2012 Annual Report - Louisiana State Police

2
Letter From The Superintendent
3
Louisiana Insurance Fraud Task Force
The Insurance Fraud Task Force is a statutorily mandated partnership of three state agencies created to combat insurance fraud and auto theft in Louisiana.
Louisiana Department of Insurance
Insurance Fraud Section
Louisiana State Police
Insurance Fraud & Auto Theft Unit
Louisiana Attorney General’s Office
Insurance Fraud Support Unit
4
5
2012 Joint Legislative Report
Table of Contents...
Letter from Louisiana State Police Superintendent
2
Louisiana Insurance Fraud Task Force Partners
4
Basic Information
Table of Contents
6
Budget
42
How to Report Insurance Fraud
7
Statistical Information
43
8-37
Top Cases Prosecuted
43-44
LOUISIANA STATE POLICE
Letter from Unit Supervisor
10-11
LOUISIANA ATTORNEY GENERAL’S OFFICE
Civil Insurance Fraud Unit
38-45
41-42
45
Three Year Statistical Profile
12
Referral Types
13
Purpose
Statistical Information
14
Personnel
Statistical Information by Field Office
15
LATIFPA
49
Arrests by Parish
16
Claims Fraud
50
Convictions by Parish
17
Prevention, Education
51
Judicial Actions
18
Producer, Claims Adjuster and Insurance Company Fraud
51
Budget
19
Background Investigations
52
LOUISIANA DEPARTMENT OF INSURANCE
46-54
48
48-49
Partnerships in the Fight Against Insurance Fraud
20-21
Fraud by Category
52
In the News
22-36
Budget
53
37
Tribute
54
Areas of Responsibilities & Phone Numbers
What Can YOU Do In The Fight Against Fraud?
55
6
How To Report
Insurance Fraud
I
nsurance fraud is the willful abuse of an insurance policy for
some kind of financial gain. In most states, including Louisiana, it is considered a felony. When convicted, insurance
fraud carries penalties which can include fines, restitution, community service, parole and jail time. Even if the penalties do not include all of the above, insurance fraud is a felony conviction which
will affect your ability to secure work and your standing in your
community.
1) To report insurance fraud, a person should go to the Louisiana Department of Insurance (LDI) Website at www.ldi.la.gov.
2) On the left, the fourth quick link down, is “Report Insurance Fraud.” Click on that link which is: http://
www.ldi.state.la.us/Legal_Services/Fraud/index.html .
3) This will open the reporting page with two choices: The “General Public Fraud Report Form”, https://
www.ldi.state.la.us/Legal_Services/Fraud/gen_fraud_report/gen_fraud_report.aspx ; and the “Detailed Industry Fraud
Report Form,” https://www.ldi.state.la.us/Legal_Services/Fraud/ind_fraud_report/ind_fraud_report.aspx .
4) Fill out the appropriate form and submit to LDI electronically. Each form allows reporting of more than one person and
allows attachment of electronic documents.
5) Or, the submitter can contact the LDI Fraud Section at (telephone) 225-342-4956 or (facsimile) 225-342-7393.
Information provided by The Louisiana Department of Insurance
http://www.ldi.la.gov
7
8
The Mission of the Insurance Fraud / Auto Theft Unit is to seek justice on behalf of the citizens of the state of Louisiana and
industry stakeholders by the execution of superior, professional, and effective investigations.
(Information in this section collected by Investigative Specialist Michele Aucoin)
9
Message From The Unit Supervisor
The Insurance Fraud / Auto Theft Unit experienced another busy and productive year. This annual report highlights the activities and accomplishments of the Insurance Fraud Task Force for calendar year 2012, and has been prepared
and submitted in accordance with L.R.S. 40:1427.
I would like to thank Colonel Edmonson along with his senior command staff for their leadership and continued
support of our unit, and the Louisiana Insurance Fraud Task Force. Without Colonel Edmonson’s support our personnel
would not be able to operate as effectively as we do each and every day.
What is unique to Louisiana is that three separate government agencies, which have common goals, work together
statutorily as a team. Unfortunately, this is not the case with most states in our union. Along with our partners from the
Lt. Trevor Smith
Department of Insurance, Attorney General’s office, and insurance industry, we continue to aggressively investigate fraud and demand justice for those who
choose to commit crime in our state.
Insurance fraud is not only a state and national problem, but rather a global problem with billions in annual loss to consumers and governments. In
addition to being detrimental to insurance companies, which may lose money paying fraudulent claims, insurance fraud also hurts everyone who buys insurance, because premiums must be higher to compensate for fraud loss.
Fraud can also involve financial loss to our government. For example, when someone profits as a result of committing insurance fraud, and they subsequently file fraudulent tax documents, this loss is burdened by our government and ultimately tax payers. Another example would be when someone purposely sets their home on fire to collect on their homeowner’s policy. In addition to potential fraud loss, this crime requires the fire department and other
agencies to respond resulting in the senseless waste of public resources.
10
Message From The Unit Supervisor (continued)
I’m encouraged by the progress our state has made and the fact that our leaders have chosen to be proactive and aggressive regarding fraud crimes. I
applaud the efforts of our program and feel confident we have one of the most successful fraud task forces in the nation.
Our goal is simple: reduce insurance rates for our citizens through mitigation of claims loss. This will be accomplished through the detection, enforcement, and prosecution of fraud criminals and criminal organizations.
I’m very proud of the competency, dedication and commitment of personnel assigned to the Insurance Fraud / Auto Theft Unit. They consistently uphold the core values of state police, and represent our department in the most professional manner.
Thank you for your assistance and support during 2012. I look forward to another year of growth and progress in our continuing fight against insurance fraud and auto theft in Louisiana.
Respectfully,
Lieutenant Trevor J. Smith, MPA, FCLS
Statewide Unit Supervisor
Louisiana State Police
Insurance Fraud / Auto Theft Unit
11
Three Year Statistical Profile
12
2012 Fraud Referrals By Type
TOTAL REFERRALS
686
Arson
Auto Claims
Auto Theft
Bodily Injury
Catastrophe
Commercial Policy
Disability
Forgery
Fugitive
Healthcare
Insurance Cards/Documents
Life
Other
Producer
Property & Casualty
Worker's Compensation
8
229
83
46
5
12
20
14
3
38
18
4
20
25
159
2
13
2012 Statistical Information by Quarter
Referrals Received
686
Cases Opened
213
Cases Closed
220
Arrests
198
Incidents Closed
369
Potential Fraud Amount
$6,704,876.31
Value of Vehicles Recovered
$989,693.00*
Number of Vehicles Recovered
88*
*Totals are for the Insurance Fraud & Auto Theft Unit only. Louisiana State Police totals (including troops) are 228 vehicles
recovered with a value of $2,362,130.61.
14
2012 Statistical Information by Field Office
15
2012 Arrests by Parish
198 TOTAL ARRESTS
Acadia
Ascension
Avoyelles
Beauregard
Bienville
Bossier
Caddo
Calcasieu
Catahoula
Concordia
East Baton Rouge
Evangeline
Franklin
Grant
Iberia
Jackson
Jefferson
LaSalle
Lafayette
Lafourche
Lincoln
Livingston
6
1
2
1
6
7
14
6
1
1
9
2
2
4
3
1
10
1
20
3
3
1
Morehouse
Natchitoches
Orleans
Ouachita
Pointe Coupee
Rapides
Sabine
St. Charles
St. Helena
St. John
St. Mary
St. Tammany
Tangipahoa
Union
Vermillion
Wasington
Webster
West Baton Rouge
Winn
4
1
18
22
1
11
3
1
2
4
3
6
5
1
3
2
3
3
1
16
2012 Convictions by Parish
129 TOTAL CONVICTIONS
Acadia
Ascension
Avoyelles
Bienville
Bossier
Caddo
Calcasieu
East Carroll
East Baton Rouge
Evangeline
Iberia
Iberville
Lafayette
Lafourche
Lincoln
Livingston
Morehouse
Natchitoches
Orleans
Ouachita
Richland
Sabine
3
1
2
1
6
15
1
1
11
5
3
2
11
1
4
1
1
2
1
17
1
1
St. Bernard
St. Helena
St. James
St. Landry
St. Martin
St. Mary
St. Tammany
Tangipahoa
Union
Vermillion
West Feliciana
Washington
Webster
West Carroll
Federal
2
2
1
5
2
2
6
2
1
1
3
2
7
1
1
17
2012 Judicial Actions
Convictions
129
Pre-Trial Interventions
29
Probation Ordered
196 Years
Fines
$41,970.50
Restitution Ordered
$791,421.38
Prison Time Ordered
135 Years & 6 Months
Community Service
535 Hours
18
2012 Budget Expenditures
OBJ
2100
2110
OBJECT NAME
21 SALARIES-CLASS - REGULAR
SALARIES-CLASS - OVERTIME
TOTAL SALARIES
2300 40 RETIRE CONTRIB - STATE EMPLOYE
2340
RETIREMENT CONTRIB - OTHER
2360
2380
2410
MEDICARE TAX
GROUP INSURANCE CONTRIBUTIONS
TAXABLE FRINGE BENEFITS
TOTAL RELATED BENEFITS
2500 45 IN-STATE TRAVEL - ADMIN
2510
IN-ST TRAVEL - CONF,CONV,ATHL
2600
2610
OUT-OF-STATE TRAVEL - ADMIN
OUT-OF-ST TRA - CONV,CONF,ATHL
TOTAL TRAVEL & TRAINING
2710 50 PRINTING
2780
MAINT-PROPERTY & EQUIP-OTHER
2791
MAINT-PEST CONTROL
2800
2810
2830
MAINTENANCE OF EQUIPMENT
MAINTENANCE-JANITORIAL/CUSTOD
MAINT OF DATA PROCESS EQUSOFT
RENTALS - BUILDINGS
2840
2890
RENTALS - EQUIPMENT
DUES AND SUBSCRIPTION
2900
2930
MAIL, DELIVERY & POSTAGE
OTHER COMMUNICATION SERVICES
2991
3000
OP SVRS-SECURITY
OT OPERATING SERVICES - MISC
2825
TOTAL OPERATING SERVICES
3100 55 OFFICE SUPPLIES
3120
OPERATING SUPPLIES - COMPUTER
3130
OPR SUPPL'S - CLOTHING & UNIFO
3160
3180
OPERATING SUPPLIES - FOOD
OPERATING SUPPLIES - OTHER
3190
OPR SUPP'S-
2234
2234
2234
INSURANCE FRAUD
UNIT
INSURANCE FRAUD
UNIT
INSURANCE FRAUD
UNIT
2012
811,678.18
81,917.69
2013
817,921.95
71,114.64
TOTAL
1,629,600.13
153,032.33
893,595.87
30,423.01
392,452.51
889,036.59
35,342.90
485,421.39
1,782,632.46
65,765.91
877,873.90
12,399.73
12,401.36
24,801.09
102,455.58
95,715.08
198,170.66
16,021.90
16,064.30
32,086.20
553,752.73
9,171.17
1,916.00
644,945.03
806.80
6,035.00
1,198,697.76
9,977.97
7,951.00
2,846.00
10,962.32
548.40
2,846.00
11,510.72
24,895.49
600.06
7,390.20
32,285.69
600.06
3,612.23
253.48
180.00
3,865.71
180.00
858.00
7,025.36
6,282.94
858.00
13,308.30
1,125.00
1,950.00
3,075.00
88,218.10
116,550.58
204,768.68
4,578.69
120.00
1,863.31
6,442.00
120.00
45.00
14,256.86
45.00
33,711.74
480.00
4,800.00
480.00
4,800.00
125,592.32
10,754.41
146,662.17
10,189.56
272,254.49
20,943.97
1,729.72
802.12
1,501.27
176.13
3,230.99
978.25
202.68
2,348.40
149.31
2,947.40
351.99
5,295.80
37.43
37.43
19,454.88
Budget Continued..
TOTAL SUPPLIES
3650 65 MISCELLANEOUS CHARGES
15,837.33
4,835.41
15,001.10
209.66
30,838.43
5,045.07
OTHER CHARGES-OPER SERVICES
OTHER CHARGES-SUPPLIES
OT CHRG-ACQUISITION/MAJOR
REPA
OTHER CHARGES
70 ACQUISITIONS - EQUIPMENT
ACQN-CAPITALIZED EQUIPMENT
12,384.65
3,980.80
29,125.43
16,365.45
29,125.43
1,123.93
20,170.20
21,294.13
18,343.99
9,259.16
46,138.96
53,486.09
71,830.08
9,259.16
46,138.96
TOTAL CAPITAL OUTLAY
5040 85 IAT - TELEPHONE AND TELEGRAPH
5100
IAT - MISCELLANEOUS
55,398.12
4,427.99
3720
3730
3750
TOTAL
4440
4442
TOTAL IAT
TOTAL
INSURANCE FRAUD UNIT
4,427.99
1,691,843.84
3,155.66
10,000.00
55,398.12
7,583.65
10,000.00
13,155.66
1,769,676.84
17,583.65
3,461,520.68
NOTE: All receipts are maintained in accordance with state law and state police policy, and are available upon public records request.
19
Partnerships in the Fight Against Insurance Fraud
by Sgt. David Stelly, Lafayette
“It Takes a Village to Raise a Child” is the translation of an old Nigerian proverb. Historically, scholars have argued about the meaning of the proverb. Some consider it
strong scrutiny of the family unit, challenging that parents alone could not possibly
meet the physical and emotional needs of a growing child. Others dispute that meaning,
believing that the child is a product of its environment, with its growth based not only
on the actions of the parents but on the influences provided by its environment—in particular, people. The rationale being the better the environment, the better the child. No
matter how you interpret the proverb, all can agree to a few drawn conclusions: Two
heads are better than one, and that individuals bring unique sets of skills to a group,
unique sets of values, and unique experiences to be passed on. This is the basic premise
and goal of partnerships.
For years, law enforcement agencies have believed in and relied on partnerships. State
Police is no different. The goal of the State Police Bureau of Investigation has been
crime interruption and suppression. Historically, State Police has supported its efforts
by signing task force agreements with other state, local, and federal enforcement agencies whose goals and missions were similar to ours. Those agreements have been vital
to the success and growth of the Department and its reputation as a premier law enforcement agency. Of recent years, State Police expanded its partnerships to include
non-law enforcement entities. Some of the partnerships are etched in formal agreements such as the State of Louisiana Insurance Fraud Task Force, comprised of agency
personnel from Louisiana State Police, the Louisiana Department of Insurance, and the
Louisiana State Attorney General’s Office. This formal partnership collected assets
