Insurance Fraud Weekly ePort: Week Ending April 4

Apr 4, 2008

 

Insurance Fraud Weekly ePort
Week Ending April 4, 2008
www.InsuranceFraud.org
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LEGISLATION & REGULATION

  • The Kansas legislature passed a bill (SB 491) creating a prescription monitoring program for the state. The program will keep track of highly addictive prescription medicines that are prescribed by physicians and filled by pharmacists. The drugs often are procured by bogus prescription claims paid by insurers, notes the coalition’s new report Prescription for Peril.
  • The Maryland legislature passed a bill (HB 404) requiring fraud warnings on insurance claim and application forms. The governor is expected to sign the measure, which originated from the Maryland Insurance Administration and has widespread support within the state’s insurance industry.

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

CRIMINAL CONVICTIONS

  • Rhasaan Walker’s arson-fueled temper tantrum landed him a fraud conviction. The Tannerville, Pa. man claimed someone stole his 1995 BMW from the Bronx. He received nearly $7,400 in insurance money. Police later recovered the car and impounded it at an auto service station. Walker tried to reclaim his Beamer, and got mad when told ownership had transferred to the service station. He sneaked in one night and set the car on fire. But Walker burned himself, then ended up at the hospital, and soon to court for the torching. He tripped himself on the stand, however, saying the car was stolen from Main Street in Stroudsburg. That didn’t jive with his tale of a Bronx theft. Walker received 15 to 30 months.
  • Probation was a former deputy sheriff’s payback Tuesday for covering up an affair by lying to her insurer about how her van was damaged. Jennifer Reynolds was having an affair with fellow Washtenaw (Mich.) County deputy sheriff Christopher Campbell. They got into a fight at another officer’s home, and she claimed he rammed her vehicle while hurriedly leaving, crunching her door. Campbell denied all. But anxious to keep things quiet because he was going through a divorce, he agreed to pay her deductible and write up a fake police report saying the crash was a hit-and-run at a sheriff’s substation. Reynolds used the report for her damage claim with Reynolds’ insurer, State Farm. But State Farm said it was defrauded because Campbell’s insurer actually should’ve paid. Reynolds also lied in court that she never saw the forged accident report until she reached the witness stand. Campbell received probation last summer; each could’ve received up to 10 years.
  • What’s in a name? In Kerry Clabaugh’s case, a jail term. Clabaugh owned an Albany, Ga. temp firm. His comp premiums were cancelled for nonpayment, so Clabaugh simply changed the name of his business and reapplied for coverage in the new company name. His insurance application said the business was new and owned by others. Clabaugh pulled this stunt four times. He received three years in federal prison and must repay four insurers more than $1 million total.

