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ARIZONA
Gregory Enswiler, a 31-year-old, Arizona construction worker, is not a happy camper. He recently had the dubious honor of being the first individual to be convicted under Arizona’s new anti-fraud statutes.
Enswiler filed a workers’ compensation claim against Fremont Compensation in 1994, alleging wrist, rib and facial injuries while working for a construction company. While collecting benefits, however, he was videotaped working for a second construction company.
Fremont was not amused. Ditto for the judge. Enswiler was found guilty of six counts (including insurance fraud, theft and forgery), ordered to pay $7,000 in restitution and sentenced to a year in jail.
CALIFORNIA
Noses Fixed – While You Wait! In a case that involved recruiting individuals to undergo cosmetic procedures that weren’t always (medically) necessary, three individuals were recently sentenced to one year each in the Orange County jail.
Cam Thach Thi Le (a.k.a. Elizabeth Tran) owned the Cam Thach Clinic where the questioned surgeries, generally involving eye or nose reconstructions, were performed between August 1989 and February 1990. The clinic is alleged to have induced one individual to have surgery when he stopped in only to pick up his sister.
Tran was convicted of seven counts of filing false claims and two counts of grand theft. Dr. Alexander S. Sinclair of Los Angeles, an employee of the clinic, was found guilty of four counts of insurance fraud and two counts of grand theft. Dr. David Page, also an employee of the clinic, was convicted of five fraud counts.
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Lee Sanders, an insurance agent from Fontana, had a nifty scam going — for a while. He was collecting premiums for workers’ compensation and general liability insurance and pocketing the money instead of mailing the applications to the carriers. Victims who attempted to file claims soon found out they were left holding the bag.
Sanders, the co-owner of Pacific Contractors Insurance Services in Ontario, pleaded no contest to three counts of grand theft and was sentenced to six months in jail. He was also ordered to pay $14,000 in restitution to his victims.
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A Sacramento insurance agent, Thongsangoune Sayakhom, 42, has been indicted on 20 counts of mail fraud.
According to the indictment, the agent is alleged to have sold phony life insurance policies to at least 971 customers in eight states. Solicitations were sent via mail from the Sacramento based Asian Assistance Center. Laotian, Hmong, Mien and Cambodian people were victimized the most.
Sayakhom sold the worthless policies between January 1992 and January 1995, collecting over $400,000 in insurance premiums and membership dues from unaware clients.
The two and a half-year investigation was carried out by the Department of Justice, the California DOI, the Internal Revenue Service and the US Postal Inspection Service.
Sayakhom faces a maximum penalty of five years per charge and/or a $250,000 fine. If convicted on all counts, she could be sentenced to 100 years in prison and fined $5 million. Whew…
FLORIDA
Love that Love! And love that bail … $1.10 million of it!”
Doctor Douglas Love was charged with I h’1 counts of racketeering, insurance claims fraud, grand theft, conspiracy, cheating awl unlawful solicitation. Even though his medical license was suspended two years, earlier due to illegal drug possession, Love had continued in the medical field as a “manager” of an orthopedic center in Sun rise.
At the center of the scam, which may have• cost insurers hundreds of thousands of dol lars, was the falsification of patient test i c suits and doctor signature forgeries.
The operation code name was code Swamp Rats and it was part of the Federal Sudden Impact crack-down on organized auto fraud rings. The joint investigation combined the talents of many investigators from many agencies: the NICB, Metro Dade Police Department, DIF, IRS and FBI.
The results? A 43-count indictment against Doctor Jesus N. Castillo, Lisa M. Chutjiau Pinto, Joaquin Garcia, Digna Lopez, Juana Mendez, Lilia Dejesus Gonzalez, Francisco Alcantara and Rogelio Cabrera, charging lhr defrauding of Medicare, Medicaid and private insurers.
The indictment alleges $6.5 million was taken between 1991 and 1995. The providers owned by Dr. Castillo and specifically named are:
Dade Health Care Center, Inc.
Miramar Hospitals & Health Centers, Inc.