from three state agencies whose missions of crime suppression and interruption within
the insurance industry comingled. In contrast, State Police has formed other less formal
partnerships with entities having differing goals, but possessed unique skill sets needed
to accomplish State Police’s mission. Colonel Mike Edmonson, knowing the power of
teamwork, tirelessly preaches the importance of creating and maintaining partnerships.
One such partnership or workgroup was formed in the spring of 2011 to address a criminal complaint. In January of 2011, Louisiana State Police Insurance Fraud Unit received a complaint of insurance fraud through the criminal referral process at the Louisiana Department of Insurance. A concerned citizen making the complaint agreed to
meet with troopers at the State Police Office in Lafayette, Louisiana. The concerned
citizen told Troopers of a medical practitioner and his administrative staff, working in
concert at a local clinic, committing healthcare insurance fraud. In detail, it was alleged
that the physician and his staff were billing for services not rendered and billing for
more expensive services than those provided. The concerned citizen informed troopers
that this illicit activity involved numerous, unsuspecting patients and occurred over a
two year period. The concerned citizen identified the clinic as the Acadiana Doctor’s of
Chiropractic in Lafayette, Louisiana, and the medical provider as Dr. Michael Johnsey.
Lafayette Insurance Fraud Unit Troopers knew this illicit group’s activities needed to be
interrupted and dismantled, not only to stop them, but hopefully suppress other groups
from similar fraudulent activity. To accomplish this task, Troopers would need partners
who possessed specialized skill sets to build a workgroup capable of understanding
medical billing codes, billing practices, medical records, and the application of Federal
statutes dealing with allegations of healthcare fraud.
Troopers reached out to the FBI Lafayette Field Office. The office offered experience
in the investigation of doctors and other medical providers committing healthcare fraud
and the application of Federal statutes which address healthcare fraud.
20
Partnerships in the Fight Against Insurance Fraud continued
by Sgt. David Stelly, Lafayette
BlueCross/BlueShield was their next contact. Troopers determined through a review of
the complaint that BlueCross/BlueShield (BCBS) suffered a vast majority of the fraud
exposure from the clinic. Therefore, we knew BCBS could fill the role of a subject
matter expert (SME) during a detailed review of their own billing records as part of the
investigative process. We also knew from previous investigative endeavors with
BCBS, that they could provide analytical support of billing practices and tendencies
based on computer forensics performed on their billing databases. In reaching out to
BCBS, Troopers learned that a similar complaint concerning Dr. Johnsey had been forwarded to them as well. With the workgroup established, the investigation could proceed.
and were able to detect illicit billing patterns in the Johnsey patient’s files. Johnsey’s
schemes involved charging insurance companies for patient first time visits when it was
a returning patient, and for charging insurance companies for units of massage therapy
not provided. The workgroup identified approximately 798 incidents of up coding and
charging for services not provided committed by Johnsey. The workgroup findings
were corroborated by the interviews of over 35 former patients and witnesses. In all, in
excess of $176,243.49 in overpayments for fraudulently billed services was identified.
On October 18, 2012, Johnsey pled guilty to a Federal Bill of Information charging him
with three counts of Healthcare Fraud in violation of 18USC1347. He was ordered to
pay $176,243.49 in restitution back to BlueCross/BlueShield. His sentencing is schedHaving received their own complaint, BCBS conducted an on-site inspection of medical uled for spring 2013.
records belonging to BCBS insured at the Acadiana Doctors of Chiropractic Clinic. At
This investigation is just one example of the success that can be experienced and enTrooper’s investigative request, the findings of the inspection were provided to officers.
joyed through the building of partnerships. Our State Police Insurance Fraud Unit enAccording to the BCBS report, medical records at the clinic were not in order, and were joys the productivity we do because of the strong partnerships established with the Loulacking proper documentation of services provided, and in some cases no documentaisiana Department of Insurance, The Louisiana State Attorney General’s Office, and
tion was present. Based on information provided by the concerned citizen and an exam- investigators employed privately within the Insurance Industry. But our partnerships
ination of records provided to Troopers by BCBS, Troopers with the assistance of the
don’t stop with fellow law enforcement/regulatory agencies; we are constantly seeking
FBI served a search warrant at the clinic. Troopers seized hundreds of medical recout partnerships which provide us access to skills we do not currently possess. These
ords. Computer data records, computer programs, and computer hardware were seized partnerships enable us to grow, gain personal experience and knowledge, and provide
as well. FBI Agents and LSP Troopers interviewed medical and administrative staff
us with the needed support to suppress, interrupt, and dismantle groups committing inpersonnel. A clearer picture of alleged illicit activities was revealed to the officers.
surance fraud. These partnerships are our strength and future.
FBI and Troopers solicited the aid of BCBS subject matter experts to compare and contrast the clinic’s medical records against billings submitted on behalf of the patients by
Johnsey. Experienced BCBS subject matter experts, Troopers, and agents collaborated
21
In the News
Louisiana State Police jail suspected insurance fraud ring
www.magnoliareporter.com
1/25/2012
LSP Investigations result in Arrests across Southeast
Louisiana
www.youpostthenewsmedia.com
1/27/2012
Four arrests have been made, with more pending, in a Ouachita Parish, Louisiana staged
crash ring.
LSP Investigations result in Arrests across Southeast Louisiana
Detectives with the Louisiana State Police Insurance Fraud Unit investigated a staged
Troopers assigned to the Louisiana State Police Bureau of Investigations brought severcrash ring in Ouachita Parish that was suspected in more than 20 staged crashes. The
al separate criminal cases to conclusion this past week resulting in arrests across numerLSP investigation focused on six of these crashes where individuals were staging crash- ous parishes.
es and then making false bodily injury claims.
The payments made by insurance companies in two of the six crashes resulted in more
than $18,000 paid to these individuals. Payments were denied by the other insurance
companies due to misrepresentation and non-cooperation.
Seven warrants were signed on Monday and three people were arrested Tuesday. They
were:
Keshanta Reed, 26, insurance fraud, two counts
Constance Jenkins, 33, insurance fraud
Ladeiszem McGraw, 31, insurance fraud, four counts
On Wednesday, detectives arrested Quanisha Marshall, 26, for insurance fraud. Three
additional arrests are expected and pending in the investigation.
The Insurance Fraud Unit is responsible for investigating referrals of suspected fraudulent insurance acts; assisting federal and local law enforcement in the investigation of
fraudulent insurance acts; cooperating with local prosecutors and the attorney general's
office in the prosecution of fraudulent insurance acts; and promoting awareness of insurance fraud throughout the state.
On January 25th, 2012, LSP detectives arrested Qasim Raouf (O/M age 23) following
an investigation into access device fraud. During the course of the investigation, detectives discovered that Raouf had defrauded a Whitney bank customer of approximately
$2000 and had 8 active warrants for separate instances of access device fraud and traffic
violations in both Jefferson and Orleans Parishes.
On January 26, 2012, State Police Investigators assigned to the Criminal Investigative
Division Baton Rouge Field Office arrested Joseph Fitzgerald (W/M age 60) for failure
to register as a sex offender in Iberville Parish. During the investigation, it was discovered that Fitzgerald was living in Plaquemine and had failed to register when he moved
there. Fitzgerald had been convicted of 1st Degree Rape in Alabama in 1993. This
charge is the equivalent of Forcible Rape in Louisiana, which requires a lifetime registration. He was required by Louisiana law to register with the Iberville Parish Sheriff's
Office, which he never did. State Police Investigators, with the assistance of the United
State Marshals Service, located Fitzgerald at his place of employment in Sunshine, LA
and placed him under arrest. He was then booked into the Iberville Parish Jail.
22
In the News
Following an investigation into a complaint made by Progressive Insurance Company,
Troopers arrested William White Jr (B/M age 27) of Hammond, LA, on one count of
Insurance Fraud. The investigation revealed that in June of 2010, White filed a property
damage claim on his vehicle with Progressive Insurance following an alleged hit and
run crash that occurred in a retail store parking lot. The claim was denied due to a lapse
in coverage; however, prior to denial, Progressive assigned an adjuster to inspect and
photograph the vehicle damage.
In October of 2010, White initiated a new policy with Progressive and shortly thereafter
reported being the victim of another hit and run crash filing a property damage claim on
the same vehicle. The damaged area on the vehicle was the same for both claims and
photographs from the initial claim showed the damage to be identical. The investigation
concluded White attempted to defraud Progressive by misrepresenting the facts of the
loss. On January 26th, 2012, White turned himself in to LSP detectives and was booked
into the Tangipahoa Parish Jail.
Luling woman charged with doctor shopping at 16 medical
centers
www.heraldguide.com
2/10/2012
A 30-year-old Luling woman has been arrested after police say she visited 16 different
medical offices and received the same prescription from multiple doctors.
Antoinette McGovern was booked with three counts of fraudulently obtaining a controlled dangerous substance.
Anyone wishing to report criminal or suspicious activity to the Louisiana State Police
Bureau of Investigations is urged to contact detectives at (225) 925-3682. There is also
an online reporting system available at www.lsp.org. Click on the Suspicious Activity
link to access the form.
Hammond man arrested on insurance fraud
by rguillot www.nbc33tv.com
02/20/2012
State Police Detectives assigned to the Insurance Fraud Unit arrested Richard Beshears,
43, of Hammond on a charge of insurance fraud on February 17.
The arrest was the result of an investigation into a complaint made by the Permanent
General Assurance Corporation. Troopers’ investigation revealed that Beshears had
falsified information regarding a parking lot crash that occurred in June 2011.
Beshears struck a parked vehicle in the CVS Pharmacy parking lot in Hammond and
left a note on the vehicle with his name and number. He then left the scene and obtained
an insurance policy from Permanent General Assurance Corporation.
When he was later contacted by Hammond Police Department regarding the crash, he
provided insurance information to the officer investigating the crash. Beshears misrepresented the time of the crash in an effort to show that he had insurance coverage before
the crash occurred.
After working with the Hammond Police Department, Permanent General Assurance
Corporation, and the other party involved in the crash, Troopers obtained a warrant for
Beshears’ arrest and booked him into the Tangipahoa Parish Prison.
According to a Louisiana State Police investigation into alleged "Doctor Shopping,"
McGovern visited 16 different medical offices between July of 2008 and April of 2011.
She was booked into the Jefferson Parish Jail without incident.
23
In the News
Hammond man arrested for filing fake police report,
insurance fraud
by smorgan at www.nbc33tv.com
02/20/2012
A man attempting to file an insurance claim for a fake theft landed himself behind bars
over the weekend.
State Police Detectives were assigned to check out an insurance claim that seemed suspicious. Tim Wells Jr., 25, of Hammond claimed that his father’s home had been burglarized and that several power tools had been stolen back in October 2011.
scription pain medication and crack cocaine.
Narcotics agents discovered multiple dosage units of Clonazepam, Diazepam, Xanex,
Lortab, Oxycodone, and Hydrocodone in addition to 2 grams of crack cocaine and two
shotguns in his business. McNabb was booked into the St. Helena Parish Jail charged
