Fraud News Weekly

Friday, February 22, 2019

* Public adjusters in Virginia soon may have to undergo fingerprinting and federal criminal background checks if a new law is signed by the state’s governor. Licenses would be valid for 2 years, and subject to renewal. The law aims to keep unlicensed public adjusters out of Virginia, and protect consumers from potential fraud. Others insurance personnel such as agents would need checks as well.

* Illinois lawmakers are looking to stop dishonest body shops from repairing vehicles using substandard aftermarket parts, especially if they’re billing for manufacturer originals. Repair estimates, including listing non-original manufacturer parts, must be authorized by the customer in writing. Insurers and consumers continue debating the use of aftermarket parts. Still, bodyshops must accurately disclose parts used to repair vehicles, the Coalition agrees. The bill is now in the state Senate.

* Prescription drug scammers in Georgia may find their names popping up longer and for more anti-fraud purposes in the state’s prescription drug monitoring database. Prescription drug data must be kept for 5 years instead of the current 2 years under a bill in the state Senate. The state AG’s Medicaid fraud unit also would gain full access to the database. Medicaid fraud costs up to $36 billion a year nationally, the GAO estimates.

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

* Prosecutor Mike Gmoser downloaded pacemaker data to find crucial evidence against a home-arson suspect. He convicted 2 other arsonists whose home blaze killed firefighter Patrick Wolterman. Such excellence earned the Butler County, Ohio courtroom whiz a national award from the Coalition. And a glowing resolution from the state House of Representatives: “This prestigious distinction is a fitting tribute to Michael Gmoser in recognition of his exemplary endeavors as a prosecutor for Butler County,” the House resolution reads. “Thanks to his use of technical evidence obtained from phone records as well as data obtained from a pacemaker, he was able to successfully prosecute two individuals for the crimes of arson and murder.” Gmoser received an Award of Distinction as part of the Prosecutor of the Year award competition sponsored by the Coalition last year.

* “It’s among the most insidious forms of insurance fraud,” the Coalition’s Matthew Smith says in an NICB blog about airbag ruses that defraud insurers and jeopardize motorists. “Phony air bags are dangerous and can kill; it’s like a time bomb on four wheels.”

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* The son of a socialite who ran a $20-million insurance theft that exploited a mansion fire pled to his role in the Philly-area scam. Carl Risoldi was nailed with 3 misdemeanors. He received 4 years of probation and will forfeit the family’s mansion on 10 acres. Family matriarch Claire Risoldi made $20 million of false and inflated claims after a fire damaged the family mansion called Clairemont. Claire was a lavish fundraiser for local Republicans. She sought inflated payouts for fire damage and lost possessions. That included $10 million of jewelry she falsely accused firefighters of stealing, and an inflated bill for a mural she had an artist submit to AIG. Carl’s exact role is unclear, though he testified against his mother at trial. The AG plans to liquidate the mansion property, which Carl co-owns, and transfer the proceeds to AIG. The court also will return Carl’s frozen assets to him: 2 other properties, 14 cars including 6-figure sports cars, Rolex watches, and 1/3 of the money in bank accounts held by him, Claire and Carla Risoldi. Felony charges against Carl were dropped as well. Claire was criminally convicted and awaits sentencing.

* A Beverly Hills workers-comp doc marked up med equipment sold to his medical practice by a medical supply firm he owned. Dr. Gil Tepper wrote fraudulent invoices charging inflated prices for hardware used for spinal surgeries. The stuff was bought by his Miracle Mile Medical Center, from his supply firm Metalink Distributors. The scam lasted from 2006 to 2014. Tepper must repay $1.7 million to 9 comp insurers. He also was kicked out of California’s comp system, can’t run a medical supply firm anymore and received 6 month of electronic monitoring.