Miramar Medical Trauma Center
Sausalito Medical Trauma Center
Dade Diagnostic Services, Inc.
Dade Diagnostic Center, Inc.
The undercover investigator gave the doctor every conceivable opportunity to release him (the investigator) from treatment. During five long months the investigator insisted he was fine and not in any pain. Perhaps the doctor has bad ears because the medical records were later shown to reflect pain and spasms in the neck and back.
Dr. Frank Darrow of Coral Springs was arrested and charged with five counts of insurance fraud and one count of grand theft. The “patient”/doctor relationship was initiated by a runner (that’s a capper on the West coast) who illegally solicited the undercover investigator after an alleged auto accident.
Hey, if he was really a Clairvoyant, he would have known that he would get caught!
Luxene Clairvoyant of Palen Reach put more than a million miles on his taxi last year! He managed to shuttle Medicaid patients back and forth to doctor visits and still have time to file the receipts to collect fares from the government insurance program.
Clairvoyant and his brother shared the cab operation duties. Medicaid received billings for 1,031,059 miles. Now for some simple mathematics: Each brother drives eight hours per day, seven days a week. The daily average works out to be 3,248 miles. Problem is, when you divide the miles per day (3,248) by the hours worked (16), it’s obvious that they only slightly exceeded the speed limit … driving 203 miles per hour?
ILLINOIS
William Devoney, a former Chicago police lieutenant with a 34-year career of distinguished law enforcement service, made two mistakes.
His troubles peaked last November when he pleaded guilty to taking part in a $70,000 slip-and-fall insurance fraud. He was initially looking at a four month federal sentence for his part in the scam.
Before his actual sentencing took place, however, prosecutors made an issue of Devoney’s interference in a friends rape conviction. It was charged that the former police officer posed as police investigator and tried to convince the rape victim that she had identified the wrong man.
While Devoney denied the allegations, the judge handed down a far stiffer sentence for the federal fraud conviction, sending him to prison for 16 months.
LOUISIANA
The case has all the pizzazz of a made-for TV movie — a few mobsters, a little bit of courtroom drama and some terrorized witnesses.
Felix Riggio III of Hammond is in deep mud. He’s awaiting trial, along with 16 other men, for a video poker skimming scam that is alleged to have ties to organized crime. If convicted, the sentencing judge will have to take the fact that Riggio is already in prison on an insurance fraud conviction into consideration.
Riggio is currently appealing the fraud conviction, claiming that he was denied a fair trial because an anonymous jury was used. But what’s a US attorney to do when the accused brags of his Mafia ties and threatens two key witnesses? The court will decide the issue on September 6 — just in time for the video poker trial on September 18.
Riggio remains in prison, serving a 101-month sentence on the charges of burning down an Avoyelles Parish automobile dealership as part of the insurance scam.
MASSACHUSETTS
Sean DiPietro, 31, of Salisbury, has just earned quite a dubious title and distinciiun he’s the 100th person convicted through a special investigation funded by the insurance industry.
DiPietro pleaded guilty to four counts of insurance fraud, one count of workers’ cornpensation fraud and one count of larceny. The charges stemmed from a comp claim) filed in 1991 wherein DiPietro claimed to he totally disabled following an injury suffered in conjunction with his employment at a Midas Muffler shop.
But somehow, some way. despite his total disability, the claimant was found to have workedthree other full time jobs. DiPietro was sentenced to one year in prison, a two year suspended sentence and restitution of almost $32,000.
Richard DiChiara of Tewksbury collected $97,000 for a work-related injury. But the claimed injury didn’t keep him from working as a security manager, nor did it stop him from running a mail order business out of his home.
He was recently indicted by the AGs office.
Esam Shadid of Worcester, Massachusetts, asked his employer for time off to take care of some personal business in February 1994; the employer, Gourmet Donuts, agreed. Shadid returned several months later and attempted to bribe his former employer into supporting his claim of a work-related injury. Despite Shadid’s generous offer of two cars, $1,000 cash and $3,000 in checks, the employer refused to be bribed and reported him to its insurance carrier, ITT-Hartford.
