Archive for the ‘insurance fraud’ Category

Insurance Brief: Arkansas Man Sentenced for Defrauding FEMA

September 7th, 2010 by Iris | No Comments | Filed in flood insurance, insurance fraud, insurance news

A resident of Fort Smith, Arkansas has been sentenced to 18 months in prison for lying to FEMA in order to receive disaster aid meant for Hurricane Katrina victims, the Insurance Journal reports.

In addition to the prison sentence, United States District Judge Robert Dawson also ordered Anthony Owens, Sr., age 46, to pay restitution of almost $11,000.

Last December, Owens reached a plea agreement with the prosecution, and pleaded guilty to filing a false claim with FEMA. He admitted that he told FEMA officials that he was living in an apartment in New Orleans when Hurricane Katrina struck the city five years ago. FEMA records show that Owens received $10,780.

The truth that eventually came to light was that the address where Owens claimed to live was fictitious. In fact, he’d never been a New Orleans resident, and was nowhere near the city when Katrina hit.

Owens’ attorney was unavailable for comment.

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Louisiana Insurance Department Targets Health Insurance Scammers

August 12th, 2010 by Iris | Comments Off | Filed in health insurance, insurance fraud, insurance news

Stories about insurance fraud abound in the auto insurance industry, but investigators in the Louisiana Department of Insurance Fraud Section have now served the American Trade Association, along with its thirteen companion companies and fourteen employees with “cease and desist” orders for selling fraudulently marketed “medical discount plans” as health insurance plans in the state of Louisiana.

The named companies, entities and individuals were ordered to cease and desist from all unauthorized insurance business, including delivering, issuing, mailing, offering, or soliciting any resident of Louisiana any kind of certificate, coverage, plan, policy, or “any other contract” which claims to provide insurance benefits or medical discounts for health benefits.

In addition to receiving C&D orders, the named people and companies were directed to provide a complete list of all Louisiana businesses or residents that had purchased any products from them, and report all premiums that were received in connection with those customers. In addition, they were required to notify any of the affected Louisiana consumers of the C&D order, and issue immediate refunds of any monies or premiums held in behalf of those consumers.

Along with the Louisiana Department of Insurance, the same scammers have had lawsuits and/or regulatory actions filed against them by the Federal Trade Commission and law enforcement agencies in 23 other states.

The FTC alone has filed three different lawsuits targeting fraudulent medical discount plans, and Attorneys General and Insurance Commissioners around the country have brought numerous actions to stop the scammers. Included among these lawsuits and actions are those addressing sham insurance, as well as illegal automated phone calls, fax blasting, and licensing violations.

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Questionable Insurance Claims on the Rise

August 2nd, 2010 by Iris | Comments Off | Filed in auto insurance, homeowners insurance, insurance fraud

The Insurance Journal is reporting today that suspicious property and casualty insurance claims rose again in the first half of 2010, as compared to the first half of 2009.

The Journal cited a recent QU (questionable claims) report released by the National Insurance Crime Bureau, which examined six categories of referral reasons for claims: property, casualty, commercial, workers’ compensation, vehicle, and miscellaneous. Overall QCs increased by 14% in four of those categories in 2010, as opposed to 2009. These are claims which are referred to the bureau by member insurance companies that feel closer examination and examination is necessary because of indicators of possible fraud. A single claim can contain up to seven referral reasons.

This year saw a 107% increase in questionable hail damage claims and a 527% increase in questionable auto glass claims. Specifically, the bureau’s report notes: “Hail loss claims and QCs are generally concentrated in the central section of the U.S. However, seven of the top 10 states with the highest hail loss QC-to-claim ratio are not in the central section. This suggests that fraudulent hail losses can occur in any part of the country.”

Joe Wehrle, NICB’s president and CEO adds, “While there have been modest declines within a few categories of referrals, the 14 percent increase in the overall number of questionable claims for 2010 raises concerns.”