* Burglars shot Carla Lewis in a home-based marijuana grow room and then stole her car to get away, her husband John Lewis told 911. Except the St. Joseph, Mich. man shot Carla himself for $246,000 of life insurance. He ran a small and legal marijuana business inside their home. That made the couple a robbery target, Lewis claimed. Yet Lewis had affairs with multiple women. He discussed wanting to kill his wife with 1 woman. Lewis also wasn’t fully employed and worked odd jobs. Carla made $80,000 per year, and had a $246,000 life insurance policy and $70,000 in retirement money. Lewis was the beneficiary. He also searched online for guns and silencers in the week leading up to Carla’s murder. Shooting Carla opened up drug charges as well. He was the only person legally allowed in his grow room. Carla’s body in the room proved he violated the state’s marijuana law. Lewis will be sentenced March 25.

* Rossana Ramirez had a $7-million nest egg despite a nursing assistant’s salary. She helped run a home healthcare firm in the Miami area called F&E. The firm fleeced Medicare and Medicaid out of millions. The outfit paid kickbacks to Medicare and Medicaid recipients. They pretended to be home-health patients, yet didn’t need home healthcare. Ramirez and her husband also paid recruiters to bring in the patients. F&E billed Medicare and Medicaid for useless and often phantom home-health services. The business model was a standard template for widespread home-health scams throughout South Florida. Home-health scams also are high on the national radar of the feds, and a frequent target of Strike Force operations in key hotspots. Ramirez and her hubby Evelio each received nearly 4 years in federal prison.

* An auto-repair owner stole $2 million from an elderly woman using bogus repair charges and phantom suit against an auto insurer, prosecutors charge in Mesa, Ariz. The allegations: The woman hired Donaldo Parra to fix her 2006 Jaguar after a crash. She paid him more than $80,000 up front for repairs after Parra said her insurer would reimburse her. Parra next said he was having trouble getting the insurance money, and she needed to sue the insurer. He convinced her to use an attorney he’d hire. She could get an $8-million settlement from the insurer, Parra said. The senior depleted her savings and wired hundreds of thousands of dollars from retirement accounts. The visibly shaking senior went to her bank in Mesa to withdraw $40,000 in cash. A bank teller grew suspicious after noticing she’d withdrawn hundreds of thousands of dollars in cash over just several weeks. The attorney doesn’t exist, and the insurer says no lawsuit was filed. The Arizona AG charges Parra with fraudulent schemes and theft.

* A fake adjuster tried to steal more than $68,000 in bogus claims after Hurricane Irma blew through Florida, the state CFO charges. As alleged: Mary Bruce approached homeowners whose roofs and interiors were damaged. The Orange City woman said she was an “independent claims adjuster” who’d negotiate settlements with their home insurers. Bruce required homeowners to pay $3,500 and sign a power of attorney for the repair claims. She then submitted cost estimates to the insurers. Bruce also approached roofing firms and homeowners in Central Florida. She falsely identified herself as a “claims manager.” She could increase prior hurricane insurance settlements up to $30,000, she said. Bruce also required homeowners to sign a power of attorney. She doubled the original cost estimates and sent the claims to insurers. Bruce placed a lien on the homeowner’s property if an insurer refused to pay up. She’s charged with being an unlicensed public adjuster and filing bogus liens. Up to 10 years in jail awaits Bruce is she’s convicted.

* Jason Doyle Cook claimed he was driving in his 1995 Ford F350 when he collided with a semi tire in the freeway, and a wood post. The crash damaged the truck’s entire driver bedside and rear brakes, the Salt Lake City, Utah man told American Family Insurance. Cook said the semi tire hit the slideout on the trailer coupling, rendering the coupling inoperable. The semi-tire also damaged the sewer line under the trailer, he said. American Family Insurance searched Cook’s and his wife’s social-media accounts. The insurer allegedly found a photo posted 8 months prior. It shows the F350 in the background with the same damage. Other photo evidence shows the truck was damaged before Cook even bought it, officials say. He’s charged with insurance fraud.

* A former deputy turned himself in to face fraud and theft charges. Edward Hobbs was a Clayton County (Ga.) deputy. Prosecutors lay out these allegations:A woman rear-ended Hobbs while he drove an unmarked county vehicle. There was no damage, and both told medics at the scene they weren’t injured. But Hobbs went to the hospital and filed a claim through the woman’s insurer. Hobbs never told the sheriff’s office about the incident. He reported back to duty, though told the woman’s insurer that crash injuries forced him from work for a period of time. Hobbs forged a letter by his supervisor to support the claim. Nor did he return a computer and cell phone confiscated from a suspect. No word on potential sentence if convicted.