with the Distribution of a Schedule III controlled dangerous substance, Possession with
Intent to Distribute a Schedule II CDS, Possession with Intent to Distribute a Schedule
III CDS, Possession of a Firearm by a Convicted Felon, and Possession of a Firearm
while in Possession of a CDS. .
On March 5th, 2012, LSP Detectives arrested 36 year old Lucian Meyers of Bogalusa
following an investigation into a complaint received from the Office of Motor Vehicles.
Wells also filed a report to the Hammond Police Department to support the claim.
The investigation revealed that the theft had never actually occurred. The claim made to
The investigation revealed that Meyers used her sister's name, social security number,
Allstate Insurance Company was false.
and date of birth to obtain a driver's license and identification card at the Bogalusa Motor Vehicle Office. Meyers was booked into the Washington Parish Jail on 2 counts
Troopers arrested Wells and booked him in the Tangipahoa Parish Prison.
each of Filing False Public Records and Forgery.
STATE POLICE MAKE 8 ARRESTS IN 7 DAYS
Following an investigation into a complaint received from State Farm Insurance, Troopers assigned to the LSP Insurance Fraud Unit arrested 44 year old Charles Gary Jr. of
New Orleans. The complaint originated from a medical claim submitted to State Farm
by Gary in 2008. Police say Gary was paid $3,139 by State Farm after submitting a
The Louisiana State Police Bureau of Investigations brought numerous criminal cases to medical bill from West Jefferson Medical Center for medical treatments following a
a close this past week after nine people were arrested across several parishes.
vehicle crash. Trooper's investigation revealed that medical documents submitted to
State Farm were altered and that Gary was never treated at WJMC. On March 5th,
On March 2nd, 2012, investigators arrested 62 year old Jerome McNabb of Pine Grove
2012, Gary surrendered to investigators at the Orleans Parish Jail and was booked on
following a joint investigation between LSP Narcotics Detectives and the St. Helena
one count each of Insurance Fraud and Theft.
Parish Sheriff's Office.
www.wbrz.com
3/12/2012
The investigation revealed that McNabb used his business, The Snack Zone, to sell pre24
In the News
Also on March 5th, Troopers arrested David Benders, age 37 of Shelbyville, KY, on
charges of Insurance Fraud after receiving a complaint from the Scottsdale Insurance
Company. The investigation revealed that Benders submitted an altered plumbing repair
receipt to Scottsdale in the amount of $14,940 after claiming subsurface plumbing damage to his rental property in Gretna. Benders fraudulently inflated the original cost of
the repairs by $9,440 and altered the receipt before submitting it for reimbursement.
Benders turned himself in to Troopers and was booked into the Jefferson Parish Jail
without incident.
counts of Obtaining a CDS by Fraud (Doctor Shopping). The investigation revealed that
Mangrum fraudulently obtained prescriptions from multiple physicians and filled the
prescriptions at several pharmacies in the Washington Parish area. Mangrum was
booked without incident into the Washington Parish Jail.
Finally, on March 9th, Troopers assigned to the Gaming Enforcement Division based
out of Harrah's Casino arrested 36 year old Joseph Lewis of New Orleans, LA following the discovery of two female juveniles outside of the Harrah's Canal Street entrance.
Further investigation revealed that Lewis abandoned his 8 and 6 year old daughters outside of the entrance at 6:45 pm while he gambled in the casino. The two young girls
On March 6th, Troopers arrested Tyra Cyprian, age 33 of Hammond, following an inwere left alone for approximately 30 minutes before being discovered by casino securivestigation into alleged identity theft. Troopers discovered that Cyprian used a fraudu- ty officers. Troopers were successfully able to make contact with the mother of the two
lent name and social security number to open residential accounts at AT&T and Entergy juveniles who arrived at the casino to take custody of her daughters. Lewis was booked
leaving an unpaid balance of $3,200. Cyprian was booked into the Tangipahoa Parish
into the Orleans Parish Jail on two counts each of Child Desertion and Contributing to
Jail without incident.
the Delinquency of Minors as well as an outstanding arrest warrant from the Jefferson
Parish Sheriff's Office.
On March 7th, LSP Detectives arrested 32 year old Ameshia Cheatham of New Orleans, on charges of Insurance Fraud following a complaint received from State Farm
Troopers make several arrests around the state
by smorgan at www.nbc33tv.com
Insurance. Troopers' investigation revealed that Cheatham provided State Farm with
3/19/2012
altered medical bills from injuries sustained in a vehicle crash. Cheatham was booked
into the Orleans Parish Jail.
The Louisiana State Police Bureau of Investigations concluded several separate criminal investigations this past week resulting in arrests across several parishes.
During the course of ongoing narcotics investigations in the Washington Parish area,
Troopers identified and arrested Wesley Magee, age 31 of Bogalusa, LA, on charges of On March 13, 2012, LSP Detectives working in conjunction with the St. Charles and St.
Bernard Parish Sheriff’s Offices arrested Walter Maiden, 23, after conducting a search
Distribution of a Schedule II CDS and Violation of a Drug Free Zone. Magee was arof his Chalmette residence.
rested without incident and booked into the Washington Parish Jail. At the time of his
arrest, Magee was currently on parole for a previous narcotics conviction.
The search warrant stemmed from an online child pornography investigation which led
investigators to an address in St. Bernard Parish.
On March 7th, a joint investigation between LSP Narcotics Detectives and the Bogalusa
Police Department led to the arrest of 56 year old Gregory Mangrum of Bogalusa, on 11
25
In the News
During the search of Maiden’s computer, detectives discovered 113 files indicative of
child pornography. Maiden was booked accordingly into the St. Bernard Parish Jail.
Following an investigation into a complaint received from the Viven Insurance Agency,
troopers have arrested Jackie Hills, 52, of Knollwood, TN, on charges of Forgery and
Filling False Public Records.
Bell was booked without incident into the Tangipahoa Parish Jail.
TWO ARRESTED IN OUACHITA FOR INSURANCE
FRAUD
by Colby Howell at www.kpel965.com
3/16/2012
The investigation concluded that Hills, the owner of a Slidell based home health service
(Gracious Care Inc.), submitted a fraudulent certificate of insurance to the Department Stephen Sanderson and Sherry Williams were arrested last Friday in Ouachita for allegedly defrauding Louisiana Farm Bureau Insurance. They were brought in on 24 counts
of Health and Hospitals in order to conduct business with the state.
of insurance fraud.
On March 15, 2012, Hills turned herself in to investigators and was booked into the St.
Investigators with the State Police Insurance Fraud Unit have been investigating them
Tammany Parish Jail.
for some time after Louisiana Farm Bureau Insurance discovered more than 80 claims
Agents from the State Attorney General’s Medicaid Fraud Control Unit are continuing submitted to them between 2006 and 2010.
the investigation into Hill to determine if she unlawfully obtained Medicaid funds
Sanderson and Williams operated a windshield repair and replacement business.
through her business.
On March 16, 2012, troopers assigned to the LSP Insurance Fraud Unit arrested Frederick Bell, 36, of Kentwood, on charges of Insurance Fraud and Felony Theft. The arrest
stemmed from a complaint received by the Farmers Insurance Group.
Lake Charles woman arrested for insurance fraud
In April of 2011, Bell filed a burglary report with the Tangipahoa Parish Sheriff’s Office claiming three television sets and a laptop computer were stolen from his Kentwood residence. After filing the report, Bell submitted a loss claim to Farmers Insurance Group and was paid $2,014 for the items.
The following is a Press Release from the Louisiana State Police:
Further investigation revealed that Bell purchased the items from a Wal-Mart in Hammond and several days later returned the items to another Wal-Mart location in Amite,
LA. Bell used the original purchase receipts to fraudulently support his loss and receive
the claim from Farmers Insurance.
In April 2010, a vehicle registered to Fontenot was involved in a crash in a private parking lot in Westlake, LA.
www.kplctv.com
3/23/2012
On March 23, 2012, detectives assigned to the Louisiana State Police Bureau of Investigations arrested 26-year-old Natalie Fontenot of Lake Charles for insurance fraud.
26
In the News
Tammany Parish.
Fontenot claimed that she was the driver and that her
juvenile son was with her at the time of the crash.
On April 10th, 2012, LSP Investigators arrested 47 year old Linda Williams of New
Orleans, LA following an investigation into alleged insurance fraud. The investigation
stemmed from a complaint from State Farm Insurance Company alleging that Williams
submitted fraudulent medical bills from injuries sustained in a motor vehicle crash in
2008. Troopers’ investigation revealed that nearly nine months after the original crash,
Williams submitted medical bills to State Farm totaling over $6000 from medical services provided by Modern Healthcare. Upon further investigation, Troopers discovered
that Modern Healthcare was a fictitious business created by Williams to fraudulently
support her claim. Williams was booked without incident into the Orleans Parish Jail.
Through investigation, troopers determined neither
Fontenot nor her son were present at the time of the
crash. During an interview, Fontenot admitted to not
being in the vehicle at the time of the crash.
Fontenot was charged with insurance fraud and
booked into the Calcasieu Parish Correctional Center. If convicted, Fontenot faces up to 5 years in prison and a $5,000 fine.
On April 11th, 2012, a joint investigation between Louisiana State Police Detectives
and the Office of Inspector General for the Social Security Administration resulted in
the arrest of 44 year old Nanette Broadus of Covington, LA. The investigation concludThe Louisiana State Police Insurance Fraud Unit is responsible for investigating refered that Broadus fraudulently filed for and collected Social Security Disability Benefits
rals of suspected fraudulent insurance acts; assisting federal and local law enforcement for her step son despite never having custody of the child. Detectives discovered that
in the investigation of fraudulent insurance acts; cooperating with local prosecutors and Broadus’ step son was in fact solely under the care and support of his biological mother
the attorney general's office in the prosecution of fraudulent insurance acts; and promot- and never received the benefits collected under his name. Over a four year period,
ing awareness of insurance fraud throughout the state.
Broadus submitted fraudulent reports to the Social Security Administration documenting the care and support of her disabled stepson while collecting almost $50,000 in benState Police arrest Covington woman on alleged disability efits. Broadus surrendered to Troopers and was booked accordingly into the St. Tammany Parish Jail.
Photo from www.kplctv.com
fraud
www.actionnews17.com
4/16/2012
Report alleges woman collected disability checks for stepson not in her custody
From Louisiana State Police:
The Louisiana State Police Bureau of Investigations brought two separate criminal
fraud investigations to conclusion this past week resulting in arrests in Orleans and St.
27
In the News
Bogalusa man among two arrested for fraud | Charges of
insurance fraud and forgery
www.gobogalusa.com
5/30/2012
The Louisiana State Police Bureau of Investigations brought two separate criminal cases to conclusion last week resulting in two arrests in the Troop L area, one in Washington Parish.
Following an investigation into a complaint received from Progressive Insurance Company, Troopers arrested Michael Loper, 34, of Bogalusa, on charges of Insurance Fraud
and Forgery.
According to the State Police, that investigation revealed that in November of 2011,
Loper filed a bodily injury claim with Progressive following a minor vehicle crash.
Loper additionally claimed that he was a physician and his injuries resulted in the loss
of wages and income. To support the claim for lost wages, he submitted invoices totaling over $8,000 and emails between himself and another physician arranging for the
care of Loper’s alleged patients.
ly designated payee for a disabled relative receiving federal disability benefits, and that
he received over $12,000 in disability benefit funds for the care and support of his relative, but fraudulently converted the funds to his own use.
Investigators located Bourg at the Social Security Administration field office in
