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ARKANSAS
Investigators determined that arson was the cause of a fire at the Kentucky Missionary Baptist Church in Saline County. They also determined that the torch was none other than former pastor Eric Daniel Harris. Upon pleading guilty, Harris claimed he did it because church members needed a project to get them back to working together as a team. SOme solution!
CALIFORNIA
Okay, now follow along closely. Our perp is Tina Marie Gains of Elk Grove. Our story is like so many others. Gains loses her job and decides she has a pre-termination injury which renders her disabled instead of unemployed. She begins receiving benefits. She gives a deposition to State Compensation Insurance Fund, swearing that she has no other employment. She supplies a doctor’s treatment note. Yada, yada, yada. But some hot-diggity investigation reveals that Gains was allegedly employed at the same time she was allegedly forging doctor notes and receiving disability benefits as a workers’ compensation claims examiner. If convicted of the five counts of insurance fraud and one count of unemployment benefits fraud, Gain could be sentenced to five years in state prison and fined up to $50,000 for each count. The case is being prosecuted by the Alameda County DA’s Office.
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Oops! It was the fine investigators at the Republic Indemnity Company (not Royal Insurance Company as we erroneously reported in our last issue) who made the case against Edward Eugene Santibanez. Mickaela Erath, SIU Manager for Republic, tells us that work comp fraudster Santibanez pled guilty to felony insurance fraud and has now been sentenced. Mea culpa!
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Avi Avraham of North Hollywood did what responsible citizens do when they own a car. He purchased automobile insurance. Unfortunately for him, however, he bought the policy a few hours after his wife had an accident with the car. Then he filed a claim a week later, changing the date of loss by seven days. The pending charge of one felony count of filing a false insurance claim could cost Avraham five years behind bars and/or a maximum fine of $50,000.
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Did Dutschi do it or didn’t Dutschi do it? The former,s aid the court, as they sentenced Alfred John Dutschi to three years behind bars for stealing more than $500,000 from the Bartlein Property Management Company, handlers of about 80 homeowners associations. The money in question was stolen from State Farm Insurance Company during the repair of a large condominium complex in Stevenson Ranch.
DELAWARE
Dr. Yasmin Behmanshah of Yorklyn faces one count of health care fraud, one count of money laundering and 20 counts of mail fraud. She has been tried on charges of defrauding insurers out of an estimated $1.2 million via a double-billing (and triple, and quadruple, and quintuple and so on and so forth!) scheme wherein she would bill for work that was not done or bill multiple insurers for the same tests. Behmanshah’s credibility in denying the allegations was hot helped by her attempt to flee while out on bail awaiting trial. She blamed it on depression and being hounded by investigators. The prosecution blamed it on guilt. The jury is still out as we go to press.
FLORIDA
Four individuals who participated in the decline and fall of National Heritage Life Insurance Company were sentenced to 845 years, 740 years, 24 years and 1 year in jail for the parts they played in the crime. The lucky guy (if spending a year in a Federal prison is lucky) was Richard Langer, a New York computer consultant who cooperated with the government in the unraveling of the complicated fabric of the crime. The four were found to have conspired to steal $400 million from National Heritage and to have been largely responsible for its 1994 collapse. The longest sentence went to Sholom Weiss, a New York businessman, but he remains a fugitive. Jan Schneiderman, an attorney who used her trust account as a washing machine for National Heritage funds was hung out to dry for 24 years. The trial took place in Orlando Federal Court and was the culmination of six years of investigative work.
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In a lobster diving trip-gone-bad, Kerry Stephen Scheele was presumed drowned when he disappeared. The Coast Guard searched the waters off of Key West for 18 days, but never found the young diver. Scheele’s father was the named beneficiary on a $1 million life insurance policy and filed a claim. But Scheele wasn’t dead, he was just thinking about things after his staged disappearance. In reality, he had hitchhiked north to Wisconsin and moved in with a girlfriend leaving his estranged wife and his father to imagine the worst. The Monroe County courts have ordered Sheele to pay $55,000 to reimburse the Coast Guard for rescue costs. Kemper Insurance Company does not believe the father knew of the hoax.