* Georgia’s insurance department has busted 11 suspects since the new commissioner took office Jan. 15. Among the charges: Michael Simpson (Lawrenceville) filed a property damage and injury claim with Geico, the at-fault driver’s insurer, after a collision. Simpson ordered an MRI and submitted forged medical records showing a torn meniscus. The real records show an MRI wasn’t ordered, and that a torn meniscus wasn’t diagnosed. … Marcus Kentoya Johnson (Milledgeville) entered businesses and claimed he slipped and was injured. Johnson used fake names to file claims, and hide his identity to avoid suspicious claim patterns. … Maria Luisa Blanco (Lawrenceville) sold workers comp without a license through a firm called Central Tax.

* A Tennessee pain doc and pastor is a prolific drug dealer who wrote suspicious internet scripts for an addictive muscle relaxer to California patients he never examined, the feds charge in the Nashville, Tenn. area. Dr. Samson Orusa moonlights as pastor at God’s Sanctuary Church International. He prescribed opioids to large groups, and wrote more than 66,000 scripts for addictive drugs. Orusa wrote internet scripts for the addictive muscle relaxer Soma, to 16 California patients. Soma enhances the effects of opioids. It’s widely abused in with opioids and benzodiazepines in the “holy trinity” of prescription-drug abuse. Orusa also billed Medicare and Medicaid for patient exams he couldn’t possibly have done. He charged for 11-21 hours of patient exams though he was at his clinic for just 5-8 hours a day. He also billed for more than 24 hours on 8 more dates — a seemingly impossible medical feat. Orusa faces numerous federal charges.

* A fully armed SWAT team raided the office of gyno doc Sheetal Kanar Kumar. The Stuart, Fla. woman allegedly made more than $637,000 of false claims against Medicare and private insurers. The raid may have been a message to other docs in the area, and shut down Kumar’s practice. The feds charge: Kumar billed for procedures that should’ve required diagnostic or therapeutic equipment. Yet that equipment often stood idle in Kumar’s office. She also billed for other procedures at higher levels than what was performed. Kumar mounted a defense: She used reliable manual techniques when her diagnostic equipment malfunctioned, she said. Kumar also kept lousy records, which doesn’t amount to fraud. And the medical coder who blew the whistle is an unreliable witness who’s on felony probation for a separate crime. Kumar had to move her 3 teens to Tallahassee. The closest place her gastro doc husband could find work is Georgia. Kumar awaits the jury verdict.

* Fraud fighters’ personal liability for bad faith will be on the line when oral arguments open in the Washington state Supreme Court next Tuesday. The case is Keodalah v. Allstate Insurance Company. Investigators, adjusters, and even IME physicians and legal counsel can be sued personally for bad faith in the state, the appeals court ruled a year ago. Personal bad faith gives fraudsters a free pass because insurance personnel may let claims slide on through instead of challenging them and risking being sued, the Coalition warns in an amicusbrief urging reversal of the decision.

* The Coalition welcomes these 5 new members, bringing membership to an alltime high of 180 organizations: Attorney General, State of Michigan … Cozen O’Connor … Greenberg Traurig … Insurance Care Direct … Lewis Brisbois.

The son of a socialite is convicted for his role in their $20-million property scam after a fire at their Philadelphia-area mansion. … An auto body-shop owner allegedly steals $2 million from a senior for bogus car repairs and a sham lawsuit against the auto insurer. … Social-media posts allegedly show a Utah man’s truck was damaged long before a claimed highway collision. Click the map to read about these and other scams around the U.S.

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Fraud News Weekly is published each Friday except for Thanksgiving week and the week between Christmas and New Years. Copies of previous issues are available in the members-only section of Employees of member organizations may share this newsletter freely internally. Sharing by non-members strictly prohibited.