Lacombe and placed him into custody without incident. He was booked into the St.
Tammany Parish Jail.
New Orleans car thief arrested
by rguillot at www.nbc33tv.com
6/12/2012
On June 6, 2012, troopers assigned to the Louisiana State Police Bureau of Investigations Auto Theft and Insurance Fraud Unit received a LoJack alert on a stolen 2009
Toyota Camry in the area of 3300 block of Baudin Street, New Orleans. One person,
later identified as Robert Lavigne, 18, of New Orleans, was seen using a key to gain
entry into the vehicle.
Lavigne was arrested for Possession of Stolen Property and Possession of a Firearm by
a Convicted Felon. He was booked into the Orleans Parish Correctional Center.
Troopers’ investigation revealed that Loper was not a physician and had fraudulently
submitted altered documents and emails in an attempt to defraud Progressive Insurance.
Lo Jack is a stolen vehicle recovery system that consists of a small radio frequency
Despite portraying himself as a physician to his friends and family, Loper never postransceiver hidden in the vehicle. The transceiver has a unique code specifically tied to
sessed a license to practice medicine nor ever worked in a medical facility.
that vehicle’s VIN number. When LoJack is activated, the transceiver sends out an inauLoper surrendered himself to investigators and was booked accordingly into the Wash- dible signal that is automatically traced in LoJack equipped police units.
ington Parish Jail.
In a separate investigation, troopers working in conjunction with the Office of the Inspector General for the Social Security Administration issued an arrest warrant for
Keith Bourg, 43, of Slidell, on charges of Theft of the Assets of a Disabled Person.
According to the State Police, that joint investigation revealed that Bourg was the legal28
In the News
State Police make several arrests over southeast Louisiana
by smorgan at www.nbc33tv.com
6/15/2012
Troopers’ investigation revealed that Murphy filed a disability claim with Colonial and
claimed her injuries prevented her from working as an insurance agent. She filed for the
loss of wages between the periods of November 2010 thru June 2011. She claimed she
worked at a funeral home in Hammond and was an employee for a life insurance company. In support of these statements she provided Colonial with letters from these businesses explaining that she was unable to work.
Detectives assigned to various LSP offices throughout southeast Louisiana have
brought several cases to closure over the past week. Several arrests have been made as a
result of these investigations. The following are recaps of those investigations and sub- Further investigation revealed that the letters were not authentic and were misrepresentations. The letter from the funeral home was fabricated and the manger’s signature had
sequent arrests.
been forged.
On June 12, detectives assigned to the Baton Rouge Insurance Fraud/Auto Theft Unit
arrested Wilbert Lewis, 49, of Baker on a charge of insurance fraud. The arrest was the Troopers obtained a warrant from the 21st Judicial District Court for Murphy’s arrest
result of an investigation into a complaint made by CIGNA Group Insurance (CIGNA). and subsequently booked her into the Tangipahoa Parish prison.
The investigation revealed that in August 2008, Lewis filed a long term disability claim On June 13, detectives assigned to the Criminal Investigations Division, Hammond
Field Office arrested Terrance Wilson, 30, of New Orleans and booked him into the
with CIGNA on a group policy held by his employer. He claimed he was unable to
work due to nerve damage in both feet and began receiving benefits in February 2009. Orleans Parish Central Lockup on charges of possession of a firearm by a felon, possession of firearms with controlled dangerous Substances (CDS), possession with intent to
distribute Heroin, and possession of a stolen firearm.
During the months following his initial claim, he was required to periodically submit
documentation stating he had not worked and could not work due to his injuries. Due to
his answers, the benefits continued and, over the course of 22 months, he received over The arrest was the result of a joint investigation with Washington Parish Sheriff’s Office, the Franklinton Police Department, and the St. Charles Parish Sheriff’s Office that
$7,000. Further investigation revealed that Lewis was working without any apparent
was initiated following several residential burglaries which occurred in Washington
physical hindrances, in contradiction to assertions he made in support of his claim.
Parish. The joint investigation led to detectives obtaining a search warrant for a residence at 6230 Vermillion Street in New Orleans.
Troopers obtained a warrant for Lewis’ arrest and booked him into the East Baton
Rouge Parish prison on the felony charge of insurance fraud.
During the execution of the warrant, Wilson was in the home and broke out an upstairs
On June 13, detectives assigned to the Hammond Insurance Fraud/Auto Theft Unit ar- window, throwing a loaded pistol into the front yard. After Wilson was taken into cusrested Cindy D. Murphy, 51, of Tickfaw, LA on charges of insurance fraud and forgery. tody, two other revolvers were located in his bedroom, one of which came from the
The arrest was the result of an investigation into a complaint made by the Colonial Life Washington Parish burglary.
and Accident Insurance Company.
29
In the News
A further search of the house also discovered 1 ounce of heroin and packaging materials. A criminal records check revealed Wilson was on parole for a cocaine conviction.
On June 13, detectives assigned to the Criminal Investigations Division, Lafayette Field
Office arrested Verne A. Lightfoot, 34, on charges of theft, forgery, and malfeasance in
office. Troopers investigated allegations of fraud involving forgery and theft of the Juvenile City Court of Morgan City’s funds. Lightfoot, as the Juvenile Service Administrator, was writing checks from Juvenile Services to individuals and cashing those
checks for herself.
mined that A-1 allowed Sinclair to accumulate the premium debt and this was a civil
agreement by both parties. However, the investigation did find evidence that Sinclair
failed to return documents regarding bail transactions and threatened to destroy the documents unless his demands were met. The bail documents were material to A-1’s operations.
Based on the Investigations findings, a search warrant was obtained for Sinclair’s residence and was executed without incident. Investigators recovered several boxes of documents relating to the bail transactions. Detectives obtained an arrest warrant from the
Investigation also revealed that Lightfoot was using company checks to make purchases 19th Judicial District Court and took Sinclair into the East Baton Rouge Parish Prison.
from various places and then returning the items and keeping the refunds. The theft of
funds totaled nearly $35,000 over the period of one year.
On June 15, detectives assigned to the Criminal Investigations Division, Hammond
Field Office arrested Edward Couret, 57, of Covington and booked him into the St.
On June 13, detectives assigned to the Criminal Investigations Division, Baton Rouge
Tammany Parish Jail, charging him with felony theft. The arrest came after an investiField Office arrested Brandon Mayers, 29, of St. Amant, charging him with pornogragation into a complaint that Couret, a St. Tammany Parish Contractor, had been receivphy involving juveniles. The arrest followed an investigation that led detectives to obing payments for jobs and not doing the work agreed upon.
tain a search warrant for Mayers’ residence in St. Amant. With the assistance of the
Troopers’ investigation revealed that Couret received at least $42,000 in September
Ascension Parish Sheriff’s Office, detectives executed the search warrant and located
2011 for a job, and that no materials were ever ordered. Troopers obtained a warrant
several images indicative of child pornography on a computer belonging to Mayers.
from the 22nd Judicial District Court for Couret’s arrest and booked him into the St.
Tammany Parish Jail without incident.
He was booked into the Ascension Parish Prison in Donaldsonville.
The Criminal Investigations Division (CID) within the LSP Bureau of Investigations
has offices throughout the state and is responsible for the investigation of criminal acOn June 14, detectives assigned to the Insurance Fraud / Auto Theft Unit in Baton
Rouge arrested Jeremy Sinclair, 33, of Pride for the theft of business records. The arrest tivity and for intelligence gathering in the State of Louisiana. The division consists of
was the result of an investigation into a complaint made by a bail bond business called two investigative regions (Region 1 & Region 2) and a statewide Investigative Support
Section (ISS). Each investigative region has field offices comprised of Detectives, NarA-1 Unlimited, Inc. Sinclair is a licensed bail bond producer and recovery agent who
cotics, Special Crimes, and/or Insurance Fraud-Auto Theft Squads. ISS consists of the
works in the Baton Rouge metropolitan area.
Criminal Intelligence Unit, Analytical Support Unit, and Technical Support Unit and
The complaint alleged Sinclair failed to remit over $100,000.00 in premium money on also has field offices located throughout the state. While uniform patrol is considered
the “backbone” of the agency, Troopers and investigators assigned to CID perform a
bail bonds he issued and of intentionally keeping and failing to return business documents and bail powers that were needed to reconstruct bail transactions in order to com- valuable service to the citizens of Louisiana and work in partnership with officers from
plete bond forfeitures. Troopers initiated an investigation into the allegations, and deter- local, state, and federal agencies throughout the state.
30
In the News
Gambino couple arrested in Folsom for loss of car found
torched
www.tangilena.com
7/27/2012Tangilena.Com
The investigation concluded that the Gambinos intentionally misrepresented their
whereabouts prior to the theft and filed a fraudulent claim through their St. Tammany
State Farm Insurance office. Upon the issuance of arrest warrants for Frank and Madeline Gambino, the couple turned themselves in to authorities and were booked accordingly into the St. Tammany Parish Jail.
On July 24, LSP Insurance Fraud Investigators arrested 41 year old Frank Gambino, 41,
On July 25, Troopers arrested Marrero resident Danielle Walker, 28, following an inand his wife, Madeline Gambino, 35, both of Folsom, on charges of Insurance Fraud.
vestigation into a complaint received from State Farm Insurance Company.
Troopers assigned to the Louisiana State Police Insurance Fraud Unit brought two othert separate criminal cases to conclusion the week of July 23 resulting in several arrests. The complaint alleged that Walker submitted a fraudulent lost wages claim following
injuries received from a motor vehicle crash.
Wendy Gregorio, 40, of Franklinton, LA following an investigation into alleged fraud.
Troopers’ investigation revealed that Walker intentionally committed the crime of Insurance Fraud and Forgery by fraudulently submitting an altered pay stub in order to
Marrero resident Danielle Walker, 28, following an investigation into a complaint resupport her lost wages claim in the amount of $3,080.
ceived from State Farm Insurance Company.
The Insurance Fraud Unit is responsible for investigating referrals of suspected fraudulent insurance acts and promoting awareness of insurance fraud throughout the state.
Walker was placed under arrest without incident and booked into the Jefferson Parish
Correctional Center on the above charges in addition to several additional outstanding
warrants.
The Gambino arrests in Folsom followed an investigation into a complaint received by
the State Farm Insurance Company. Troopers’ investigation revealed that in July 2011,
the Gambinos submitted a theft loss claim for their 2009 Ford Flex after alleging that
the vehicle had been stolen from the French Quarter in New Orleans.
On July 27, LSP Investigators arrested Wendy Gregorio, 40, of Franklinton, LA following an investigation into alleged fraud.
Shortly after reporting the vehicle stolen to the New Orleans Police Department, the
Ford was discovered burned and abandoned in New Orleans East.
The investigation initiated from a complaint received through the Department of Children and Family Services alleging that Gregorio misrepresented her family’s income in
order to receive food stamp assistance.
Troopers’ investigation revealed that for nearly a three year period, Gregorio received
Through investigative efforts, Troopers discovered that the Gambinos had not been in
the French Quarter on the night of the alleged theft and in fact had been in New Orleans over $17,000 in supplemental nutrition assistance benefits that she was not entitled to.
East where the vehicle was later recovered.
