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Daniel Trent Bailey hung a shingle and went into business as an insurance broker. Problems arose, however, when motorists who purchased coverage from Bailey’s agency, Southland Insurance Brokerage,S had accidents. It was at that time that they found out Bailey was just selling so much paper and had never procured coverage from any legitimate company. The fact that he couldn’t get coverage from any legitimate companies because he was not even a licensed agent just made it worse. He was charged with 56 counts of grand theft.
In another “agent-gone-bad” story, Carlton John “Carl” Hagmaier, who operated under the banner of Pacific Financial Group, pleaded guilty to three counts of mail fraud, one count of embezzlement from an employee benefit plan, one count of making a false statement to a federally insured financial institution and one count of subscribing to a false tax return. Some of his misdeeds included stealing pension funds, taking out fraudulent loans on his clients’ policies and submitting fraudulent financial statements to obtain loans. At least $2 million of clients funds was spent by Hagmaier, of San Luis Obispo, personally. He’s been sentenced to a stint in Federal prison and ordered to pay $3.2 million in restitution.
And then there was the psychiatrist who used a Corona hotel as his office and billed insurers for more hours in a day than the day is long. In fact, Dr. John Ravin and a partner submitted 50 hours worth of billing for a single day’s work. (Editor’s note: and I thought I was the only one who worked those kind of days!) The doctor, however, is disputing the grand theft and insurance fraud charges.
Gerald Paul Benedetti of Corona was having a tough time making the payments on his car. So he decided to sell it to the insurance company; well, kind of. First he gave the car to one of his friends and instructed the friend to dismantle it and sell the parts. Then Benedetti told his insurance company that the car was stolen. The Auto Club suffered a loss of $13,663 on the bogus claim, and Benedetti faces up to five years in jail and a $50,000 fine.
Mmmmm. Smart guy. Thomas Shirley of Los Angeles contacted a tenant who was renting a house from him and tried to talk the tenant into destroying another piece of property. Shirley allegedly wanted to use the insurance settlement to fix up the property. The tenant was to receive $1,500 and back rent credit, but instead he agreed to cooperate with law enforcement. Shirley, when he delivered spray paint and a baseball bat to the tenant, was arrested.
It would have made a lot more sense, as attempted fraud goes, not to use receipts borrowed from another claimant. But when San Jose residents Joseph Nam Vu and his wife, Julian Bichahan Nguyen, filed their Mutual Service Insurance Company homeowner’s claim, they used receipts that had previously been used on a Farmers Insurance Company claim. That was their first mistake. The second mistake was their deposition testimony that they purchased the stolen electronic goods at a Good Guys store … when the Good Guys store had no record of such purchases ever being made. Three strikes and you’re out – they altered a few more receipts. For the $3,924.46 they received in payment of their claim, they face $50,000 in fines and prison sentences. Not a very good trade.
It appears that Long Beach resident Kimberly Williams just didn’t want to go back to work and give up her medical disability check. So when the doctors released her, she allegedly took matters into her own hand … um, pen. Prosecutor’s believe Williams signed her doctor’s name on the forms to enable her to receive additional payments. She faces jail time and a fine.
Winston Dennis, a former insurance salesman from Grand Junction, has been accused of taking $700,000 from 14 victims. He’s been indicted by a state grand jury on charges of securities fraud, theft from an at-risk adult, forgery and theft.
It took six years for prosecutors to get their man, but they finally did it. Samuel Aidoo of Windsor pled guilty to fudging reimbursement forms and cheating insurance companies out of $150,000. He faces ten years in prison and $250,000 in fines when he is sentenced in July.
But the state’s gonna settle. So what if five people managed to overbill the Medicare program. David and Pamela Salermo, a brother and sister team, took thousands of dollars from the system while operating three companies in Bridgeport and New Haven. Sis’s husband and both of her parents were also implicated in the scam.