According to Wehrle, NICB, along with member insurers and law enforcement agencies have pursued unscrupulous roofing companies that take advantage of storms to fake or deliberately cause damage to roofs in an effort to get insurers to pay for a replacement roof that wasn’t damaged by a storm. Also under pressure from law enforcement, insurance companies and the NICB are staged accident rings, which are found in various regions including Tampa, FL, where this has become a major problem.

“We’re seeing concern from our members about criminal rings that are deliberately damaging vehicle windshields in order to file an insurance claim, and in some cases are not doing satisfactory repairs or replacements,” Wehrle said.

NICB is supported by nearly 1,100 property and casualty insurance companies and self-insured organizations.

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Feds Announce Largest Healthcare Fraud Takedown Ever

July 19th, 2010 by Iris | Comments Off | Filed in health insurance, insurance fraud, insurance news, medicare

Anyone who is, or has a parent who is, covered by medicare knows that healthcare fraud is a tangible risk. Some good news, then, on this Monday, is that Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced last Friday at a healthcare fraud summit in Miami, that the feds are in the process of the largest fraud takedown ever, with 94 defendants charged in five different cities (Baton Rouge, LA, Detroit, MI, Houston, TX, Miami FL, and New York, NY)

Also in conjunction with the Miami summit, which gathered together insurance providers, consumer advocates, and patients as well as federal, state, and local authorities, came the announcement from HHS that the state of Florida has been granted a Medicaid waiver which will help fund a program allowing the state’s Medicaid Fraid Control Unit to scan insurance claims for patterns that are red flags for insurance scams. Currently, Federal law prohibits federal matching funds from being used in such fraud control efforts.

As of Friday morning, 36 alleged participants had been arrested in connections with schemes involving over $250 million in fraudulent claims, according to the Justice Department. The suspects include insurance company owners, medical assistants, and doctors, and the allegations against them fit the profile of the kind of healthcare fraud typical of South Florida over the last several years – fraud that is now spreading across the country, with scammers filing false claims for HIV infusion services, home healthcare, durable medical equipment, and physical therapy, and beneficiaries getting monetary kickbacks for their Medicare numbers.

There are plans for additional, similar healthcare fraud summits to be held in Boston, Detroit, Las Vegas, Los Angeles, New York, and Philadelphia.

Source: Modern Healthcare

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Firing a Claim?

July 14th, 2010 by Iris | Comments Off | Filed in auto insurance, insurance fraud

A man in Belfast, Maine, is facing charges that he set a car on fire, and then posted photos of the flaming vehicle on Facebook.

The suspect, 36-year-old Asgard Tarick Gilbert, was arrested for felony arson roughly two weeks after local police found a1982 Mercedez-Benz smoldering on River Avenue.

According to the police, Gilbert told officers that he saw the car with a “small campfire” blazing in the back seat. They arrested him after examining his cell phone and computer, and watching surveillance tapes from a local store.

The owner of the car, which wasn’t working, had been trying to sell it.

Photo Credit: Belfast, ME Facebook Page | Click to enlarge

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Preacher’s Son Pleads Guilty to Church Arson

June 16th, 2010 by Iris | Comments Off | Filed in insurance fraud, insurance news

Maurice Arnold and Bruce Edward Smith – two thirds of a trio of men who were charged with arson in 2005, in connection with a fire that destroyed a church – pleaded guilty in Barrow County (Georgia) Superior Court. Two of three men charged with arson in a 2005 fire that destroyed a church pleaded guilty in Barrow County Superior Court in Georgia.

According to the prosecutors, the Reverend Quincy Arnold of Lawrenceville, GA, asked Maurice (his then-25-year-old son) to burn down his New Life Deliverance Church five years ago. They also say that Maurice Arnold hired Smith (age 48) to help him with his task.

The senior Arnold is expected to face charges in October, which will included insurance fraud, vandalizing a place of worship, first-degree arson, and conspiracy to commit a crime.

Superior Court Judge Currie Mingledorff has agreed to sentence Smith with two years in prison followed by fifteen years of probation, though the prison sentence is suspended on his arson plea.

The younger Arnold pleaded guilty to three charges: vandalizing a place of worship, conspiracy to commit a crime, and arson, and will be sentenced next month.

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