Gregorio was booked accordingly into the Washington Parish Jail.
31
In the News
Pineville Woman Faces Drug Charges
State Police book Kenner woman with insurance fraud
www.kalb.com
8/3/2012
By Michelle Hunter, The Times-Picayune
8/6/2012
Police arrested a Pineville woman on Thursday on pharmaceutical drug charges.
Authorities have arrested a Kenner woman who they say received money to repair her
house after Hurricane Gustav, then filed a claim with a separate insurance company for
the same damages. Loretta Burgess, 53, was taken into custody Friday after an investigation by the State Police Insurance Fraud and Auto Theft unit, according to Trooper
Melisa Matey, a spokeswoman for the department.
Authorities say they were notified in May that Cindy Jowers, 23, was receiving scheduled pharmaceutical medications from multiple prescribers at the same time.
After police completed an investigation and an arrest warrant was issued, Jowers was
arrested on 10 counts of obtaining CDS by fraud and insurance fraud.
According to reports, Jowers surrendered herself to agents at the Rapides Parish Courthouse, and booked into the Rapides Parish Jail.
Police Make Arrests In Recent Robberies
www.kalb.com
8/3/2012
Alexandria police closed a case involving a number of robberies around the city.
Officers have arrested two suspects, 28-year-old
Dontrale Phillips of Alexandria and 27-year-old
Cherie Moose of Wichita, Kansas for three robberies last month.
Police say the two robbed the Circle K and Subway on Masonic Drive and a Dollar General on
Macarthur Drive.
Photo from www.kalb.com
Investigators received a complaint about the alleged fraud from California-based Geo
Vera Insurance in July 2009, Matey said. Representatives said Burgess had filed a claim
with the company in March of that year for damage to her former residence on Cabernet
Drive in Kenner that she said occurred during a
heavy rainstorm.
Geo Vera paid out an undisclosed amount of money
on the claim. But representatives discovered that
Burgess had made a previous claim at that address.
Louisiana Citizens Property Insurance Corp. paid
Burgess $29,000 for damage to the residence that
occurred during Hurricane Gustav in 2008, Matey
said.
"They obtained a copy of the paperwork and the photographs from the 2008 claim and compared them
with the photographs and paperwork from the 2009
claim and found it was the same damage," Matey
said.
Photo of Burgess from The Times
-Picayune
They've been booked into the parish jail and charged with armed robbery.
32
In the News
Burgess, of 2 Chalet Court, Kenner, was booked Friday at the Jefferson Parish Correctional Center in Gretna with insurance fraud, an arrest report said. It was unclear Monday why it took investigators more than two years to book Burgess in connection with
the case
Georgeanna Calais, 28, Carencro, charged with insurance fraud.
Jamal Arceneaux, 28, Opelousas, charged with insurance fraud and theft.
Burgess was released Friday on a $50,000 bond. She could not be reached for comment. Lillie Broussard, 29, Opelousas, charged with insurance fraud and theft.
State Police make fraud arrests
Jamarcus Butler, 31, Breaux Bridge, charged with insurance fraud.
www.acadianagazette.net
8/15/2012
Carletta Jones, 36, Breaux Bridge, charged with insurance fraud.
Louisiana State Police detectives with the Insurance Fraud Unit assigned to the Lafayette Field Office have made several arrests over the past few months in relation to the
state's insurance fraud laws.
Quanisha Charles, 24, Houma, charged with insurance fraud.
Sheila Smith, 50, Franklin, charged with insurance fraud.
Eight people were arrested in late May, the result of three independent criminal investi- Rachel Celestine, 24, Breaux Bridge, charged with insurance fraud.
gations conducted by the insurance fraud unit into allegations of persons staging vehicle
crashes to obtain insurance proceeds from fraudulent bodily injury and property damage If convicted of insurance fraud, under the state statute, it is a felony and a person may
claims.
be imprisoned up to five years and fined up to five thousand dollars. The person may
also have to pay restitution to the insurance company for any payments the court deterThe crimes committed involved such illicit acts as preparing and submitting false medi- mines were not owed.
cal bills, claiming pre-existing damage on vehicles, and exaggerating bodily injuries.
If convicted of felony theft, under the state statute, a person may be imprisoned for not
Some of the suspects involved staged crashes using their own vehicles, while one used a more than five years, and be fined up to$2,000.
vehicle borrowed from a family member, and another rented a vehicle to perpetrate
these crimes. Arrest warrants obtained by detectives ranged in charges from insurance
Detectives assigned to the Lafayette Insurance Fraud Unit arrested a Breaux Bridge
fraud to felony theft.
woman in March for charges relating to insurance fraud.
Among those arrested without incident:
In November 2009, Jennifer Ballard Richard, 30, of Breaux Bridge, filed a claim with
her insurance company for a $20,000 engagement ring she claimed she lost.
Leroy Hawkins, 45, Jeanerette, charged with insurance fraud and theft.
33
In the News
Richard’s insurance company paid her to settle the claim. Richard provided information percent of all property/casualty claims are inflated or outright fraudulent, and that fraud
to the insurance company indicating that she had lost the ring and wished for the policy raises premiums about $300 per year per household.
to remain in effect. In April 2010, Richard filed another claim with her insurance company for the second ring, again claiming that it was lost.
These investigations were the result of complaints submitted to the state police and the
Louisiana Department of Insurance through their website. Anyone wishing to report
During the course of the investigation detectives determined that both rings were the
suspected insurance fraud is urged to contact the Louisiana State Police at
same ring. Richard was booked into the St. Martin Parish Jail for insurance fraud and
337.262.3341, or the Louisiana Department of Insurance website at www.ldi.state.la.us.
theft.
All information will remain strictly confidential.
State Police are still looking for three people in connection with a September 2010 investigation into another case of insurance fraud involving automobiles.
Louisiana State Police was successful in these investigations because of collaborative
partnerships with the Louisiana Department of Insurance, National Insurance Crime
Bureau and the Louisiana State Attorney General’s Office.
Apparently an August crash involving a Lafayette city bus, struck from behind by a
Toyota Tundra as the bus was picking up passengers, aroused suspicion in detectives
with the Region 2 Insurance Fraud Unit.
Further investigation revealed the crash was minor and should not have caused the serious injuries filed by six people.
Troopers arrested and charged with one count each of insurance fraud, Hilda Wiltz, 60;
Reynold Corbin, 44; and Dorothy Prejean, 49, all of Lafayette.
Still being sought by detectives are Stacey Stelly, 24; La'Sha Jones, 20; and Rodrick
Flintroy, 50, all of Lafayette.
According to INSWEB car insurance report, Louisiana ranked No. 1 in automobile insurance costs for 2011. Insurance fraud, in particular companies having to pay for false
or exaggerated claims, is a key factor in the high cost of insurance in Louisiana.
A report compiled by the Maryland Automobile Insurance Fund found that the insurance industry pays out about $20 billion in bad claims nationwide. It also found that 10
34
In the News
LAFAYETTE CHIROPRACTOR PLEADS GUILTY TO
FRAUD CHARGES
by Colby Howell at www.kpel965.com
10/19/2012
Michael Keith Johnsey pleaded guilty to federal fraud charges.
The charges were filed by Blue Cross Blue Shield who investigated the matter after
learning that they were being charged for surgeries that weren’t being performed.
Johnsey worked with the Acadiana Doctors of Chiropractic and is looking at a maximum of ten years in prison on three counts of health care fraud. He allegedly charged
the company from 2008 to 2011.
The total amount billed to the company was $176,243 and Blue Cross/Blue Shield was
seeking restitution.
Johnsey brought a check for the entire amount to the court hearing Thursday.
these illegal activities, investigators from the State Police executed several arrest warrants. Assisting with the investigation and arrests were the Avoyelles Parish Sheriff’s
Office and the LaSalle Parish Sheriff’s Office.
Arrested were Laurie Mayeux, age 32, of Hessmer, on three counts of obtaining a controlled dangerous substance (CDS) by fraud. Rhonda Worley, age 38, of Simmesport on
two counts of obtaining a controlled dangerous substance (CDS) by fraud.
Both women were booked into the Avoyelles Parish Sheriff’s Office into the Avoyelles
Detention Center #1.
Also arrested were Amber Norris, age 32, of Jena on two counts of obtaining a controlled dangerous substance (CDS) by fraud; Davin Tellifero, age 34, of Ball on four
counts of obtaining a controlled dangerous substance (CDS) by fraud; Morgan Burlew,
age 35 of Pineville on four counts of obtaining a controlled dangerous substance (CDS)
by fraud, four counts of insurance fraud, and criminal conspiracy.; and Summer Humphries, age 33 of Deville on three counts of obtaining a controlled dangerous substance
(CDS) by fraud, three counts of insurance fraud and criminal conspiracy.
Two Avoyelles Parish women arrested by Louisiana State
Police
Norris was booked into the Catahoula Parish jail while Tellifero, Burlew and Humphries were booked into the Rapides Parish jail.
www.avoyellestoday.comAvoyelles Today.Com
11/2/2012
State arrests, suspends Covington insurance agent
by Jennifer Larino at www.neworleanscitybusiness.com
12/4/2012
Two Avoyelles Parish women were arrested, along with four others, after investigators
from the Louisiana State Police Bureau of Investigations/Alexandria Field Office arrested all six individuals on Thursday, November 1, for illegally obtaining controlled dan- Editor’s note: This corrects an earlier version of the story that contained math and attribution errors.
gerous substances, on numerous occasions, among other charges. The six arrests
spanned three different parishes, including Avoyelles.
A Covington insurance agent has been arrested and suspended from the industry after
allegedly failing to remit thousands of dollars in premiums intended for insurance
After receiving information from various sources and an intensive investigation into
35
In the News
companies.
Louisiana State Police arrested Shantell Perniciaro, owner of A-Tell Insurance Agency
in Covington, on Nov. 2 for failure to remit premiums for an insurance policy and for
forgery of an insurance certificate, according to a release issued by the state Department
of Insurance.
The Department of Insurance Fraud Section Investigators has suspended Perniciaro’s
license and prohibited her from conducting insurance business in Louisiana.
Complaints against Perniciaro’s firm trace back to March 2007, when Stone Creations
Inc. reportedly paid Perniciaro and A-Tell $3,955 for a general liability policy from
American Vehicle Insurance Co., according to the cease-and-desist order released by
the department. Stone Creations later cancelled the policy but did not receive the refunded premium until October 2008. The order details $17,740.72 in total payments
collected from 2007 to 2011 that A-Tell had not refunded or returned to customers in
violation of state law as of Nov. 27.
Perniciaro established A-Tell Insurance in 2002 and has held an insurance producer
license in the state of Louisiana since January 2007, according to state records. A-Tell
writes auto, general liability, homeowners and worker’s comp insurance but specializes
in commercial insurance, according to its website.
State Police arrest New Iberia businessman for insurance
fraud
by Tonya LaCoste at www.katc.com
12/17/2012
The owner of a towing company in New Iberia is charged with Insurance Fraud. John
Bell Jr., 70, owner of Jo-Bell's Wrecker Service, is accused of filing a $9,000 false
theft claim with his insurance company. "In the claim, Bell stated a 2005 Ford truck
had been stolen from his property. The truck was recovered one week later, and Bell
claimed that damage on the truck had been sustained during the period for which it
was missing," State Trooper Stephen Hammons said. Detectives said they discovered
the truck was damaged before it was reported stolen and before it was insured.
Following a two-month long investigation, state police arrested Bell on December 14
and booked him into the Iberia Parish Jail. Troopers with Louisiana State Police Towing and Recovery Unit have been informed of the arrest, and have begun a separate
investigation of Bell's business, said Hammons.
Perniciaro, who could not be reached by telephone, was served the cease-and-desist