It seems ITT-Hartford had rejected Shadid’s claim for a March 1994 work-related hand injury after the employer verified that no such injury had occurred and that Shadid had quit his job prior to the reported date of injury. Shadid was arrested after investigators observed his bribery efforts.
Adding insult to injury, investigators also obtained videotape of Shadid working at a new job while he was allegedly disabled by the hand injury. Shadid was charged with insurance fraud, workers’ compensation fraud, corruption of a witness by bribery and larceny.
MICHIGAN
The Michigan State Police teamed up with the Attorney General’s medical fraud division and with Michigan Blue Cross Blue Shield to investigate allegations of “drug peddling” and “Medicaid thievery” against medical clinics and doctors in four counties.
After a year long investigation, charges were filed in Detroit’s 36th District Court against Park Medical Clinic and osteopath Dr. Carl Pelino of Troy, the clinic’s president and co-owner. The other co-owner and office manager, Mildred Pelino, was also charged. as were three employees: William York and Edward Keasley of Highland Park and Rajesh Doshi of Sterling Heights.
The charges include submitting false Medicaid and Blue Cross claims, conspiracy, unauthorized practice of a health profession and prescription drug abuse. The accusations against Keasley include obtaining drugs from the clinic and then reselling them.
Charges were filed in Pontiac’s 50th District Court against Dr. Clarence McRipley, Jr., of Bloomfield Hills, for Medicaid fraud and for illegal delivery of controlled substances.
Identical charges were filed in Washtenaw County’s District Court against dentist, Dr. Nathanial Holloway, Jr.
The fourth set of charges were filed in St. Joseph’s District Court and included Medicaid fraud, fraud against Blue Cross and conspiracy and prescription abuse. On the receiving end of the charges were Dr_ Gabriel Orzame of the Napier Clinic in Benton Harbor and patient Charles Wysinger.
NEW JERSEY
Richard Ball, a resident of Newton, just didn’t know when to quit. In December 1994, Ball wrecked his car while driving under the influence. Then, in order to protect his own interests, he filed a report claiming his parked car was damaged in a hit-and-run accident.
When a witness to the accident gave police a different story, Ball tried to force her to change her account. Finally, in February 1995, he threatened to kill his girlfriend if she contradicted the story he gave his insurance company about the alleged hit-and-run accident.
Earlier this year, Ball was charged with two counts of tampering with public records, one count of tampering with a witness and one count of making a terroristic threat. On the charge of witness tampering alone, Ball was eligible for a ten-year prison term and a fine of $100,000.
NEW YORK
In January 1995, Frederick Dona, Jr.. a former field underwriter with Mutual Life Insurance Co. of New York, pleaded guilty to charges that he caused false statements to be made on an employee benefit plan document.
Using a forged signature, Dona had obtained approximately $47,000 in fraudulent commissions in 1989. He was sentenced to 100 hours of community service, six month’s home detention and two year’s probation. He has already made restitution to MONY for the $47,000.
NORTH CAROLINA
It was a scam that just didn’t work. Larry Rhinehart, dazed and bloody, wandered out of the Cupertino hills in California. He claimed that he didn’t know what his name was or how he had sustained the injuries to his head and leg.
He was taken to Kaiser Permanente Medical Center for examination. Doctors there could find no reason for his loss of memory and he was transferred to the psychological ward at Valley Medical Center in San Jose. After the story of the poor lost man hit the media, he was identified by his mother, Darlene, of Murfreesboro, Tennessee.
A bounty hunter from a Jacksonville bail bonding company solved the amnesia mystery for authorities when he flew to California to pick up the forgetful Rhinehart — who is alleged to have burned up a new pickup truck for the insurance bucks and then skipped out on the bail after he was picked up and charged.
