CHICAGO A federal grand jury in Chicago has charged 23 defendants with participating in a fraud scheme through which they allegedly swindled ten life insurance carriers out of at least $26 million in fraudulent benefits. Your car is your castle on four wheels. Whether its FNOL processes, the ease of digital interactions or the time it takes to settle the claim, where is the industry delivering for customers? If convicted, the Court must impose reasonable sentences under federal statutes and the advisory U.S. The insurance company pays the claim for your damage. - Nineteen defendants, primarily from the Columbia and Kansas City, Missouri, areas, have been indicted by a federal grand jury for their roles in a $1.2 million insurance fraud conspiracy that involved false claims of injuries suffered in car accidents. The Pierre Conspirators further defrauded automobile insurance companies by billing insurance companies for unnecessary, harmful, and excessive medical treatments, falsifying clinical injuries in reports, and lying under oath to insurance company representatives. Claims filed by individuals residing hundreds of miles outside the disaster-zone. Just by providing false statements such as this toan insurance company, you have committed insurance fraud. The main duties of an SIU is todetect, investigateand pursue action against fraudulent activities on the part of insureds or claimants. Works with and trains law enforcement agencies on how to investigate and prevent fraud. Data is pulled from an abundance of sources to analyze for a fraudinvestigation. Watch the 2 Your Health report for Friday, April 28, 2023. The exact cost of insurance fraud is difficult to estimate because much of it goes unreported. It affects everyoneindividuals and businesses alikeand causes tens of billions of dollars in losses each year. Ask to see it. Asset diversion often involves acquiring control of an insurance company with borrowed funds. The investigation revealed Vallery submitted fraudulent insurance documents to larger corporations alleging he was insured with BXS Insurance Company. On September 8, 2005, the Attorney General created the Hurricane Katrina Fraud Task Force (HKTF). Together, we will continue to be relentless in fighting crime that impacts the people we serve wherever, and however, it occurs.". A weak frontal system will push through the No. The Gulkarov Conspirators further defrauded automobile insurance companies by billing insurance companies for unnecessary, harmful, and excessive medical treatments and lying under oath to insurance company representatives. According to the criminal summons, Black told AFLAC that he could no longer work when he was still employed and working., Andrew Davis, 32, of Whitakers, was charged with four counts of insurance fraud and four counts of obtaining property by false pretense, all felonies. April 5, 2023. Charged in the indictment are JAMES MILLS, also known as Jamie Montes, 47, of Oak Lawn, Ill., JOSEPH BROWN, 50, of Chandler, Ariz., JULEY ELY, 47, of Oak Lawn, Ill., GINGER ELY, 26, of Oak Lawn, Ill., SYLVIA EVANS, 48, of Kissimmee, Fla., HOLLY STERGO, also known as Holly Stego, 29, of Missouri City, Texas, JESSICA VACA, 51, of Deerfield Beach, Fla., ANGELA BECHO, 30, of Fort Lauderdale, Fla., FRANK COSTELLO, 44, of Hoffman Estates, Ill., JOE ROUGA, 29, of Oak Lawn, Ill., MARY BACCO, 53, of Bridgeview, Ill., STEVE MONTEGA, also known as Fonzie Cerano, 44, of Orland Park, Ill., NIKO RISTICK, 23, of Orland Park, Ill., TONY RISTICK, also known as Anthony Walker, 52, of Orlando, Fla., RACHEL MONTEGA, also known as Samantha Walker, 48, of Orlando, Fla., ROBERT CRAIG, also known as Jake, 37, of Lakeland, Fla., STEVE VEGA, also known as Cabby, 45, of Fort Lauderdale, Fla., SOPHIE BECHO, 46, of Fort Lauderdale, Fla., MARK BLANCA, 30, of Burbank Ill., DIANA LUMAS, 30, of Burbank, Ill., RICKY BLANCA, also known as Fonz Ristick, 48, of Orland Park, Ill., DAVID JENSEN, also known as Tony, 52, of Lakeland, Fla., and JOE JOHN, 66, of Arlington Heights, Ill. Raleigh NC 27699-1201, Contact NCDOIEmployee DirectoryCareers at NCDOICalendar, An official website of the State of North Carolina. all felonies that could bring up to 20 years in prison if convicted of all three charges. All Rights Reserved. No. United States Attorney Nick Hanna, center, at an earlier press conference on April 29, 2019. Special agents with the Department of Insurances Criminal Investigations Division accuse Davis of pursuing automobile insurance claims with State Farm Mutual Automobile Insurance Co. for a vehicle he did not own that was involved in staged crashes. This Office was one of the districts affected by the SolarWinds intrusion. New York law also prohibits fraud involving senior life settlements. The Criminal Enforcement and Financial Crimes Bureau is led by Bureau Chief Stephanie Swenton and Deputy Bureau Chief Joseph G. DArrigo. Fraud is the crime you pay for! Secure websites use HTTPS certificates. Deceptive people alsooften use language that minimizes references to themselves, lays blame on others, provides lack of detail or alludes to actions without just saying it. Click here for information on the investigation into the Mount Vernon Police Department. This cost is almost always