F. Scott Culberson of Marietta has been sentenced to prison for paying runners to bring patients to his chiropractic clinic and then padding the insurance bills. Adding “insult” to Culberson’s “injury” is the pending charge of underreporting almost $2 million of income. But it doesn’t end there. A federal grand jury has recently indicted Ike Duru, at Atlanta personal injury attorney, as part of the same scheme. Duru, a resident of Powder Springs, was charged with 64 total counts of mail fraud, tax fraud and money laundering. The case against him concerns claims filed against insurance companies on behalf of “injured” claimants between 1992 and 1995.
Dina Abduelhaq insured her baby daughter’s life for $200,000. When the infant was seven weeks old, she died from what appeared to be SIDS. Federal prosecutors did not charge Abduelhaq with murder; instead they went with insurance fraud charges. Prosecutors say Mom was more interested in feeding her gambling addiction than she was in feeding her infant.
FBI investigation has resulted in a grand jury indictment against Magdalena Dino (Duarte, California) and Jerico Dino (Pelham, New Hampshire) for conspiracy and fifteen counts of mail fraud in an auto accident medical mill. The Highlands Medical Clinic Inc, later known as the Mercy Medical Clinic Inc., was set up by the mother-son Dino team, Allan Sta. Maria Perez and Estrella Diamante, to administer physical therapy treatments to auto accident victims – even though there was not a licensed P/T on staff. The clinics built medicals until the $2,000 tort threshold was met, regardless of whether the patient required that much treatment. In some cases the treatment was administered and in others the records were simply changed to reflect that the appointments were made and kept. Company SIUs participating in the investigation include Metropolitan, Sentry and Liberty Mutual.
Call it a menage-a-three. The combined investigative efforts of the FBI, the Insurance Fraud Bureau and Hartford have led to the conviction of father-and-daughter fraud team, Joseph Tuohy and Judith Connolly of Bridgewater. Tuohy owned employee-leasing businesses and charged his clients for the workers’ compensation insurance he said he was carrying. Turned out, however, that he wasn’t providing the claimed coverages, and when an employee was hurt, Tuohy and Connolly passed it off as covered by another policy on another business. Dad and daughter face five years in prison and a $250,000 fine on each count of conviction.
A violation of the state’s Medicaid antikickback statute has resulted in Novo Nordisk Pharmaceuticals, Inc. agreeing to a $10,000 fine plus a free distribution of $90,000 worth of patented insulin delivery systems, as well as insulin, to Medicaid recipients. Novo Nordisk was offering cash rebates, based on the volume of products ordered, to independent pharmacists, and that’s a no-no.
“A crook is a crook is a crook.” It’s John Cooke’s favorite quote, and it applies to Corey Walthers of Olivia. He was already facing charges of sexual misconduct and providing alcohol to minors, and now authorities have added insurance fraud charges to the list. And what was Walthers occupation? Sadly, he was a Deputy County Sheriff.
Ah, the East Coast home of chiropractic insurance fraud has bagged “the top of the fraud chain” – quote attributed to Insurance Fraud Prosecutor, Ed Neafsy. In this case, the three health care professionals (?) arrested were accused of conspiring to obtain copies of computerized North Bergen PD accident records by bribing a supervisor. Three runners were charged with trying to obtain the same kinds of records from the Newark PD using a similar bribe scam. Insurance fraud charges have been brought against Robert Matturro, owner of Bloomfield and Union City chiropractic offices, Nicholas Rosania, a chiro working out of the Union City office, and Annette Licea, a physical therapist at the Union City office.
She was just a small player by DME insurance fraud standards, but she was fair game for charges of Medicaid fraud. Vicki Poh-Eikom of Paulsboro, president of Sun Rehab in Mullica Hill, a now-defunct supplier of medical equipment, was accused of collecting $24,000 for equipment that never made it to patients.
You take 2 teaspoons of insurance fraud and mix it with a tablespoon of financial fraud and you end up with – Mark Weisman of Basking Ridge. Weisman, the owner of a Parsippany insurance agency, forged signatures and took withdrawals and loans on life insurance policies he’d sold to clients. Then he went a step further and kited checks between three New Jersey banks. Customers were defrauded of $500,000, and Weisman received a 21-month sentence. Ouch! We hate when that happens.
