Pennsylvania Fraud Stories - Pennsylvania Insurance Fraud

Transcription

Pennsylvania Fraud Stories
MARCH 2016
Inside this issue:
Public Relations
2
Know the Risks!
3
Pet Insurance Fraud?
3
Hurricane Sandy Still on
4
the Minds of Claimants
Workers’ Comp Fraud
5
Mother-in-Law BEWARE!
6
Insurance Producer
7
Pennsylvania
Insurance Fraud Prevention
Authority
Message from the Executive Director
Many states have taken the route of creating fraud bureaus to combat insurance
fraud. Going in a different direction, Pennsylvania’s legislators, with insurers, consumers and law enforcement created the Insurance Fraud Prevention Authority not
only to combat insurance fraud, but also to prevent insurance fraud.
We provide nearly $13 million in grants to state and local law enforcement each
year to prosecute insurance fraud; so that the arrests and prosecutions of some, who
are jailed, fined and ordered to pay restitution, will hopefully deter others from
committing the crime. But, unless a law enforcement agency issues a press release
on a case, or the news media picks up on a case, the bulk of cases go unreported
and the general public remains uninformed.
Ralph Burnham
Thomas
Donahue
Alleged to Have Kept
To combat this, we’ve developed a year-long campaign that will keep Pennsylvanians
Thousands in Premium
aware of the risks and penalties of committing insurance fraud. The IFPA expanded
its “real life” storytelling to target the younger audience segment and automotive fraud. This new campaign,
Payments for His Personal Use
Philadelphia Man Sells
“See How They Lie,” includes high-octane video “movie previews” that feature “real life, real lies, real foolish”
insurance fraud schemes. These are deployed statewide through paid digital and social media channels. In addi8
Motorcycle then Reports it Stolen to Police
Auto Accidents During
tion, we’ve aired our traditional television and radio ads this spring in the Philadelphia area. New this year are
our new radio ads, similar to the “See How They Lie” videos which will be aired during Philadelphia Phillies
and Pittsburgh Pirates games. Our “See How They Lie” videos will also be shown on the ballpark Jumbotron
and Phanavision before each home game.
& Progressive
Prescription Fraud
Executive
Director
IFPA
Executive
Director
9
10
Policy Lapses & Rate
Evasion
The IFPA continues our “Don’t Be a But” (DBAB) campaign on social media through daily memes, animated
videos, online interactive content, and other grassroots marketing. This multi-tiered campaign was implemented
to expose the “BUTS” (i.e. lies and excuses) and consequences of false insurance claims to a younger audience
(18-35) via social media, YouTube, live events and more.
The campaign has been expanded by placing dozens of billboards in high traffic areas in the Harrisburg area as
11
well as placing digital video boards at the baggage claim area of the Harrisburg airport. The goal is to draw attention to the DBAB message and direct viewers to our website and You Tube sites.
Know the Penalties!
12
The IFPA has entered into an agreement with the Harrisburg Senators AA Baseball team to sponsor strikeouts
of opposing players. Whenever a visiting player strikes out, a short ”Don’t Be a But” video will be displayed on
Mark Your Calendar!
20
Who to Call
21
the scoreboard along with the announcer saying something like “Don’t Be a But-Strike Out insurance fraud in
Pennsylvania.”
Undisclosed Criminal
History
As you can see, we are using different avenues to spread our anti-fraud message throughout the state. Please visit
our websites www.helpstopfraud.org and www.dontbeabut.org for further information and to view our new
videos.
A reminder that our 2016 Fraud Awareness Conference will be held in Hershey, PA on April 7th and 8th. Interested in attending? Please click here to preview our conference agenda (to see the conference events and
breakout sessions that you'll want to attend) and then click here to register; and then, forward this email on to
your colleagues if they've not yet heard the news.
Thank you for your continued efforts in combating insurance fraud in Pennsylvania!
Page 2
Public Relations
Visit our website at www.helpstopfraud.org;
Be on the look-out for new billboards popping up
throughout Central Pennsylvania!
Weasy’s on Facebook at www.facebook.com/dontbeabut
Facebook at www.facebook.com/PennIFPA;
Rumor has it that Weasy’s been seen hanging out at Penn
State football games, and there are pictures to prove it!
and on YouTube!
Know the Risks, Know the Penalties
Page 3
Fraud Stories
The accounts of insurance fraud and insurance-related crimes that follow are drawn from Pennsylvania
law enforcement’s filed criminal complaints, press releases and newsletters. Criminal complaints docketed may be viewed online, using the “OTN” shown in each of the following accounts, through the web
portal of Pennsylvania’s Unified Judicial System. Individuals shown charged with crimes are to be presumed innocent until they are proven guilty.