order at her place of business on Tuesday. She has 30 days to appeal the action.
36
Areas of Responsibility
Headquarters:
7919 Independence Blvd., A-19
Baton Rouge, La 70806
Lt. Trevor Smith, Unit Supervisor
(225) 925-3701
[email protected]
Michele Aucoin, Investigative Specialist
(225) 925-3702
[email protected]
Helena Graham, Admin. Coordinator
(225) 925-3536
[email protected]
Office Fax
(225) 925-3769
Office Email
[email protected]
Website
http://lsp.org/ifu.html
37
Louisiana Department of Justice
Livingston Building, Baton Rouge
38
Louisiana Attorney General’s Office
Insurance Fraud Support Unit
(Information in this section provided by Chief Prosecutor Thomas McCormick)
39
INSURANCE FRAUD SUPPORT UNIT
2012 REPORT
Attorney General Buddy Caldwell is proud of the efforts of his Insurance Fraud Support
Unit. Through prosecutions and the recovery of thousands of dollars in restitution, he
believes this unit is a valuable asset in the fight against criminals who defraud the state
and its taxpayers. The Unit operates as part of a tri-agency task force created by the
legislature and dedicated solely to fighting insurance fraud in Louisiana. The Insurance
Fraud Support Unit fulfills three primary responsibilities: providing legal advice and
consultation to the other two task force agencies, the Louisiana State Police (LSP) and
the Louisiana Department of Insurance (LDI), in insurance fraud matters; prosecuting
individuals statewide charged with insurance fraud; and presenting insurance fraud information and training to the insurance industry along with state and federal agencies.
The Unit’s section chief, Thomas A. McCormick, former Judge Advocate General in
the U.S. Air Force, has been the chief prosecutor within the Insurance Fraud Support
Unit for the past five years.
local law enforcement agencies throughout Louisiana concerning insurance fraud matters. The unit consults with and provides legal support to all local and state law enforcement agencies. This includes, but is not limited to, reviewing drafts of arrest and
search warrants; conducting legal research; and evaluating the case from a prosecutor’s
perspective, i.e., whether sufficient evidence exists to satisfy legal burdens of proof.
Due to the complex nature of some of the cases handled, the local district attorney may
be consulted while the investigation is ongoing to obtain the necessary authority to offer
a plea agreement, immunity to a target of the investigation to secure his cooperation
concerning other targets or request to prosecute the case outright.
Assistant attorneys general and investigating officers communicate regularly and engage in ongoing evaluation as cases progress. An assistant attorney general maintains
contact with the LDI fraud unit investigator for updates on administrative action and for
testimony preparation on active prosecutions.
At least once a month, unit attorneys attend intelligence sharing meetings hosted by
LSP in Baton Rouge and Alexandria. These meetings are attended by members of special investigative units from many of the insurance companies that do business in Louisiana. Under a statutory grant of immunity from civil liability, these personnel share
information regarding fraud trends and specific ongoing cases. This level of cooperation has resulted in the successful prosecution of several staged accident rings, producer
fraud cases and theft of equipment and automobiles. Two to three times a year, unit
attorneys also attend similar meetings hosted by the National Insurance Crime Bureau
(NICB) regional office, usually in Alexandria, Monroe or Shreveport.
The Insurance Fraud Support Unit provides legal consultation, assistance and support to
the LSP and LDI agents who conduct insurance fraud investigations. Twice a month,
the unit attends meetings with the LSP and LDI to screen insurance fraud referrals.
Although most cases are with the LSP, the Insurance Fraud Support Unit also handles
workers’ compensation and unemployment fraud cases investigated by the Attorney
General’s Office pursuant to contract with the Louisiana Workforce Commission
(LWC).
With regard to training, the Unit often gives presentations on insurance fraud prosecuIn addition, the Unit also works closely with the Louisiana Department of Revenue tion issues before organizations such as the National White Collar Crime Center
(LDR), as insurance fraud and income tax fraud often go hand-in-hand. Our office is (NW3C), Orleans Parish District Attorney’s Economic Crimes Unit, the Insurance Seworking closely with the Governor’s executive counsel to dedicate two post-certified curity Association, the American Council of Life Insurers, NICB, Louisiana District
investigators that will investigate LDR tax fraud cases exclusively. We anticipate these Attorneys’ Association, and the Louisiana Claims Association. In addition to providing
newly created positions in 2013 will not only pay for their offices, but also bring addi- training to other agencies, our unit attorneys are required to attend continuing legal education training from various sources, including the National Association of Insurance
tional revenues to the state through restitution orders and act as deterrent to tax fraud.
Commissioners (NAIC) for the fraud sessions and other NAIC or NICB sponsored
The Unit may handle insurance fraud cases that originate from a complaint made direct- training. As a valuable informational tool, the task force is connected with the tracked
ly to the Attorney General’s Office, and, from time to time, the unit receives calls from from start to finish.
40
This network allows everyone involved with our cases from attorneys, investigators and industry members to have real time access to that information 24 hours a day. Through
HISN, unit attorneys are able to access online CLE training in a variety of courses sponsored by NICB.
Like all Criminal Division attorneys, those assigned to the Insurance Fraud Support Unit are expected to handle opinion requests. When the opinions are assigned, work is done
to research and draft an accurate response to the opinion request. This process is monitored in the criminal division’s case tracking system.
BASIC INFORMATION ABOUT THE INSURANCE FRAUD SUPPORT UNIT
(6 Attorneys, 3 Investigators and 1 Administrative Assistant)
Statutory Authority for Operations
La. Const. Art. IV, Section 8 provides, in pertinent part:
As necessary for the assertion or protection of any right or interest of the state, the attorney general shall have authority
(2) upon the written request of a district attorney, to advise and assist in the prosecution of any criminal case; and
(3) for cause, when authorized by the court which would have original jurisdiction and subject to judicial review, (a) to institute, prosecute, or intervene in any criminal
action or proceedings, or (b) to supersede any attorney representing the state in any civil or criminal action.
La. Code of Criminal Procedure Article 682 provides, in pertinent part:
When a district attorney is recused…it shall be the duty of the Attorney General to appoint a member of his staff…to act in the place of the recused district attorney.
La. R. S. 36:702(E) provides:
There shall be within the Department of Justice a criminal division. It shall be responsible for criminal appeals, amicus curiae briefs in criminal prosecutions, habeas corpus defense, assistance to district attorneys in criminal cases, criminal prosecution, public corruption, institutional and insurance fraud cases, and extraditions, in accordance with Article IV, Section 8 of the Constitution of Louisiana.
Additional Statutory Authority for Insurance Fraud Support Unit Operations
La. R. S. 40:1421 et seq.
41
Primary Purpose
To provide superior legal representation to the Louisiana Department of Insurance (LDI) and the Louisiana State Police (LSP) in insurance fraud investigations and prosecutions
To attend LDI and LSP meetings to screen insurance fraud referrals
To handle workers’ compensation and unemployment fraud cases pursuant to contract with the Louisiana Workforce Commission (LWC)
INSURANCE FRAUD SUPPORT UNIT
Special Challenges Faced by State Prosecutors
Attorneys assigned to the Criminal Section/Insurance Fraud Support Unit prosecute violations of Louisiana’s criminal laws under Titles 14, 22, 23 and 47 by conducting, or assisting in, criminal prosecutions upon the recusal or request of local district attorneys. Prosecutors often must travel from their headquarters in Baton Rouge to courthouses
around the state to interview witnesses, review evidence, and otherwise prepare for trial. In almost all cases, the trials are held where the alleged crime was committed, putting
these prosecutors on the road for the duration of the trial. In 2012, our prosecutors each averaged 55 hours of travel time. It is important to note that the Unit has seen travel
time and related expenses decrease since many of the new cases are being prosecuted in the 19 th Judicial District Court in Baton
Rouge.
Insurance Fraud Support Unit
Although assistant attorneys general are versed in prosecuting fraud matters under Title 22 and Title 23, we do not always get the 2012 Budget
cases from the local district attorney to prosecute, which can limit the overall effectiveness of our combined Insurance Fraud Task
Force.
Salaries
$362,473
However, when we do get the cases from various district attorneys’ offices, prosecutors must meet the challenge of addressing the Related Benefits
vast differences in local criminal court rules or, in some cases, the lack thereof. Without consistency of local court rules, practicing
Travel
criminal law in all 64 parishes can sometimes be like practicing law in 50 different states.
$141,788.00
The challenge before this select group of criminal prosecutors in successfully prosecuting some of the most complex criminal cases Operating Services
in statewide venues with inconsistent local rules is met only through the most dedicated efforts of these skilled attorneys. In the
Supplies
face of these challenges, and perhaps because of them, we submit that criminal prosecutors in the Attorney General’s Office are
among the very best in the entire nation.
Equipment
$7,411.00
$3,775.00
$10,001.00
$0.00
IAT Charges
$0.00
Total
$525,488.00
42
INSURANCE FRAUD SUPPORT UNIT STATISTICAL INFORMATION
A strategic objective for the Insurance Fraud Support unit during calendar year 2012 was to provide legal support to law enforcement agencies investigating criminal insurance
fraud referrals by responding to 95% of requests for legal consultation within two working days and attending 90% of monthly intelligence sharing meetings hosted by the Louisiana State Police Insurance Fraud Unit by 2013. During calendar year 2012, the Fraud Unit exceeded this goal by handling 100% of all requests for legal consultation within two
working days, and attended 100% of monthly intelligence meetings.
In calendar year 2011, 711 active insurance fraud cases were opened and the trend continues to be steady. During calendar year 2012, the unit received 691 new active cases that
the unit is either prosecuting or monitoring the prosecution by the local district attorney’s office, bringing the two year total of new referrals to 1,402. In that same time, the
Fraud Support Unit closed over 493 cases as either a conviction, pretrial agreement or as a consult. In addition, the Insurance Fraud Support Unit receives monthly arrest messages from the Louisiana State Police, using this information to track the case from arrest to disposition.
The Unit has increased its workload through a partnership with LWC as it pertains to the Unemployment Insurance Trust Fund Fraud. This partnership was created with the focus of going after all Unemployment Insurance (UI) fraud within the state. The state now has the ability to track payroll data from employers and cross-reference that data with
recipients of unemployment benefits. As a result, it was apparent that unemployment fraud was prevalent in Louisiana. Prior to this partnership, there had been no criminal
investigations or prosecutions of UI fraud in Louisiana. Since March 2011, the Unit has received 195 UI cases from LWC and has made 92 arrests. The total amount of the UI
fraud for these cases alone totaled over $1,508,000.00 dollars. From those arrests, we have received faithful cooperation from East Baton Rouge District Attorney Hillar Moore,
who has allowed our unit to prosecute those cases as an assist with his office. Of the 92 arrests, our unit has formally charged 65 of those cases. The Unit has received 15 UI
convictions with over $45,000.00 in restitution to the state. In addition, we have allowed 20 pretrial intervention agreements to take place with those defendants who have not
had any previous dealings with law enforcement and whose dollar amounts are relatively minor in comparison to the larger cases.
SAMPLE CASES PROSECUTED in 2012
In 2012, there were several noteworthy convictions from the Insurance Fraud Support Unit. Below is a sample of some of the cases UI excluded:

