while the lawsuit continues. The AG also seeks restitution, injunctive relief, civil penalties and attorney fees. No word about criminal charges.

Two local law firms may have helped Victor Van Vickery fleece Uber with false crash-injury claims, officials allege in Boca Raton, Fla. Vickery ordered an Uber ride for his girlfriend. The vehicle crashed shortly after the pickup. Police responded and documented the people involved. Here’s what allegedly happened next: Two law firms obtained the crash info. They contacted Vickery, believing he was in the crash because he ordered the ride. Vickery signed with the Billera Law Firm. It made an injury claim against Uber, saying Vickery was hurt in the crash — even though only his girlfriend was in the vehicle. Vickery got medical treatment at the Bougie Center for Chiropractic and Alternative Medicine. The Billera firm sent the bills to Vickery’s insurer, Progressive. The insurer started questioning the bills, so Billera dropped Vickery as a client. He then hired attorney Marco Quesada, in Miami. Quesada continued pressing the injury claims. The investigation heated up when the state CFO’s investigators got involved, leading to Vickery’s arrest for insurance fraud. 

Melissa Dopheide’s two-year-old kid was inside the house when she set it ablaze for an insurance score, prosecutors allege in Scranton, Iowa. The home went up in flames the day the she and her live-in were being legally evicted. Investigators found a loosened furnace line. A lit candle was used to ignite the gasoline. Dopheide also moved all her belongings to a detached garage the night before the fire. She said the fire started accidentally, and declared her possessions a total loss. Dopheide received nearly $54,000 of insurance money from Lemonade. A GoFundMe page also raised $1,670 for the family. In addition to fraud and arson-related charges, Dopheide charged with neglect of a dependent. Her live-in also is charged. 
 

An agent ambushed clients, looting them for her own gain. Koreasa M. Williams persuaded her client to cash in several life policies to invest the proceeds in annuities the Tucson, Ariz. agent said she’d procure. Over six months in 2019, Williams convinced her client to give her $1.2 million. She used nearly $900,000 to pay victims of a prior unrelated annuity scheme in an attempt to avoid criminal charges. Williams later pleaded guilty in the unrelated con and was sentenced to 51 months. She used the remaining $300,000 to pay her attorney fees for the unrelated scheme, and to settle a civil suit brought by another client. Williams pled federally guilty to the recent life scheme. Sentencing comes later. 
 

Seeming cause of death: Poisoning. Suspected motive: Steal $750,000 of life insurance with a fake death in Ukraine, officials say of Oksana Brown in York County, Pa. Fraud allegations: The former Baltimore police trainee bought term life plus accidental death and dismemberment policies. She then flew to Kyiv. Her hubby Paul later reported that Brown died from “poisoning by unknown substance” in Ukraine. She faked her death to steal the life insurance — and avoid serving time for falsely accusing a state trooper of sexual assault after he busted her for shoplifting $30 of merchandise at a Walmart. Brown took out the policies after her bust. She lied on the application, saying she was never charged with a crime or had pending charges. In fact she was convicted of the shoplifting and was charged with lying about the sexual assault. Paul reported her presumed poisoning death in Ukraine. He next filed a death claim with State Farm, then withdrew his claim after the insurer learned of her prior criminal charges and conviction. Oksana later blew her cover when she emailed the U.S. embassy in Ukraine to reinstate her passport. She was extradited back to the U.S. Oksana’s charged with conspiracy to commit insurance fraud. Paul is charged with insurance fraud and criminal conspiracy. 

An NBA assistant coach filched $350,000 from the league’s health plan for retired players, federal officials allege in New York City. Kenyon Dooling was a former NBA player, Utah Jazz assistant coach and VP of the player’s association. Dooling is among the latest of 19 people charged with billing the plan $5 million for fake med and dental services. Here are the federal allegations: The suspected scheme allegedly was led by former New Jersey Nets and Houston Rockets shooting guard Terrence Williams. Dooling recruited others to join in and made false claims himself. He pocketed $350,000 in the process. One alleged Twitter feed: Dooling: Let’s make this thing grow sir. Dentist Aamir Wahab: Lol I’m down bro[.] Get me the whole NBA. Dooling: Yes we will[.] Dooling contacts another suspect: “Hey bro, here’s the breakdown: 5600 for you and me. Then 10800 for the guy. I fronted him 4300$ so you can put it with my 5600=9800 to My [bank account] … That way everything is under 10k.” Dooling is now suspended as Jazz assistant coach.. He also spent parts of 13 seasons as a player with seven NBA teams.

California Governor Gavin Newsom appointed Sherry Thompson-Taylor to the San Diego Superior Court on March 14. She spent a successful 26-year career fighting against fraud at the San Diego County DA’s office — which is a longtime and active Coalition member. Thompson-Taylor received this honor. She served as Chief of the Insurance Fraud and Workplace Justice Division for five years, and credits her success in the Insurance Fraud Division to the hard work, vision and the leadership of Dominic Dugo — former San Diego County Chief Deputy DA and former Coalition Co-Chair. “Dom’s passion for fighting insurance fraud helped shape my desire and drive to fight for our victims and protect the community from unscrupulous individuals,” Thompson-Taylor says. Her work in the Insurance Fraud Division included supervising 60 employees: attorneys, paralegals, investigators and support staff. She also prepared, coordinated and maintained grant applications for six grant-funded units with a $12-million dollar budget. In 2021, the division changed its name to the Insurance Fraud & Workplace Justice Division. Thompson-Taylor’s division also started focusing on workers’ rights, wage theft and labor trafficking. She took the oath of office on March 17. Thompson-Taylor presides in the San Diego Superior Court East County Branch, handling misdemeanor matters and felony drug court.

We’ve extended to May 31 the early-bird rate for you to attend IASIU’s Annual Conference, Sept. 11-14 in San Diego. Your conference committee has put together an outstanding program. Over 40 sessions are scheduled with the industry’s leading experts in fraud investigations. Whether you’re an experienced investigator or are relatively new to SIU, you’ll find training that takes your investigations up a notch. View the program to see what courses can boost your investigations with the latest techniques and trends. And be sure to register by the end of the May to save $100. I look forward to learning exciting and proven ways to chase down fraudsters with you in September!