passed to consumers of private insurance or subsidized programs established to help those in need. A lock () or https:// means you've safely connected to the .gov website. After winning first basketball title in LSU history, Kim Mulkey says it's SEC considering drastic new punishments to deter fans from storming the field, Offense-Defense ties 32-32 in LSU's Spring Game, For help accessing the WBRZ-TV Public File, contact: Joey Verrett at. As alleged, the leaders of the Gulkarov Conspirators are non-physicians, including ALEXANDER GULKAROV, a/k/a Little Alex, ROMAN ISRAILOV, a/k/a Roman Matatov, PETER KHAIMOV, a/k/a Peter Khaim, and ANTHONY DIPIETRO. Telling your insurance company your vehicle is primarily garaged in a rural area and only driven for pleasure use- but in reality, you live and drive in the city, primarily back and forth to work or school daily. Body shops may enhance existing damages or conspire with adjusters to inflate the repair estimate. Thats how many insurance companies are convinced fraud is spreading farther in recent years. ARONOV then took photos of the reports using a pre-paid burner phone and transmitted the photos to the leaders of the Gulkarov Conspiracy using an encrypted messaging application. AARP Membership $12 for your first year when you sign up for Automatic Renewal. Agents arrested: Six cases of fraud by insurance agents in 2021 By Heather A. Turner | June 28, 2021 at 12:00 AM A $86,000 crime A former Kansas agent was sentenced in March to 24 months of. The vast majority of consumers say theyre concerned about insurance fraud and its damage. More scam alerts FraudPod Lets say you have damage to your car, but do not have physical damage coverage on your insurance policy. How one behaves in the claims process often tells insurance representatives and investigators a lot andmay oftenreveal more than they intend through their choices of words. As part of the scheme, the Gulkarov Conspirators fraudulently owned and controlled more than a dozen medical professional corporations including medical, acupuncture, and chiropractic practices by paying licensed medical professionals to use their licenses to incorporate the professional corporations (collectively, the Gulkarov Clinics). But the greatest cost is a human onetens of thousands of lives are lost to addiction each year. Don't allow high-pressure salesmanship to persuade you to sign up for a type of policy or certain coveragethat you are not sure you need. Even a legitimate accident may lead to fraud if towing bandits haul your damaged vehicle to a crooked body shop for shoddy, inflated repairs. All told, the Pierre Conspirators billed insurance companies for more than $70 million in fraudulent medical treatments. Washington, D.C. 20005 At the end of the day, society as a whole pays the costs of insurance fraud through increased premiums. Check carefully to confirm that you were not billed for more expensive procedures than were actually provided, a practice known as upcoding. ANDREW PRIME is a Runner who bribed 911 operators and operated an additional call center as part of the scheme. U.S. Attorney Damian Williams said: The thirteen defendants charged in todays indictments are alleged to have collectively perpetrated one of the largest no-fault insurance frauds in history. Some entities purport to provide workers compensation insurance at a reduced cost and then misappropriate premium funds without ever providing insurance. But the shot only grazed his head and Murdaugh, 53, was charged Thursday with insurance fraud, conspiracy and filing a false police report. Accessibility & Reasonable Accommodations, A driver and a body shop worker agree to inflate the auto damage claim and share the "profit.". Insurance policy holders across New York State are victimized to the tune of more than half a million dollars a day. Terry Garcia, however, was a fiction in an elaborate scam that left F.K. If the company doesnt have a reporting system or fraud hotline, call or write the company headquarters. [emailprotected]. Stay informed about the newest fraud legislation. In another case, officials said a Raleigh woman had damage to her 2020 Ford Explorer. Others may feel lying to an insurance company is fair game because they just want something in return for their premiums. Criminal, civil or administrative legal actions relating to fraud and other alleged violations of law, initiated or investigated by HHS-OIG and its law enforcement partners. The indictment charges the 23 defendants with multiple counts of wire and mail fraud. Read your policy carefully before you sign. Those charged include the following individuals: If convicted of the top count, each defendant faces a maximum of 1 1/3 to 4 years in prison. Giving back to the community through a variety of venues & initiatives. This white paper reveals how carriers can streamline complex processes, provide faster, more immediate agent support and help them to write more business. Committing fraud may be tempting for some,but rest assured, trained invesigators are always watching! The goal was to get his surviving son a $10 million life insurance benefit, state police said. PIERRE further openly communicated with Law Firm-2 about the scheme, for instance telling his family