On January 22, 2016 and February 4, 2016, detectives of the Philadelphia District Attorney’s Insurance
Fraud Unit arrested 49 year-old Anthony Foster of Philadelphia, PA and 23 year-old Cameron C. McCary
of Cherry Hill, NJ. Foster was charged with Insurance Fraud, Attempted Theft by Deception, Conspiracy
and False Reports. McCary was charged with two counts of Insurance Fraud, Attempted Theft by Deception, Criminal Conspiracy and False Reports. According to the Criminal Complaints, on May 13, 2015,
McCary contacted Jewelers Mutual Insurance Company and reported that his book bag, which contained
sixteen pieces of jewelry valued at approximately $55,000, had been stolen from a SEPTA bus where he was
a passenger on May 12, 2015. McCary then filed a lost and found report with SEPTA and a claim with
Jewelers Mutual Insurance Company. Insurance Fraud Unit detectives reviewed SEPTA surveillance footage
from the SEPTA bus which showed McCary boarding the bus, sitting in an aisle seat facing the center of the
bus and placing his book bag on the step to the right of his seat. At the next stop, a male in a gray hooded
sweatshirt, later identified as Foster, is seen boarding the bus and standing in the rear exit door near
“...it s alleged that
Davenport did not disclose
that her dog had any pre-
McCary’s seat and then moving to a seat directly behind McCary. Foster is seen minutes later exiting the
existing conditions and that
bus with McCary’s book bag. According to the complaints, further investigation revealed that McCary had
allegedly staged the theft of his jewelry by arranging for his roommate, Foster, to board the SEPTA bus and
after obtaining pet insurance
pretend to steal his book bag in order to file a fraudulent insurance claim. Jewelers Mutual Insurance Company had not paid McCary’s claim. [OTN: N9958373, N9945703]
with VPI, she submitted
On February 1, 2016, from a referral received from VPI Pet Insurance, detectives of the Allegheny County
Police Department filed a Criminal Complaint charging 28 year-old Brittney Mari Davenport of Oakmont,
multiple claims for her dog’s
medical treatment which
PA with Insurance Fraud. According to the complaint, Davenport applied for pet insurance with VPI Pet
Insurance eight days after her dog had been diagnosed with a dry nose, a torn cruciate ligament, an ear
resulted in VPI paying
infection, dental calculus, blood in his urine, a urinary tract infection, food allergies and dermatitis. During
the application process, it is alleged that Davenport did not disclose that her dog had any pre-existing condi-
approximately $820 in
tions and that after obtaining pet insurance with VPI, she submitted multiple claims for her dog’s medical
treatment which resulted in VPI paying approximately $820 in veterinary bills. [OTN: G7341751]
On February 1, 2016, from referrals received from Nationwide Mutual Fire Insurance Company and Erie
Insurance Company, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed two Criminal Complaints charging 29 year-old Chintan Patel of Jim Thorpe, PA with three counts of Insurance Fraud
and Attempted Theft by Deception and one count of False Swearing. According to the complaints, on August 11, 2015, Patel had applied for and obtained a “Valuables Plus” insurance policy from Nationwide
Mutual Fire Insurance Company to insure a sapphire pendant, sapphire ring and a diamond stud earring.
The complaint reflects that during the application process, Patel had stated that he had not had any previous losses. On September 21, 2015, Patel reported to Nationwide that he lost two of the pieces of jewelry,
one of which was the sapphire pendant, while riding his motorcycle. Nationwide subsequently conducted
an ISO Claims Search on Patel for any past claims and reportedly found that Patel had submitted a claim
on August 11, 2015 to the Erie Insurance Group for the loss of the sapphire pendant valued at $13,500,
which Erie subsequently paid. It is alleged that Patel filed a loss claim with Nationwide for the same piece of
jewelry in which Erie had paid him $13,500, and that in both claims, Patel had been in possession of the
veterinary bills.”
Page 4
Fraud Stories (Continued)
jewelry he reported he’d lost. According to the complaint, Patel later returned payment to Erie in the amount
of $13,500, and Nationwide had not paid Patel’s claim. [OTN: T7540551, T7540842]
On February 1, 2016, detectives of the Delaware County District Attorney’s Criminal Investigation Division
filed a Criminal Complaint charging 44 year-old Timothy Willis of Upper Darby, PA with Insurance Fraud.