OKLAHOMA
Several Tulsa residents were arrested in May 1995 as part of a nationwide anti-fraud effort. The program, which began in late 1993 under the name Operation Sudden Impact, was a joint effort of the FBI and local law enforcement. By mid-1995, over 325 people — including recruiters, attorneys, medical personnel and “victims” — had been arrested and charged with various counts of mail fraud, and conspiracy; mole than 270 of those had already either entered guilty pleas or been found guilty. FBI agents, utilizing wiretaps and undercover investigations, were continuing the operation. Authorities declined to name those arrested in order not to jeopardize the ongoing investigation.
UTAH
A life insurance agent was doing more than selling life insurance policies.
Ray G. Edwards is alleged to have mapped c: a fraudulent investment scheme and bilked elderly consumers out of at least 533,000. If convicted_ he faces a maximum of 30 years in prison and S40.000 in fines.
He is also charged with selling life policies and not remitting the premiums to the companies. In one case, the insured party -at least she thought she was insured — died during the investigation.
Between August 1991 and December 1994, Mark A. Green, a Salt Lake City insurance agent, is alleged to have pocketed $67,709 in premiums.
Green has been charged with six counts of fraud and, if convicted, faces a maximum sentence of 20 years in prison and $20,000 in fines.
VIRGINIA
It’s been over five years since he lit the match, but Abbas Sadegh, 56, of Fairfax is scheduled to be sentenced on September 1.
The former Alexandria restaurateur was convicted of burning down two restaurants that he owned. Federal charges included arson and mail fraud. Sadegh faces up to 15 years in prison and a fine of up to $250,000.
Norwood McMahon, 38, a Manassas chiropractor, has been found guilty of 44 counts of insurance fraud. Victims include several government and private insurers.
The US District Court in Alexandria “gotcha-ed” Dr. McMahon on felony charges including money laundering, mail fraud and cons
piracy to defraud the government.
CANADA
A total of 27 Canadian insurance company rnaployt’es have been accused of bilking US investors and are facing a $600 million lawsuit filed by Michigan’s top insurance.
Allegations include the funneling of hundreds of millions of dollars from the US branch of Confederation Life Insurance Company to its failing Canadian parent company in Toronto.
About $98.5 million dollars of US policyholder assets are at stake. The rehabilitator, hired by Confederation Life in Canada, is David Dykhouse, the former Michigan Commissioner of Insurance. Dykhouse resigned his State position in order to accept the private industry position and his move has sparked an investigation by the US Attorney’s Office.
The lawsuit, filed in Ingham County Circuit Court, charges that the executives assisted the Canadian Company in removing $600 million in cash and securities from trust funds set up to cover all US liabilities. It further alleges that money removed from the US branch was covered by nearly worthless IOUs from other Confederation companies, and that 600 notes were issued to the trust fund with face values of more than $50 billion.
Sukhbir Singh Rai, a 30-year-old Toronto auto mechanic, has been sentenced to five months in jail for insurance fraud. Police believe that a 1987 Grand Am was used in a murder and then torched by Rai.
The story is confusing, but the trail testified to by witnesses is clear. It is alleged that the car was a getaway vehicle after the drive-by shooting/killing of a man who lived on the same street as the car owner. The car then was taken to the body shop Rai owned and the owner was instructed to report it as stolen. Putting the nail in the coffin, another witness testified that he was offered $200 to set fire to the car — by Rai.
Sounds like there’s a lot of explaining to do!
GERMANY
Kicking a ball around a field apparently did not keep German soccer star Maurizio Gaudino busy enough.
He was recently charged with participating in a fraud ring that sold cars and then reported them stolen.
GREAT BRITAIN
Lord Bracket, a good friend to Prince Charles, is the owner of one of the world’s largest vintage auto collections. He reported four of his cars stolen — three Ferraris and a Maserati — and collected more than $7 million from his insurance carrier.
After the cars were found crushed to bits in London, the good Lord — the good Lord Bracket, that is — was charged with insurance fraud.
We ask you this: If he was tired of driving, or just didn’t want his cars any more, why couldn’t he ship them to 777 S. Main Street (Suite 135) in Orange, California?
© 1995 John Cooke Fraud Report