CRIMINAL CHARGES

  • A firefighter was hurt trying to douse a blaze set by two women who torched a house for $265,000 in insurance money, Indiana prosecutors charged Monday. Tori Powell’s home was destroyed when a space heater apparently ignited a couch. A firefighter fell and dislocated his shoulder while pulling a hose. The Noblesville woman collected the insurance money and allegedly paid cohort Vanessa Allen $1,000 to start the blaze. But Allen confessed that Powell took her kids to her mother’s home the night Allen started the space heater, prosecutors say. The heater also was suspiciously close to the couch—just 18 inches away.
  • Ana Laura Salgado-Antunez told Mercury Insurance that someone stole her 2006 Nissan Armada. She said she parked it at a friend’s home, only to discover it missing the next morning. But the Santa Ana, Calif. woman was behind on her car payments and faced costly repairs. So she paid several cronies to have the Nissan dismantled at a chop shop in Mexico, prosecutors say. The suspected scheme was tripped up in part because Salgado-Antunez said the car was sitting in her friend’s driveway when it already was in Mexico, prosecutors say. She faces up to 20 years if convicted; four cronies also are on trial.
  • A physician billed auto insurers more than $15,000 for costly medical tests the crash victims never received, New York prosecutors said Tuesday. Dr. German Laufer submitted claims for phantom nerve-conduction and other tests on nine people, from his clinics in the New York City area. The tests analyze the flow of electrical currents across the nerves, and record electrical activity in muscles and nerves. AutoOne Insurance, Progressive and Countrywide allegedly were bilked. Laufer faces up to four years and loss of his medical license if convicted.
  • Cell-phone dealers made fake theft, loss and damage claims on policies bought by unsuspecting phone buyers, California prosecutors say. The San Jose and Oakland dealers then sold or gave away to new customers the replacement phones paid for by insurers. The alleged schemes were repeated mostly on new cell-phone accounts without the buyers knowing, the insurance department says. Asurion Corp., which administers wireless insurance plans, shipped out about $2 million worth of replacement cell phones thanks to allegedly bogus claims, the insurance department says. The department launched a probe into several cell stores after an Asurion insurance administrator suspected a scheme was afoot.
  • A Texas agent bribed local school officials with cash, plane tickets and condo rentals to earn their votes for insurance accounts with the district, the feds charge. Arnulfo Olivarez allegedly funneled bribes worth more than $26,000 to win insurance contracts with the Edcouch-Elsa school district. Olivarez is one of three producers indicted earlier for a similar suspected scheme involving the Pharr-San Juan-Alamo school district. He faces up to 20 years in prison and $250,000 in fines if convicted in both alleged plots.
  • Stephanie Thomas and her lover killed her college-instructor husband for $240,000 in life-insurance money, Nevada prosecutors charged this week. Thomas and Shawn Pritchett were having an affair when Larry Thomas, who taught automotive technology at the College of Southern Nevada, disappeared. His $120,000 life policy stood to double if he was murdered. Pritchett also pawned some of Larry’s rings in Las Vegas. He also sold the engine and steering column from Larry’s missing 2004 Silverado truck, officials say. Pritchett also talked too much—he allegedly told his brother-in-law how he ambushed and beat Larry to death in his house, then dumped Larry’s body in a California desert. Nor did Stephanie act very distraught when told of Larry’s death, prosecutors say.
  • Medical providers used personal info stolen from patients at a South Florida clinic to make $8 million in bogus Medicare claims, the feds charged Tuesday. Isis Machado worked as a front-desk coordinator at a Naples clinic. She downloaded patient files and sold their names, addresses, and Social Security and Medicare numbers to her cousin for $5 to $10 per name. He then sold the info to medical providers allegedly to bill Medicare for phantom services and supplies. Machado and her cousin were convicted earlier, and the six providers who allegedly used the info now are charged.
  • Seven Miami medical providers billed Medicare $11 million for bogus claims of HIV infusion drugs, the feds charged Wednesday. The ring allegedly paid Medicare patients $100 to $150 each to visit Saint Jude Rehab Center. The patients signed the clinic’s logs, stating they’d received treatments even through none were given, the feds say. Clinic staff allegedly ordered useless tests and signed medical forms to make the tests seem legitimate.

CIVIL & ADMINISTRATIVE ACTIONS

  • Texas is removing the phone numbers of crash victims from police accident reports to make it harder for schemers to recruit victims for fake injury claims by crooked chiro clinics. The change takes place Monday. Crash victims receive up to a dozen phone calls a day urging them to seek treatment, says the Texas Committee on Insurance Fraud. Recruiters line up at the Central Records division of every major city in Texas each morning to buy the previous day’ crash reports. But now recruiters will have to use phone books or the Internet to find crash victims’ numbers. Most police departments should be using the new forms by June 1, the Committee says. The change was negotiated by the Committee and Texas departments of public safety and transportation.

QUOTE OF THE WEEK

“This case is particularly disturbing as it is alleged that a doctor who took an oath to do no harm to his patients tried to take advantage of their injuries by falsely billing their insurance carriers.”

— Queens District Attorney Richard Brown, on neurologist Dr. German Laufer, who allegedly made bogus insurance claims for phantom nerve tests on car-accident victims.

OTHER HEADLINES THIS WEEK

  • Calif. man charged with torching his motorcycle
  • Feds indict Alabama agent for stealing comp premiums
  • N.J. couple arrested for faking theft of their car
  • N.J. doc charged with false billing of N.Y. PIP claims
  • N.Y. workers comp claimant admits to having side job

Details at www.InsuranceFraud.org/

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