member, I'm going to make sure you ALWAYS make your quota. Law Firm-2 paid PIERRE over $4 million in connection with the No-Fault Scheme typically from Law Firm-2s Interest on Lawyers Trust Accounts (IOLA Accounts) while maintaining no documentation or ledgers identifying the purpose of these payments. Assistant United States Attorneys Mathew Andrews and Louis A. Pellegrino are in charge of the prosecution. The total cost of (non-health) insurance fraud is estimated at more than $40 billion . The matter will be kept confidential. ) or https:// means youve safely connected to the .gov website. Beware of trucks which conveniently arrive to help. TAMPA, Fla., Oct. 27 /PRNewswire/ -- Three arrests at a Fort Myers chiropractic clinic for insurance fraud are the latest results of an on-going investigation by Direct . A fraud investigation unit revealed Parker had 47 fake IDs and 11 different addresses to file her claims, which totaled more than $500,000. Most insurance customers are honest and do not set out to commit fraud. ROLANDO CHUMACEIRO, a/k/a Chuma, and MARCELO QUIROGA are licensed medical practitioners who incorporated medical practices as part of the scheme, prescribed unnecessary and excessive medical treatments, and overbilled insurance companies under the No-Fault Laws. This process resolves automobile claims without apportioning blame or fault for the accident, thereby avoiding protracted disputes, and the costs associated with an extended investigation of the accident. Raleigh NC 27603-5926, Mailing Address: As alleged, WISNICKI laundered hundreds of thousands of dollars of illicit proceeds for the leaders of the Gulkarov Conspiracy and concealed these transfers by fabricating retainer agreements, lying to law enforcement, and committing perjury before a federal grand jury. Carefully review subsequent repair estimates and claims. Please enable Javascript in your browser and try AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Fraudulent claims total at least $80 billion per year in the United States. The Insurance Frauds Bureau (IFB) was established by an act of the Legislature in 1981 as a law enforcement agency within the New York State Department of Insurance. Coalition Quarterly keeps you updated on the latest Coalition activities to help you combat fraud. Line up those $308.6 billion dollar bills stolen every year. According to the Attorney Generals felony complaints, each of the defendants owned a car that was damaged. CHICAGO The wives of convicted drug traffickers Pedro Flores and Margarito Flores have each pleaded guilty to one count of conspiracy to commit money laundering. 325 N. Salisbury Street A lock icon or https:// means youve safely connected to the official website. Ignore them, report them. In addition, be suspicious if, following an emergency room visit, you are contacted by someone claiming to be employed at the hospital who recommends a particular medical facility for follow-up treatment. Copyright 2023 ALM Global, LLC. 1201 Mail Service Center These two sweeps have now resulted in eleven arrests. Premium diversion is the embezzlement of insurance premiums. Be honest and save time, money, your freedom and reputation. If you have received medical or dental treatment that is covered by a health care provider, you will receive an "Explanation of Benefits" statement listing the services for which benefits have been paid. Stats reveal fraud trends. NC Department of Insurance They stretch to the moon and back 16 times! The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs. According to Crawfish Tracker: Signs of life (and price drops). These individuals will solicit the injured or allegedly injured parties at the accident scene or shortly thereafter and direct them to medical facilities that are involved in the scam. The total cost of insurance fraud (non-health insurance) is estimated to be more than $40 billion per year. Find the fraud facts across all lines of insurance. On April 7, 2016, Carrasquillo lowered his deductible from $2,500.00 to $500.00, and then on May 10, 2016 allegedly filed a claim for the same damage, falsely claiming that the damage had occurred on April 22, 2016. 20 (the Gulkarov Indictment), which has been assigned to U.S. District Judge Failla. Another common premium diversion scheme involves selling insurance without a license, collecting premiums and then not paying claims. Office of the New York State Attorney General. This investigation sends a strong message to others who may be contemplating engaging in insurance fraud. Edmonds told her insurance company the damage happened after she reinstated her policy but it actually occurred before the reinstatement, the news release said. Among the defendants are sets of spouses and, in some cases, their children, as well as an insurance agent who owned a side business that performed medical examinations on applicants for term life insurance policies. A worker collects workers' compensation benefits while employed. An eleventh defendant, Alexander Gulkarov, was arrested in Miami, Florida, and is scheduled to appear before a U.S. Magistrate Judge in the Southern District of Florida later today. The HKTF has a zero-tolerance policy for fraud related to Hurricane Katrina. Watch out for these common