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Our Editor says there would not be enough McDonald’s certificates in the world to bribe her into a dentist’s chair, but hundreds of South Florida children were traded free Big Macs for having X-rays, sealant applications and other dental work. Two dentists, Drs. Kazem Sudati and Raphel Arwas took hundreds of thousands of dollars from Medicaid by getting unlicensed helpers to work on the children’s teeth and then billing the State’s program as if they had performed the work themselves. Both have been charged with Medicaid fraud.
IDAHO
Willard Bert Sweath of Boise was a one-man highway menace. Sweath, acting alone as a squat vehicle, was recently convicted of intentionally causing four accidents. In each occurrence Sweath would position his car in front of a victim’s car and then slam on the brakes, causing a rear end collision. He would then try to collect on the other drivers’ insurance policies for bodily injury and physical damage claims. After being convicted of four felony counts of insurance fraud, Sweath is currently in jail … deciding if he wants to be released in a few months subject to a very stiff probation (including being prohibited from driving a car for the next ten years) or if he’d rather stay behind bars for an additional 2 to 8 years. The case was investigated with the assistance and cooperation of Allstate, Farmers, Safeco, State Farm and Unigard.
IOWA
The victim was from Iowa at least the latest victim and the bad guy has been sent off to jail. What makes this story unique is that the bad guy was none other than Steven Robert Comisar (AKA Brett Champion), star of the CFE video, Making Crime Pay – How to Locate Hidden Assets and author of the book America’s Guide to Fraud Prevention. Comisar was one of those reformed criminals gone good, or so he stated. He even was featured on NBC’s Dateline in a segment designed to educate consumers so they could avoid being taken in by fraudsters. After pleading guilty to four counts each of mail fraud and wire fraud, Comisar’s back in federal prison, perhaps penning his next book. He’s also been ordered to pay his victim $100,000 in restitution.
MASSACHUSETTS
After a Worcester jury found Doctor Albert Pike of Leominster guilty of 43 counts of Medicaid fraud and drug diversion, he appealed the sentence. But appeals don’t last forever (in this case only two years) and convicted felons eventually end up behind bars which is just what’s happened to Pike. The Medicaid Fraud Control Unit of the AG’s Office brought the charges against Pike after an investigation into his treatment of ten patients who suffered from various substance abuse problems between 1992 and 1995. The jury found that the prescriptions for various Class B and C controlled substances, including the highly regulated Methadone and Valium-type tranquilizers known as benzodiazepines, were not prescribed for legitimate reasons and that Dr. pike gave these prescriptions freely to drug addicts as a way to ensure a steady stream of Medicaid business. Before being indicted in December, 1995, Pike was being paid up to $20,000 a month by the Massachusetts Medicaid Program. Each time a Medicaid patient (Pike had 400 such patients) came into the office, Pike received $61, and 60 percent of these patients were being issued prescriptions for controlled substances.
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No appointment was necessary. A patient with a toothache could just walk in to Byron Robinson’s Roxbury office with 32 teeth and walk out with 31 teeth. In 1995, the AG’s Office filed a civil suit against Robinson , a Milton resident, for questionable Medicaid billing practices and collected $347,000 in the resulting settlement. The doctor’s license was suspended for six months and he was supposed to satisfy certain conditions and then apply for reinstatement. License or no license, he kept on pulling teeth, doing gum surgery and billing Medicaid. Now he’s up on fraud charges after an investigation by the Medicaid Fraud Control Unit. He’ll be arraigned in late March.
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Acton Medical Supply Corporation, a DME provider, has pleaded guilty to 16 counts of Medicaid fraud and 16 counts of Larceny over $250 as the result of a double-billing scam. Upon supplying goods such as pediatric formula, feeding-tube food, injection pumps, drainage bags and diapers, bills were sent to both Blue Cross and the Medicaid program. Investigators also uncovered numerous instances of upcoding and short-count deliveries. Part of the guilty plea agreement calls for Acton to pay more than $160,000 in restitution and fines. David Cutler, company president and owner, was placed on one year of probation for his role in the schemes.