State vs. Kelly Abrego, was a guilty plea that basically shut down a major mill for undocumented workers from receiving look alike LA identification cards and then, at the
same place, applying for insurance on their vehicles without ever having to see a licensed producer of insurance.

State vs. Gary Rose, involved a producer of insurance who was taking premiums from customers but never applying those premiums for coverage. Rose would also supply
fake insurance cards. He was convicted and placed on probation with restitution over $20,000.00.

State vs. Debra Ansardi and Barry Ansardi, was a case that centered around Hurricane Gustav. This case came from the LA Department of the Military where their manager
knowingly hired his wife to repair buildings but signed her maiden name to avoid suspicion during the bid process. He pled guilty to Public Contractor Fraud and she pled
guilty to forging a certificate of insurance. Both received three years suspended and placed on five years probation with full restitution to the state.
43

State vs. Tanya Weems, was another case of producer fraud wherein Weems would accept premiums from customers but never made a bona fide application for coverage. Weems pled guilty to failure to account for premiums under Title 22.

State vs. Kevin Lucas, was an unemployment fraud case wherein Lucas was working but applied for unemployment benefits and received over $20,000.00.
He was convicted and received three years suspended and placed on probation for five years with full restitution to the state.

State vs. Gino Zari, was a workers’ compensation fraud case wherein Zari faked a work related injury to receive medical benefits and indemnity payments in
excess of $70,000.00. He was convicted and sentenced to five years in the LA Department of Corrections with full restitution ordered.
In the last six months, the Louisiana Insurance Fraud Support Unit investigated or prosecuted a total of over $3,143,000.00 worth of suspected insurance fraud. In 2012, the unit
successfully recovered over $245,000.00 in restitution to various victims, including insurance companies, health insurance companies, LWC and LDR.
The unit meets the state goal for Crime and Safety Reform by bringing security to all Louisiana citizens by protecting our taxpayers from insurance related fraud.
By improving communication with law enforcement and knowing the specific needs of the insurance industry, this task force gives local law enforcement and prosecutors the
tools needed to put fraud criminals behind bars.
LDI estimates that annually in Louisiana there are over $500 million dollars lost in insurance fraud as it pertains to casualty and property claims. This does not include healthcare
fraud which is estimated to be about $1.5 billion in Louisiana alone. The typical Louisiana household pays almost $1,000.00 a year in fraud related charges passed on to them as
consumers.
OTHER ACCOMPLISHMENTS
A.
Strengthening Partnerships
On June 4-6, 2012, the newly elected South Central Regional Director, Thomas A. McCormick, Sgt Belinda Murphy, 1st Alternate Director with the Louisiana State Police, and
the Louisiana Attorney General’s Criminal Division hosted the National White Collar Crime Center’s (NW3C) quarterly board of directors meeting in Baton Rouge at the downtown Hilton. This was the first ever NW3C meeting in Baton Rouge, Louisiana.
The South Central Region of NW3C is made up of the states of Texas, Oklahoma, Arkansas, Louisiana, Mississippi and Alabama. The South Central Region combined has over
400 law enforcement agencies within its exclusive membership. The National White Collar Crime Center is headquartered in West Virginia and has over 100 employees with an
annual budget of over $40 million. The mission of the National White Collar Crime Center is to provide training, investigative support and research to agencies and entities involved in the prevention, investigation and prosecution of economic and high-tech crime. A non-profit membership organization dedicated to supporting Law Enforcement in the
prevention, investigation, and prosecution of economic and high-tech crime, NW3C has been continuously funded through competitive grants for over three decades. NW3C
membership consists of over 4,300 Law Enforcement agencies from all 50 states and four continents.
44
B.
Strengthening Legislation
AG’s office creates new Civil Insurance Fraud Unit
LA Senate Bill 765, “The Sledge Jeansonne Louisiana Insurance Fraud Preven- State Senator Dan 'Blade' Morrish and Senator Francis C. Thompson, authors of the Sledge
tion Act”
Jeansonne Louisiana Insurance Fraud Prevention Act, saw their bill take effect and become
new law on August 1st 2012.
With the help of the insurance industry and State Senator Morrish, Louisiana
now has a new civil tool to combat insurance fraud in the state. LA Senate Bill The Act has been named in honor of Kim Sledge and Rhett Jeansonne, state insurance fraud
765 from the 2012 Regular Legislative Session creates the Sledge Jeansonne investigators killed in 2011 while performing their duties.
Louisiana Insurance Fraud Prevention Act.
In order to enforce this statute the Attorney General (AG) has created a new unit in the Public
Protection Division of the AG’s office, the Civil Insurance Fraud Unit.
This Act took effect on August 1, 2012 and directs only the Louisiana Attorney
General to file civil claims against those who commit a fraudulent insurance act. This new law’s passage results from the state’s need to regulate and cut down the cost of insurJurisdiction is in the 19th Judicial District in Baton Rouge. This act grants the ance fraud. Moreover it was designed to enhance the state's efforts to fight insurance fraud,
power to authorize civil subpoenas, seizure of property, and treble damages for which costs insurance companies and their policyholders hundreds of millions of dollars every
year. In particular, Property and Casualty insurance fraud costs the state of Louisiana $500 milviolators.
lion a year, and Healthcare insurance fraud costs the state $1.5 billion annually. According to
The Louisiana Attorney General is authorized additional revenues for manning the Louisiana Attorney General's office, Louisiana families spend almost $1,000 a year because
and operating this new Civil Insurance Fraud Section. This authority is a signif- of fraud. This is higher than the national average which the Coalition Against Insurance Fraud
icant tool in combating insurance fraud in Louisiana and has enabled our office (CAIF) estimates as $950 per family annually.
to hire personnel, train them accordingly and begin casework. Like the Louisi- The Louisiana Insurance Fraud Prevention Act gives the Attorney General’s office authority to
ana Insurance Fraud Task Force, this new unit is completely self-funded with- enforce the Act, including the power to pursue civil actions after the conviction or guilty plea
out tax payer dollars.
of any violator of the law who has defrauded insurance companies. These civil actions are in
the form of restitution to the insurance companies, civil monetary penalties and civil fines.
This unit is currently comprised of one attorney, Jeremy Gathe and one investigator, Kelly Leon. Due to volume of cases since the passage of the Act, additional staff will be hired to assist
in the enforcement efforts of the Attorney General.
The Louisiana Insurance Fraud Task Force would like to take this time to welcome Jeremy and
Kelly to the team and look forward to their progress.
45
Louisiana Department of Insurance
Poydras Building, Baton Rouge
46
Louisiana Department of Insurance
Insurance Fraud Section
(Information in this section provided by Fraud Director Matthew Stewart )
47
PURPOSE
The Louisiana Department of Insurance, Division of Insurance Fraud (Fraud Section) investigates all forms of suspected insurance fraud, including claims fraud, claims adjuster fraud, producer (agent) fraud, company fraud and provider fraud. Investigators work closely with the other state Department of Insurance offices and divisions across the
nation, as well as with the Insurance Fraud/Auto Theft Investigation Unit of the Louisiana State Police and the Insurance Fraud Support Unit of the Louisiana Department of
Justice (Attorney General), local and federal law enforcement officers, prosecutors, insurance company personnel, insurance agencies and the general public in their mission to
reduce fraud in our state. The LDI Fraud Section places emphasis on investigating fraudulent claims and working closely with the respective law enforcement agencies and
prosecutors’ offices for the successful investigation and prosecution of individuals involved in fraudulent insurance activities; investigating insurance producers and companies
suspected of engaging in fraudulent insurance practices and working with the respective law enforcement agencies and prosecutors’ offices for the successful prosecution of
individuals involved in fraudulent insurance activities; performing background investigations on companies, individuals and other entities seeking to conduct the business of
insurance in Louisiana; performing background investigations on individuals seeking an 18 U.S.C. Section 1033 consent to engage in the business of insurance; and reviewing
anti-fraud plans filed with LDI by insurance companies and health maintenance organizations.
In 1999, legislation was passed that created an assessment on insurance company premiums to provide funding for an Insurance Fraud Task Force. The use of these funds was
designated for the creation insurance fraud units within the offices of the State Police and the Department of Justice and for additional assistance to the existing LDI Fraud Section. The three agencies work closely together, each playing a vital part in the process, from preliminary investigation and criminal referral by LDI, to arrest by State Police
and prosecution by Department of Justice. In 2010, legislation was passed to provide a portion of these funds to Louisiana Automobile Theft and Insurance Fraud Prevention
Authority (LATIFPA), a public agency within the Department of Insurance.
Any law enforcement authority may investigate insurance fraud, but the majority of cases are channeled through the State Police. When local authorities pursue insurance
fraud cases, the LDI Fraud Section works with them to lend our experience and expertise, as well as to serve as an informal liaison between local law enforcement authority
and State Police.
Local authorities may prosecute cases of insurance fraud, but they often lack the resources or expertise or have a conflict of interest. In such cases, they may defer to or request
assistance from the Department of Justice.
LDI FRAUD SECTION PERSONNEL
The LDI Fraud Section has eleven employees consisting of a director, assistant director, eight insurance specialists/investigators and a student worker.
48
LDI FRAUD SECTION CHANGES
La. R.S. 22:572.1, which became effective January 1, 2011, requires each authorized insurer and health maintenance organization licensed to operate in Louisiana to prepare,
implement, produce and maintain an insurance anti-fraud plan and to file the plan with the LDI between January 1 and April l,
2011. The LDI Fraud Section worked with the Department of Insurance Information Technology Division to develop and implement an electronic system for the initial filing of
the plan, the supplemental reporting of material changes to the plan and for the annual summary report of claims processed and claims referred to the LDI as suspicious.
In response to the deaths of Kim Sledge and Rhett Jeansonne who were slain while in the performance of their official duties on June 7, 2011, the Louisiana Legislature amended
La. R.S. 33:2201(B) during the 2011 Regular Session by enacting Subsection (B)(20) to provide law enforcement survivor benefits to the families of Kim and Rhett and other
similarly situated state employees. The statute provides for state employee survivor benefits to surviving spouses and children of law enforcement by redefining law enforcement
personnel to include, “on or after January 1, 2011, all state employees conducting investigations, serving subpoenas, warrants, pleadings, or other orders of the court, or collecting
evidence concerning the affairs of a person upon a reasonable belief that the person has engaged in, or is engaging in, an act or practice that violates state law.”
LOUISIANA AUTOMOBILE THEFT AND INSURANCE FRAUD
PREVENTION AUTHORITY (LATIFPA)
L.R.S. 22:2131 established the Louisiana Automobile Theft and Insurance Fraud Prevention
Authority (LATIFPA), for the purpose of combating motor vehicle insurance fraud, including
fraud by theft and other criminal acts. La. R.S. 22:2134 and La. R.S. 40:1428, amended in
2010, authorized the Commissioner of Insurance to withhold $187,000 each fiscal year from
the insurance fraud assessment to provide funding to LATIFPA. This allocation was used for
conducting educational and public awareness programs designed to inform the citizens of the state about methods of preventing motor vehicle
theft and combating insurance fraud. During Calendar Year 2012, LATIFPA expended $165,304 to raise public awareness about in surance
fraud and vehicle theft and to raise awareness among teen drivers about the consequences of vehicle theft and vehicle theft p revention.
49
CLAIMS FRAUD
The LDI Fraud Section received 3,598 reports of suspected fraudulent insurance claims during 2012, most of which were from insurance companies in accordance with La. R.S.
22:1926 and 40:1424. Since its inception in 2007, the LDI Fraud Section database has accumulated 13,376 entries of suspected fraudulent insurance claims and the LDI Fraud
Section records verify that it has processed 19,911 claims since it was founded.
The fraud database provides the LDI Fraud Section the ability to determine the patterns of numerous suspicious claims which involve an individual claimant, different insurance
companies, and specific medical providers, attorneys, and/or insurance company personnel. The database helps to expose fraudulent schemes.
Exaggerated loss statements are typically the most frequently reported suspected fraudulent claims.
There are various ways to initiate exaggerated loss statements: claiming greater and prolonged severity of a physical injury than actually occurred; claiming damage to a vehicle
from a wreck when the damage actually occurred from another wreck or incident; and/or claiming property was destroyed or burglarized in a home when in fact the items never
existed or were never stolen or destroyed. Other examples of fraudulent claims include staged accidents (i.e., planned incidents that are made to appear and claimed by the participants to be “accidents” involving some type of loss), provider fraud and medical/health care fraud.
Louisiana laws set forth in La. R.S. 22:1926 and 40:1424 require the reporting of all cases of suspected fraudulent insurance activity to the LDI Fraud Section. Suspected fraudulent insurance claim report forms are available online for both insurance companies and the general public. Online reporting also allows anonymous submissions. Since June
2010, the electronic reporting system have allowed additional information to be provided, allow reporting of more than one person or entity per form and permit the attachment of
documents to the form. The reporting system automatically opens a file, imports all data into a fraud database and generates an acknowledgement letter.
The support staff provided by the fraud assessment has enabled the LDI Fraud section to receive, evaluate and conduct preliminary investigation of suspected fraudulent insurance claim reports. After a review of the report and a preliminary examination involving multiple databases and information obtained from insurance companies, insurance agencies and their affiliated producers, individuals involved in the claim and other resources, the LDI Fraud Section may determine that a criminal referral be made to State Police or
other appropriate law enforcement authority.
During 2012, the LDI Fraud Section made 1056 criminal referrals involving fraudulent insurance claims to the State Police. Of those referrals, there were 99 arrests resulting in
276 charges from numerous insurance crimes as a result of criminal referrals related to suspected fraudulent insurance claims. The LDI Fraud Section is informed of criminal
arrests through the Homeland Security Information Network (HSIN) Web site established and maintained by the State Police.
50
PRODUCER, CLAIMS ADJUSTER AND
INSURANCE COMPANY FRAUD
Investigations of producers, claims adjusters and insurance companies may involve misrepresentation; misappropriation of funds belonging to the policy holder, premium finance company or insurer; unlicensed and/or unauthorized entities; and fraudulent insurance identification cards or certificates of insurance.
The single greatest producer fraud activity from an administrative perspective continues to be the misappropriation of funds from a policyholder. Because the funds go unreported to an insurance company or premium finance company, counterfeit insurance identification cards
2011 ACTIONS TAKEN REGARDING PRODUCER,
and certificates of insurance are often involved.
CLAIMS ADJUSTER AND COMPANY FRAUD
Investigations include the compilation, research and analysis of information obtained by the LDI Fraud
Section from consumer complaints, producers, claims adjusters, companies, other LDI departments and
additional sources. A detailed analysis is done to determine if sufficient evidence exists to justify LDI
Fraud Section action and/or criminal referral. Investigators work closely with law enforcement during
on-site investigations of fraudulent activity and with gathering of additional information.
INSURANCE FRAUD PREVENTION
The LDI Fraud Section plays a critical role in insurance fraud prevention. The two key components are
education the public and conducting extensive background investigations.
Number of Investigations Opened
36
Cease & Desist Orders Served
9
Notices of Proposed Action Served
8
Criminal Referrals to Law Enforcement
10
Arrests by Law Enforcement as a Result of Criminal
Referrals
3
INSURANCE FRAUD PUBLIC EDUCATION
The LDI Fraud Section’s efforts in the area of education include an annual fraud prevention media campaign, press releases, brochures, and increased online presence and
speaking before various groups and organizations about insurance fraud. Fraud Sections personnel participate in the annual LDI Filing and Compliance Seminar after the end
of each legislative session and every even numbered year in the LATIFPA Fraud Seminar.
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BACKGROUND INVESTIGATIONS
The LDI Fraud Section investigates the background of companies, officers, directors, Medical Necessity Review Organizations and other entities applying to conduct the business of insurance in
Louisiana. This includes changes of officers and directors of domestic companies currently authorized to do business in the state. During the course of investigating insurance-related entities
and individuals, it often becomes necessary to establish communications with regulatory, judicial
and law enforcement agencies on interstate, national and international levels. The scope of an investigation frequently becomes extensive when derogatory information is recovered.
2012 BACKGROUND INVESTIGATIONS COMPLETED
Company Applications Received
166
Company Applications Approved
137
Company Biographical Affidavits Received
1,368
Company Biographical Affidavits Approved
1,021
18 U.S.C. SECTION 1033 CONSENT APPLICATIONS
The LDI Fraud Section investigates and reviews all applications written in accordance with federal law, 18 U.S.C. Section 1033, which requires that anyone who has been convicted of certain state and federal felony must first apply for and be granted written consent from the Commissioner of Insurance to participate in the business of insurance. An
extensive background investigation is conducted for information to be provided to the Commissioner to aid the decision.
2012 INSURANCE FRAUD CHARGES BY CATEGORY—276 TOTAL
Arson
Automobile Insurance Fraud
Bank Fraud
Doctor Shopping
False Reporting of Valid License
Filing False Public Records
Forgery
Injuring Public Records
Insurance Fraud
Obtaining a CDS by Fraud
Practicing Veterinary Medicine w/o a License
Public Contractor Fraud
Theft
4
19
1
1
1
4
19
1
167
14
1
9
26
52
LOUISIANA DEPARTMENT OF INSURANCE - FRUAD DIVISION
2012 BUDGET EXPENDITURES
Object Class Name
SALARIES-CLASS - REGULAR
SALARIES-CLASS - OVERTIME
SALARIES-CLASSIFIED-TERMINATION
WAGES
STUDENT LABOR
RETIRE CONTRIB - STATE EMPLOYE
F.I.C.A. TAX (OASDI)
MEDICARE TAX
GROUP INSURANCE
Total Personal Services
IN-ST TRAVEL - CONF,CONV,ATHL
IN-STATE TRAVEL - FIELD TRAVEL
Total Travel
RENTALS - BUILDINGS
RENTALS - OTHER
DUES AND SUBSCRIPTION
MAIL, DELIVERY & POSTAGE
TELEPHONE SERVICES
Total Operating Services
OPERATING SUPPLIES - AUTO
OPERATING SUPPLIES - OTHER
Total Supplies
IAT - POSTAGE
Total Interagency Transfers
Total
Total Line Amount
$355,574.44
$138.00
$12,934.26
$2,184.00
$6,142.50
$83,510.45
$516.25
$5,064.46
$49,288.38
$515,352.74
$1,372.79
$740.37
$2,113.16
$2,656.15
$1,254.00
$1,510.00
$2,388.54
$444.67
$8,253.36
$1,062.96
$35.50
$1,098.46
$28.82
$28.82
$526,846.54
Total Expenditures
$526,846.54
Means of Financing:
Insurance Fraud Investigation Fund
LDI Self-Generated Funds
Means of Financing Total
$362,763.00
$164,083.54
$526,846.54
53
Tribute
Terry Lynn Wrobel
April 13, 1946 - December 30, 2012
A resident of Baker and a native of Baton Rouge, Terry passed away suddenly at her home on Sunday, December 30, 2012. She was 66,
and a fraud investigator with the Louisiana Department of Insurance.
Terry is survived by two daughters and a son-in-law, Nikki and John Landry of New Roads, and Stacey Baxter of French Settlement; a son
and daughter-in-law, Warren and Danielle Whittington of Springfield; six grandchildren, Brian, Kimberly, and Adam Parker, and Ian, Mason, and Grant Landry; one great grandson, Gavin; and longtime roommate and friend, Judy Caswell. Preceded in death by husband, Stevie Wrobel; and her parents, John and Jena Folse. Terry enjoyed jewelry making and football, and will be greatly missed by all.
Paul Boudreaux, Jr. Retiring from Department of Insurance
Commissioner of Insurance Jim Donelon appointed Paul Boudreaux, Jr. as the Director of the Insurance Fraud Section at the Louisiana Department of Insurance
on January 15, 2009. He officially retired from the department in December of 2012.
Paul is an attorney with over 30 years of civil litigation experience, 20 of which he spent as Special Assistant Attorney General defending the State of Louisiana
in civil litigation. Before joining the Department, Boudreaux was a solo attorney practicing in general civil law, insurance defense, medical malpractice defense
and public defense, with the majority of his work involving a myriad of issues in the insurance arena that affect insurance companies, insurance producers, policy provisions and regulatory matters.
Originally from Patterson, Boudreaux received a B.A. in Liberal Arts, History and English from Nicholls State University in Thibodeaux and his Juris Doctor from
LSU Law School in Baton Rouge. He is a member of the Louisiana State Bar Association, the Louisiana Association of Defense Counsel and the Alexandria Bar
Association, for which he served three years as Executive Counsel Member. In 1991, he was named the Alexandria Legal Secretary Boss of the Year.
We would like to wish Paul a happy retirement and thank him for his hard work with the Department of Insurance, and the Louisiana Insurance Fraud Task
Force.
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What Can You Do In The Fight Against Fraud?