insurance scams: A vehicle filled with people will stop suddenly in front of you, setting you up as the cause of a rear-end collision, while doctors and lawyers who are participants in the scheme handle the subsequent medical claims and lawsuits. Bicyclist struck and killed in Ascension Parish Man taken to hospital after being stabbed Maurepas man killed in Livingston Parish motorcycle Maurepas man killed in Livingston Parish motorcycle wreck. Property-casualty fraud steals more than $30 billion each year. A massive online fraud and money-laundering scheme, whose victims included older adults, has been broken up by federal law enforcement authorities. If you have a complaint or an inquiry not involving fraud please File a Complaint. Insurance Fraud: Avoid Becoming a Victim | Department of Financial Services Fraud and Cyber Protection Report Suspected Insurance Fraud If you suspect that insurance fraud has been committed, you should report it to the DFS or call the Insurance Fraud Hotline: 888-FRAUDNY (888-372-8369) right away. That drivers car may be uninsured or his/her insurance identification card may be fraudulent. Public Service Announcement on Sexual Assault in Public Housing. If you suspect health care fraud, report it to the FBI at tips.fbi.gov, or contact your health insurance provider. The company left to pay the claims is often a business the conspirators have set up to fail. The Runners then used this information to induce victims to seek medical treatment at, among other places, the Pierre Clinics. Rockford, IL 61101, Chicago: (312) 353-5300 They fear suits for false arrest and acting as agents of the state that caused the National Insurance Crime Bureau (NICB) this year to pay a $1.1 settlement to two accused insurance fraud perpetrators. Even a legitimate accident may lead to fraud if "towing bandits" haul your damaged vehicle to a crooked body shop for shoddy, inflated repairs. AARP Membership $12 for your first year when you sign up for Automatic Renewal. The Pierre Conspirators fraudulently owned and controlled five medical services corporations including medical clinics and a magnetic resonance imaging (MRI) center by paying licensed medical professionals to use their licenses to incorporate the professional corporations (collectively, the Pierre Clinics). Misclassification of flood damage as wind, fire, or theft. The CAIF is a national alliance of consumer groups, public interest organizations, government agencies, and insurers dedicated to preventing insurance fraud. on charges of filing or maintaining false public records and insurance fraud. I commend the FBI Chicago Field Office and the Arlington Heights Police Department for their diligent work in uncovering this complex scheme and seeking to hold the defendants accountable for their personal and economic harms., We will not allow deceitfulness to prevail for selfish financial gain, said FBI SAC Buie. Correia reinstated his insurance policy that night, then filed his claim the morning after, falsely claiming that the vandalism and theft occurred on January 18, 2016. I commend our members and our law enforcement partners for their work on this case, and we are sending a clear message that we will not tolerate fraud on any level., NYPD Commissioner Keechant Sewell said: Todays indictments reflect schemes to profit by exploiting victims through fraud. $200,000 poorer and on the brink of bankruptcy, the authorities alleged. According to the arrest warrant, Smith filed a claim with Progressive Premier Insurance for damage to his vehicle and another mans vehicle, claiming that the damage occurred after he took out the insurance policy when it occurred before he took out the policy., James Robert, 42, of Hickory, was charged with insurance fraud, a felony. Insurance premiums are a significant expense for most of us. If you then are able to obtain the insurance payment or benefitsbased on those false statements or misrepresentations, you have now obtained property by false pretenses, which can also be a felony charge. She can be reached at [emailprotected]. PIERRE conducted much of the No-Fault Scheme from his physical office located in a law firm owned by a family member (Law Firm-2), where, among other things, he monitored the Pierre Clinics using closed circuit TV cameras, communicated with co-conspirators using Law Firm-2s email domain, and met with doctors in Law Firm-2s offices. The remaining assets can then be diverted to the subject. Fraud News Weekly Your trusted every-Friday recap of all things insurance fraud: the newest cases, trends and legislation. Yes, you have now committed insurance fraud. Seeks criminal indictments. You tell your insurance company the TV was damaged by the lightning storm, so it can be covered by your homeowners/renters insurance. Often special investigative units also consist of experts in law enforcement, as well. 1 LSU baseball wins game 2 vs Alabama 12-8. Gain fresh insights into fraud bills, laws, regulations, and model acts. A .gov website belongs to an official government organization in the United States. Valuable assistance was provided by the Cook County States Attorneys Office, U.S. After making the purchase, the subject uses the assets of the acquired company to pay off the