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Chubb tries harder, or so it appears from the investigation of a sunken boat. Mark Philbin of Shirley and Robert Scarpaci of Malden are awaiting sentencing after pleading guilty to conspiracy and mail fraud. A 1992 fire on a boat owned by Philbin, Scarpaci was close enough to see the trouble and rescue Philbin. The boat was repaired to the tune of $97,238 according to documents supplied to Chubb after the second (1994) fire and subsequent sinking in 140 feet of water of the same boat. And wouldn’t you just know it, but once again Scarpaci was there to rescue his buddy Philbin. The men were apparently not considering that Chubb would raise the boat from the bottom of Massachusetts Bay and check the claimed list of previous repairs and installation of new equipment. Now it’s Philbin and Scarpaci who are in hot water and sinking fast.
NEW JERSEY
Xun-Cheng Huang was a mathematics professor at the New Jersey Institute of Technology. He has been indicted on charges of one count of second-degree health care claims fraud, three counts of third-degree theft by deception, three counts of fourth-degree falsification of records relating to medical care and three counts of fourth-degree forgery. All counts are a result of Huang’s submission of 140 fraudulent health insurance claims in his daughter’s name, for coverage afforded under a Mega Life Insurance policy she carried while a student in college. If convicted, Huang faces up to ten years in prison and $150,000 in fines.
NEW YORK
Well, it’s finally over … probably. It began as a 1995 by the Manhattan DA’s Office and concerned allegations that 21 attorneys were directly involved in paying bribes to insurance adjusters in exchange for favorable terms of settlement. Records revealed $100,000 was passed out to adjusters for Aetna, Geico, AIG and Commercial Union during the same time frame that $2.5 million was being paid to claimants. Of course, part of the defense offered up by the involved lawyers included them not knowing the middlemen on their payroll were passing a percentage of the money on to the adjusters. Imagine that….
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And speaking of mega-buck actions, Progressive, Allstate, GEICO and New York Central Mutual have joined forces to file a civil lawsuit against a group of doctors who allowed their names to be used by chiropractors and lay people. In a 270-page complaint, the companies charged 109 defendants (15 medical doctors, 1 former medical doctor, 26 chiropractors, 15 management companies, 47 medical corporations and five lay people) in the perpetration of a $60 million fraud under the RICO Act, the state consumer fraud act and the state anti-self-referral statute. Five doctors and one former doctor were responsible for a large amount of the total fraudulent billings. Alan Cohen, Swapnadip Lahiri, Robban Sica, George Battaile, Robert Mallela and John Grauerholz were all accused of selling their names and licenses to anyone willing to pay their price. Cohen had 29 bogus medical corporations linked to his name. Among the allegations of wrongdoing were billing for services not provided by a physician, billing for services never provided, duplicate billings, medically unnecessary services and equipment and referring patients in an illegal fashion.
NORTH CAROLINA
$$$ Following in the not-so-fancy footsteps of Jim and Tammy Faye are the Reverend Johnny William Bill Cabe and the Reverend Shelton Joel Shirley. Both have been accused of taking more than $7 million from investors in a Ponzi-like scheme that promised a return of 500 percent in just three months. Brothers and sister, give me Just $20,000 today, and I will return $100,000 to you in only 90 short days. (Yeah, sure!) Money invested with Hisway Ministries was to be entrusted to international money brokers and huge profits would be realized. (Yup, definitely!) Then, sixty percent of the earnings would go to fund missionary work and the other forty percent would be enough to return huge profits to investors. (Yes. Bring it on Brother!) The scheme stretched around the world into Britain, and authorities have arrested Terrence Stanley Victor Wingrove, a London antiques dealer, for his involvement in the fraud. The two US Reverends face 18 counts of money laundering and nine counts of wire fraud. Wingrove has been charged with 17 counts of wire fraud and 14 counts of money laundering. (Amen!)
OREGON
The fraud department at SAIF Corporation means business. Just ask Lawrence Sites Jr. He can tell you that it took only $241.85 worth of fraud to land him in jail. Sites, of Portland, reported that one of his benefit checks had been lost in the mail. SAIF replaced the check, and Sites cashed the replacement check AND the lost check. He was convicted of theft in the second degree.