Be aware of staged accidents, such as intentional sideswiping or cars that cut in front of other vehicles, forcing collisions
due to quick stops.

Be aware of individuals that try to get you to leave the scene of an accident without calling police or obtaining a police
report.

Be aware that some individuals report damage as vandalism in an attempt to cover deliberate or previous damage to one's
own property.

Be aware of individuals making a false stolen vehicle claim to cover previous damage to a vehicle or to dispose of the
vehicle.

Be aware of individuals that inflate genuine claims to cover a policy deductible.

Be aware of attempts to convince you that "everybody is getting rich" so you may as well try to get additional money also.

Be aware of the possibility that someone may set a small fire in their home to obtain a new paint or remodeling job.

Be aware of individuals that fake an on-the-job injury to stay off work after healing to collect Workers' Compensation
benefits.
REPORT FRAUD!!!!
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Louisiana Insurance Fraud Task Force
Louisiana State Police
Insurance Fraud / Auto Theft Unit
Attorney General’s Office
Insurance Fraud Support Unit
Louisiana Department of Insurance
Insurance Fraud Section
225.925.3536 (office) * 225.925.3769 (fax)
7919 Independence Blvd, A-19, BR, LA 70806
http://lsp.org/ifu.html
225.326.6000 (office) * 225.326.6097 (fax)
1885 N. Third Street, BR, LA 70802
http://www.ag.louisiana.gov
225.342.4956 (office) * 225.342.7393 (fax)
*1702 N. Third Street, BR, LA 70802
http://www.ldi.state.la.us
This public document was published at a total cost of $3,425. 500 copies of this public document were published in the first printing at a cost of $3,425. The total cost of all printings of this document, including reprints is $3,425. This document was published by Moran Printing, 5425 Florida Blvd, Baton Rouge, LA. 70806 to meet the requirement for an annual report of Insurance Fraud
Task Force activities under the authority of L.R.S. 40:1427. This material was printed in accordance with the standards for printing by state agencies established pursuant to R.S. 43:31. Printing of
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this material was purchased in accordance with the provisions of Title 43 of the Louisiana Revised Statutes.