Insurance Fraud Weekly ePort: Week Ending Aug. 24

Insurance Fraud Weekly ePort
Week Ending August 24, 2007

www.InsuranceFraud.org  
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LEGISLATION & REGULATION

* The Texas Board of Chiropractic Examiners finalized a rule that would place restrictions on how chiropractors or clinics use telemarketing to seek new patients. The new rule requires telemarketers to identify themselves and who they represent.  Chiropractors and clinics also would be prohibited from misrepresenting themselves as being associated with an insurer. The chiropractor or clinic also would have to keep the telemarketing script and log all persons contacted, including the date, phone number and persons called.

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

PUBLIC OUTREACH

* People impacted by flooding should resist the urge to pad insurance claims, Roy Miller, head of the Pennsylvania Insurance Fraud Prevention Authority warned this week. In a story in the Pittsburgh Tribune-Review, Miller said of recent storms and floods: “It’s a tragic situation. But you’re only entitled for replacement value of what you own, not what you wished you’d owned.” Miller advised potential claimant to “think before you act. The fact that these cases will be detected and prosecuted here in Pennsylvania is greater than it has ever been.”

CRIMINAL CONVICTIONS

* Michael Carreon’s mid-life career change will be costly. The 45-year old Pomona, Calif. man went from nursing assistant to carpenter, but unfortunately he left one job injured and on workers compensation and continued collecting while working as a carpenter. Hartford Insurance paid him about $100,000 before his benefits were cut off and he admitted the scam. This week a judge ordered him to report to prison September 11 to begin serving a two-year sentence. The case was investigated by the California DOI and prosecuted by the Riverside County DA.

* In another career change case, correctional officer Steve Felter, 36, of Pine Grove, Calif. was caught selling cars at a local Ford dealership while collecting workers comp money. Felter started collecting benefits in 2003 after he claimed he hurt his back and leg. Video surveillance found Felter walking with a limp into his doctor’s office, but walking normally other times as well as lifting heavy objects. He was ordered to pay $112,709 for benefits he received and for investigative costs, and was sentenced to 100 days in jail. The case was prosecuted by the workers comp fraud unit of the Amador County DA’s office.

* A 12-year police veteran in Michigan was placed on probation this week after pleading no contest to falsifying an accident report. Washtenaw County Sheriff’s deputy Christopher Campbell, 36, collided with another officer’s personal vehicle, and the two conspired to submit a report that would reap Campbell money from his insurer. With the plea deal, Campbell avoided jail. Charges against the other officer, Jennifer Reynolds, are still pending.

* A chiro in Pennsylvania who aided his partner in stealing $200,000 from an insurer was ordered to pay $70,000 and serve two years probation. Dr. David Fellerman of Scranton was aware of the billing fraud his partner, Dr. Robert Bittenbender, was committing and allowed his ID to be used in filing phony claims. The judge in the case said Fellerman did not personally profit from the fraud and cooperated in the investigation of his partner. Bittenbender was convicted in June for filing $200,000 in false claims against Blue Cross Blue Shield of Northern Pennsylvania, and splitting the proceeds with his staff and patients who aided in the crimes.

* A public adjuster in Georgia recently got a free trip to California, courtesy of state fraud investigators. Norman Hugh Baker, 52, was convicted of stealing nearly $100,000 from California homeowner claimants and failed to show up in court in June with a restitution check for his victims. DOI investigators tracked him down in Lawrenceville, Georgia and had him extradited back to Southern California where he now faces additional charges. In 2006, Baker posed as a licensed public adjuster and conned eight homeowners into signing over their claims settlement checks to him.

CRIMINAL CASES

* Sohan Singh Gill decided his wife needed some life insurance. Unfortunately for him, he decided to take out a policy two days after his wife died, according to prosecutors in New Jersey. Jaswant Kaur died July 22, 2000, and two days later Gill bought a $150,000 policy from Reassure America Life Insurance Company, according to a grand jury indictment. Gill, 46, of Elmwood Park, allegedly waited until January 2003 to file the claim on his dead wife, but an alert claims adjuster discovered the discrepancy and reported the suspected fraud to the state fraud bureau. If convicted, Gill faces up to 10 years in state prison.

* The owner of a Miami medical billing company falsely billed the government $170 million for HIV treatment on behalf of 75 local clients, according to a federal indictment. Rita Campos Ramirez, owner of R & I Medical Billing, was charged with false billing and conspiracy to commit health care fraud. HIV clinic owners submitted bills to Ramirez for expensive infusion treatments in the amounts that she knew were “medically impossible,” federal prosecutors said. Of the $170 million billed, the clinics were paid $105 million and Campos received a fee of 5 percent.

* A Washington state trooper claimed his 1949 classic “Woody” car was worth $60,000 when it was stolen in 2005, but local prosecutors and insurance investigators say the car was nothing more than a rusted frame and was worthless. Doug Merino, 41, of Westport, conspired with another trooper, Jim Varner, and Varner’s 30-year old son to steal the insurance money, prosecutors charged. Ken Varner of Olympia has pleaded guilty to the crime and is awaiting sentencing. The day after Jim and Ken Varner gave depositions to investigators from Farmers Insurance, Jim Varner was shot to death and that crime is still unsolved, according to reports. Merino also worked as an investigator for the state department of labor and industries and is a former mayor of Westport.

* A former insurance agent in Milford, Mass. was indicted for posing as an agent and stealing more than $400,000 in client money. Michael Minnehan, 60, lost his agent license back in 2000 for fraudulent practices. He pleaded not guilty to 12 counts that the grand jury returned earlier this month. The case was investigated by the Massachusetts fraud bureau.

 ETC.

* The president of a Wisconsin-based insurer has apologized to two claimants for hiring private investigators to infiltrate a church support group to spy on the claimants. CEO Glenn Renwick of Progressive Northern Insurance said he was appalled to learn that his company had hired the investigators who allegedly joined a Christian church in Georgia to monitor the couple, Bill and Leandra Pitts. The couple filed a claim for injuries from a 2004 auto accident. The investigators joined a church support group that reportedly discussed personal secrets such as abortion, drug use and sexual orientation. The couple has filed suit against the insurer alleging invasion of privacy and fraud.

* How much do SIUs make? Do insurers provide investigators with enough resources to do the job right? Insurance Compliance Insight newsletter has been conducting an online survey of SIUs this summer to find out. The survey will be completed shortly, but SIUs can still weigh in confidentially by clicking here.

QUOTE OF THE WEEK

”Even if he’s found not guilty, it still puts a black eye on the sheriff’s office.”

– Sheriff Mack Grimmett, commenting on the suspension of a Bolivar County, Miss., deputy sheriff who was faking the theft of his vehicle.

OTHER HEADLINES THIS WEEK

* Florida adjuster accused of soliciting kickbacks
* N.Y. comp claimant accused of working side job
* Alabama doc headed to prison for defrauding Medicare
* Miss. deputy sheriff charged with faking auto theft
* Four workers caught cheating workers comp in Texas

Details at http://www.insurancefraud.org/news.lasso

MEETINGS & CONFERENCES

* September 9-12, 2007 — Annual Seminar & Expo on Insurance Fraud Las Vegas, NV (International Association of Special Investigation Units)

* September 10-11, 2007 — 2007 Annual Meeting Lisbon, Portugal (International Association of Insurance Fraud Agencies)

* September 17, 2007 — Building, Managing and Measuring Your SIU Hartford, CT (Association of Certified Fraud Examiners)

* September 18, 2007 — Fraud and Abuse: Quality of Care Issues Las Vegas, NV (National Health Care Antifraud Association)

For more info, visit online events.