NM has one of the newest Insurance Fraud Bureaus in the country, and they just chalked up their first major bust. George Casey, an insurance agent from Rio Rancho, has been arrested and charged with 30 counts of embezzlement, 54 counts of fraud and one count of racketeering. Authorities contend that Casey took at least $32,000 in premiums from the First National Bank in Chavez County, but never forwarded them to the insurer. He is also alleged to have targeted two other banks in the southern portion of the state.
It was not a spur-of-the-moment idea. Todd Nolte of Newark, a security guard at Garlock Sealing Technologies in Palmyra, actually spent an entire year researching his plan. He asked a co-worker to shoot him while he was on the job. His intention was to file a million-dollar lawsuit against his employer and collect a significant insurance payoff. Luckily the co-worker went to police. Nolte has been charged with conspiracy to commit assault and grand larceny. Wonder if he’ll spend his time behind bars thinking of a new scheme?
We don’t know if there was a life insurance policy involved, but the latest May-December romance death needs to be mentioned. Police have recently charged Sylvia Mitchell, a member of the Tene-Bimbo family in San Francisco and New York (focus of Peter Mast’s best selling 1974 book, “King of the Gypsies”), with the death of Andrew Vlasta, a Greek lawyer and banker. Mitchell was 33 when she married the 85-year-old Vlasta. In fact, investigation reveals that she carried him to a minister to have the wedding ceremony performed, and he was dead three months later, just a few short weeks after withdrawing $80,000 from his bank accounts. The investigation was instituted when a nephew of Vlasta read an article in the San Francisco Examiner about five similar deaths, all attributed to May-December Gypsy marriages. Much of the work on those cases was done by JCIFR’s friend and fellow fraud-fighter, Fay “Rat Dog Dick” Faron.
In a move to punish all those involved, the BWC didn’t stop after nailing Michael Kerr, owner of Kerr Chiropractic Center in Toledo. Kerr was sent to jail, ordered to pay $250,000 in restitution and fined an additional $15,000 for his part in ripping off the system. Now his office manager, Jackie Stoddard, after pleading guilty to one count of conspiracy to commit mail fraud, is also going to jail.
Donald Phillip Havenar, former chief executive officer and president of First Assurance & Casualty Co., Ltd, couldn’t run far enough.Police apprehended Havenar in Hermosillo, Sonora, Mexico, pending extradition. Havenar was accused of diverting $7 million in policyholder funds to himself and to companies he controlled. Four other individuals were implicated in the same plot.
Wayne Hill “was” a police officer with the Tulsa force. “Is” became “was” when Hill was accused of augmenting his income via fake police reports to support auto accidents that never occurred. The reports substantiated bogus injuries and that led to collecting insurance settlements. He was charged with two counts of obtaining money under false pretenses.
(Editor’s Note: First, in response to a recent seminar given in Portland, I hereby declare that Oregon is pronounced “Or-eh-GUN.” From this second and forever more, anyone in the fraud investigative community who dares to say “Or-eh-gahn” will be summarily shot, quartered and sold as dog meat.)
After pleading guilty to Theft II, Jose Torres of Eugene was sentenced to jail and restitution. It’s just one of many for SAIF Corporation, the largest workers’ compensation insurer in the state. Since 1990, the company has saved an average of more than $6 million per year in fraudulent claims. What a team!
The Pocono Prescription Center Pharmacy, located in East Stroudsburg and owned by Glenn S. Walkley, opened in December 1994. Less than four years later, on August 28, 1997, the pharmacy abruptly closed. Walkley and Patrick Lenehan, manager of the defunct pharmacy, then set up the store’s computers in their shared home. It appeared to the state’s Medical Assistance program that business was continuing as usual – 62 claims totaling $27,720 were submitted during the next three months. During the same period of time, a short 90 days, private insurance companies paid 232 claims totaling $193,000. Suddenly business was good … real good. According to accusations made by authorities, the problem was that all of the prescription billings were fraudulent, a well thought out scheme by Walkley and Lenehan. The patient names were real. The doctor’s names and account numbers were real. But the hundreds of bills were strictly so much paper. If convicted of all five charges (one count of Medicaid fraud and four counts of insurance fraud), Walkley could be facing up to 35 years behind bars and $750,000 in fines. Roomie Lenehan is looking at nine years in prison and a $20,000 fine.