debt. Five additional defendants are separately charged in United States v. Bradley Pierre, et al., 22 Cr. Scam SpotlightDisaster-Related Fraud: Hurricane Katrina. We will continue to work with ourlawenforcement partnerstohold accountable those who manipulate the insurance system on which so many people depend, especially when the alleged perpetrators are professionalswho allegedlyviolated theoathsthey tookto serve and protect., State Police Superintendent Kevin P. Bruen said: These indictments are the result of years of investigative work and could not have succeeded without the collaboration between federal, state and local law enforcement. The matter will be kept confidential. Protect your health insurance information. Creating or using forged prescriptions is a crime, and prescription fraud comes at an enormous cost to physicians, hospitals, insurers, and taxpayers. The Gulkarov Indictment also includes charges against an attorney, ROBERT WISNICKI, Esq., who is the founding partner of two New York-based law firms. We Value Your Privacy When later questioned by federal agents, ARONOV lied about his involvement in accessing and disseminating the confidential motor vehicle accident reports. Over 10 months of daily emails, F.K. The charges are set forth in United States v. CHICAGO The former payroll manager for a Chicago museum pleaded guilty today in federal court to misappropriating more than $2 million in museum funds. State Government websites value user privacy. . Delacourt urged people to be aware of online scams. Deal only with licensed agents and brokers. In his claim, Floris falsely stated that the accident had occurred on July 25, 2016. False or exaggerated claims by policyholders. As alleged, as part of the scheme, ARONOV logged into NYPD computers during off-hours and searched for confidential motor vehicle accident reports on the NYPDs servers. Jevon Holder, 34, of the 500 block of N. 52nd St., Philadelphia, is charged with one felony count of insurance fraud, a separate misdemeanor count of insurance fraud and one count each of theft by deception, criminal use of a communication facility and forgery. Insurance fraud is a serious crime, and todays arrests should serve as yet another warning that my office will continue to aggressively identify and prosecute those who try to scam the system., The National Insurance Crime Bureau would like to praise the staff of the New York State Attorney Generals Office for their continued efforts in addressing insurance fraud in New York, said Kevin Gallagher, Regional Director of the Northeast Region of the National Insurance Crime Bureau. If you are taking opioids, take them exactly as prescribed by your doctor, ideally, for the shortest amount of time possible. Any person who willfully makes a false statement or misrepresentation of a material fact for the purpose of obtaining or denying any benefit or payment or assisting another to obtain or deny any benefit or payment can be charged with a felony. JEFFERSON CITY, Mo. Don't give it to others to use, and be mindful when using it at the doctor's office . If you suspect that insurance fraud has been committed, you shouldreport it to the DFSor call the Insurance Fraud Hotline: 888-FRAUDNY (888-372-8369) right away. By doing this, rates may be lower, but providing knowingly false statements are still fraudulent. Mr. Williams noted that the investigation is ongoing. Be sure to make note of the other vehicles license plate number and obtain important insurance information. April 26, 2023. Go directly to the insurer you think is being defrauded. Your big screen TV just quit working, then a week later your home was struck by lightning. Supervision by DFS may entail chartering, licensing, registration requirements, examination, and more. Todays charges are the result of Operation Crash & Buy II, an investigation initiated by the Attorney Generals Auto Insurance Fraud Unit (AIFU) in conjunction with the National Insurance Crime Bureau. For more information or to contact the Louisiana State Police Insurance Fraud and Auto Theft Unit, Bicyclist struck and killed in Ascension Parish early Monday. This case is being prosecuted by Assistant Attorney General Michael Hendrick, with the assistance of Legal Analyst Yuriy Kurbatov and Supervising Legal Analyst Paul Strocko of the Criminal Enforcement and Financial Crimes Bureaus Auto Insurance Fraud Unit. Insurance fraud hurts more than just yourself and an insurance company. Braving the elements: Manage rising peril risk with science. Federal authorities cited the case of a Japanese woman, known only as F.K. in court papers, as one example of the alleged romance scams that began through what she assumed was an international social network for digital pen pals. Investigators reported that Holder was involved in an automobile accident in May 2016. FBI.gov is an official site of the U.S. Department of Justice. Click here to report information on Amazon warehouses. Consumers can sometimes be victimized by unscrupulous agents or brokers and discover only after they file a claim that they are without coverage. Rockford: (815) 987-4444. Sentencing Guidelines. Purposely staging an accident in any way, is insurance fraud.
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