TEXAS
And sometimes the verdict goes against the company. A Dallas couple, Jack and Kathran Martin, was awarded $11.2 million after suing Great American Life Insurance Company for fraud and misrepresentation. The disagreement occurred when the Martins filed bankruptcy in 1994, having been assured by an attorney for GALIC that it would not cause any problems with the contractual general agency arrangements between the Martins and GALIC. After they filed, however, GALIC canceled their contract and took over direct writing for the 150 sub-agents that had been working for the Martins. The jury sided with the Martins, returning their unanimous verdict in less than two hours.
WASHINGTON
Ah, the beauty of a clear and concise surveillance tape! A former Vancouver resident, Alvaro Jim Jardin (more recently of Portland), injured his left foot while forking as a welder. Jardin said he was in too much pain to return to work, however investigators from SAIF discovered that despite his claims of too much pain, Jardin was racing a stock car at a local speedway and stopped limping once he left the doctor’s office. He was also capable of standing, lifting and carrying heavy objects without difficulty although he did not share his seemingly pain free ability to do any of these things with his treating physicians. Jardin has pleaded guilty to Theft in the First Degree. He’s been sentenced to jail time, restitution, fines and probation upon release from jail.
WISCONSIN
How many bad breaks can one man be expected to suffer? John Veysey was only 27 years old when his home in Twin Lakes burned and his insurance company paid him $357,000 for his loss. Just two years later, his wife Patricia died mysteriously while she was home alone and the grieving widower collected $200,000 in life insurance benefits and his spouses entire estate. And a year after that, a fire destroyed Veysey’s Galena home and another $242,000 found its way into his pocketbook. And two years later, in 1998, still another fire nearly gutted his Cary home with his second wife and son inside (although firefighters were able to rescue them). Prosecutors want to try the matter as a single case. Defense attorneys for Veysey want separate trials. (We just want this guy off the streets and away from gasoline cans!) Veysey has been arraigned in US District Court.
CANADA
Maybe the cold weather went to his brain and froze a few cells. Winnipeg resident Jason Scott Campbell had a fight with his girlfriend. Lots of couple have fights; we understand that. He got mad. Lots of guys get mad when they fight with their girlfriends; we understand that. After the fight, he went outside; good thinking, that’s how lots of guys handle getting mad and we understand that. And then Campbell took a baseball bat … and beat up his VW Beetle. Smash, bam, boom. Raging testosterone, we suspect. And we do not understand that. After the deed was done and the beetle was in really bad shape, Campbell apparently decided that the best way to cover up the results of his batting practice was to light a fire. Whoosh. He reported the fire to his insurance company and said it was vandalism. After pleading guilty to insurance fraud, Campbell was fined $4,000 and ordered to pay off the rest of his car loan.
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Okay, now we are sure of it. It’s something in the Canadian air. Take the case of Giles Bechard, a gentleman who blinded himself in one eye in order to collect insurance benefits. When a medical examination ordered by his insurer, Groupe assurance Desjardins, revealed Bechard was not as blind as he claimed, the Montreal resident finished the job and reapplied. The second time was a charm and he collected $100,000. Not quite satisfied, Bechard took on another identity, Dany Boucher, and made a similar claim. During the process of collecting substantiating documents, the insurer became suspicious and the fraud was revealed. (They were keeping an eye on him!)
MEXICO
If you ever receive a billing form listing Dr. Washington Adolfo Roman Quinteros as the physician, don’t pay it! Quinteros, a Junior High School dropout from Argentina was operating on women from various states in the Mexican republic. Representing himself as a plastic surgeon, Quinteros first insisted that he be able to sketch them in the nude. But he didn’t just limit his activities to drawing and sawing, he also dabbled in credit card fraud, pretended he was a diplomat (an Argentine consul), traded in US stolen cars, and falsified documents including forging the signature of Carlos Menem, the President of Argentina. Quinteros has been arrested and is awaiting trial … unless, of course, he can get the Mexican President to sign a pardon. With his forgery skills, anything could happen.
UGANDA
Three employees of leading insurance brokers, AON, Hogg-Minet and United Assurance, are being investigated by the Uganda Insurance Commission. Allegations levied accused the brokers of accepting commission paybacks.
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