Phony auto accidents and personal injury claims, unlicensed public adjusters and phantom auto repairs and fake theft reports. They did it all. After $165,000 in false claims from 11 Philadelphia dwellers, arrest warrants were issued and insurance fraud charges were levied. Let’s hope it slows them down.
A Rapid City grand jury has indicted six individuals for running a stolen car ring operation. It is alleged that the six people obtained stolen New York City cars and switched the VINs with salvaged vehicles. The 22-count indictment includes mail fraud, wire fraud and conspiracy charges. The six defendants have all pled not guilty.
Hayfever, Payfever. Hermitage allergist Michael Dao may be sneezing his way into jail as a result of accusations he filed more than 100 bogus claims to Tenncare. The federal Medicare fraud charges could reap a ten year prison sentence.
The two-and-a-half-year prison sentence doesn’t seem very long when you consider that Marie Benavides admits to scamming more than $6 million from the Medicare system. Benavides, the former president of a Hebronville home health corporation, took the money over a four-year span by writing checks to family members out of a reimbursement account. She was ordered to reimburse Medicare.
Jose Cantu, a Waller County insurance agent, has been sentenced to a 20-year prison term for selling fake car insurance policies to unsuspecting customers of the (also fake) All American Insurance Agency. He rightfully should have named the agency the “All Mine,” because Cantu pocketed the premiums.
It started out as a stolen-boat plot, for insurance money of course, and then escalated into a murder-for-hire scheme. Mark Woodland, a Riverton landscaper, thought his accomplice in the $60,000 boat scam was so competent, that he approached him with a $10,000 offer to kill David Elmore, the owner of the Utah Grizzlies, a minor league hockey team. Unknown to Woodland, the accomplice was working undercover for the police. Oops.
Bonnie Riffle filed a police report claiming she was attacked while working in her Charleston office. Then she filed a workers’ compensation claim. Prosecutors contend the police report was fake, and Riffle just wanted to make an insurance claim for self=inflicted injuries. Pretty typical, you say? Not quite. Riffle was the Morgan County Magistrate. She’s been ordered to stay away from the courthouse while the matter is sorted out.
Delores Thomas claimed that there is no such crime under state law as prescription fraud. Thomas, of Casper, arranged to have prescription drugs delivered to an address that belonged to a cemetery. The court ruled against her, however, and upheld the conviction.
When an ambulance responded to a call in South Woodford, east London, attendants found it was too late for Rechard Cajee. He had been shot in the head four times; his body was lying across his bed. Farah Cajee, his wife, told police she’d returned from shopping with her stepfather-in-law, Yusif Ali (formerly Peter Bradfield), and found poor Rechard. She was able to supply timed store receipts and store surveillance cameras confirmed she was in the stores at the times she claimed. But investigation would later reveal that the hysterical widow was after Rechard’s substantial life insurance and that Ali (her mother’s husband) was actually her lover who helped pull off the murder. Evidence includes residue particles from the murder gun found in the car she used, a suspicious safety deposit box opened the morning of the killing and more. The prosecutors are arguing their case at the Old Bailey in London.
Rex DeGeorge, Paul Ebeling and a third man reported to authorities that drug runners had taken over their yacht off the Mediterranean coast and subsequently severely damaged it. The resulting insurance claim was sinking number four for DeGeorge, a Los Angeles attorney, and just too much to swallow for insurers. Upon closer examination, investigators surmise the trio cut holes in the hull to assist the bottom-of-the-sea landing of what was left of the yacht. DeGeorge and Ebeling (also a Californian) have been arrested.
Also from WTMJ radio, we are happy to report that an embezzler in Thailand who was sentenced to 865 years in jail was able to get his sentenced reduced, by cooperating in the case, to a more reasonable 576 years.
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