According to the complaint, Willis’ auto insurance policy with Progressive Insurance Company was canceled
due to non-payment on February 25, 2015. He contacted Progressive to reinstate his policy on February 27,
2015 at 6:34 AM, and stated that he nor anyone else in his household had been involved in any accidents
during the time his policy was lapsed. Subsequently, at 10:22 AM the same day he’d reinstated his policy,
Willis contacted Progressive again to report that he’d been involved in an accident on February 27, 2015 at
6:15 AM. According to the complaint, Willis admitted in a recorded interview that he was aware that his
policy was lapsed at the time he was involved in the auto accident and that he had called in to reinstate his
policy after the accident had already occurred. [OTN: T7543631]
On February 2, 2016, from a referral received from Progressive Insurance Company, detectives of the Cumberland County District Attorney’s Office filed a Criminal Complaint charging 51 year-old Betsy Fay Webb of
Carlisle, PA with Insurance Fraud and Attempted Theft by Deception. According to the complaint, on Au-
The Truth is in
the Pics
gust 12, 2015 at 10:50 PM, Webb applied via the internet for and obtained an auto insurance policy with
Progressive. On August 13, 2015 at 8:05 AM, an online claim was reported under Webb’s policy which stated
that Webb had backed into another vehicle. Progressive’s claims adjusters contacted Webb on August 17,
2015 to obtain a recorded statement from Webb who stated that the accident occurred on August 13, 2015;
however, upon viewing digital data of photos taken a short time after the accident had occurred, it was revealed that the accident had actually occurred on August 12, 2015 at some time prior to 9:31 PM and before
Webb’s policy was obtained. Progressive did not pay Webb’s claim. [OTN: T7546232]
On February 3, 2016, Office of Attorney General special agents filed a Criminal Complaint charging 30 yearold Mohamed D. Kerdy of Philadelphia, PA with Insurance Fraud and Attempted Theft by Deception-False
Impression. According to the complaint, Kerdi reported to his insurer, Utica First Insurance Company, that
the awning of his pizza shop was damaged by Hurricane Sandy on October, 29, 2012, and sought over $4,000
in benefits to replace it. Utica assigned an independent adjuster to inspect the awning, and according to the
complaint, the adjuster reported to Utica that the damage he saw had been present when he had inspected
the pizza shop in both June of 2012 and September of 2012 in connection to several other claims. In fact, the
damage to the awning was visible in photographs that the adjuster took during earlier inspections. The complaint states that under Kerdi’s policy with Utica, the damage to the awning would have been covered by an
extraordinary event such as a hurricane, but not by ordinary wear and tear or ordinary weather conditions.
Utica denied Kerdi’s claim. [OTN: N9957043]
On February 4, 2016, Office of Attorney General special agents filed a Criminal Complaint in York County
charging 68 year-old Juanita Mae Pownell of Delta, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on January 8, 2013, Pownell allegedly contacted State
Farm Insurance Company and reported that her stove and refrigerator were damaged by a power surge which
occurred during “Superstorm Sandy.” State Farm advised Pownell to submit technical reports in support of
her claim. According to the complaint, nearly a year later, on or about December 5, 2013, State Farm received
copies of four documents from Pownell, which included purported service repair invoices from Sears and
Home Depot, and purported receipts totaling $2,556.79 for the purchase of a refrigerator and stove from
HHGregg. State Farm questioned the authenticity of the documents and assigned an investigator to follow
Page 5
up. The investigator had reportedly attempted to verify the expenditures and ultimately determined that the
receipts and invoices were fraudulent. And further, when State Farm attempted to take a recorded statement
from Pownell, she allegedly refused and withdrew her claim. Pownell reportedly later admitted to law enforcement investigators that she altered and submitted the documents to State Farm as she knew that much of her
home’s storm-related damage was not covered under her policy. [OTN: T7557060]
On February 4, 2016, from a referral received from Donegal Insurance Group, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint in Monroe County charging 67 year-old Joseph
Benoit of East Stroudsburg, PA with Insurance Fraud. According to the complaint, Benoit’s auto insurance policy with Donegal was canceled on April 17, 2015 due to non-payment. On May 4, 2015, Benoit contacted Donegal to reinstate his policy and during his application for the reinstatement of his policy, reported that there had
not been any losses, damage or accidents during the time his policy was canceled. Subsequently on May 6, 2015,
Benoit contacted Donegal to file an accident claim for a crash he reported had occurred on May 5, 2015; however, a Pennsylvania State Police Accident Report showed that the accident occurred on April 29, 2015 at 6:00
PM, during the time in which Benoit’s auto insurance policy was canceled. [OTN: T7558283]
On February 4, 2016, detectives of the Delaware County District Attorney’s Criminal Investigation Division
filed a Criminal Complaint charging 53 year-old Alberta Harris of East Lansdowne, PA with Insurance Fraud
and Attempted Theft by Unlawful Taking-Moveable Property. According to the complaint, on July 9, 2013, Harris was shopping at Save A Lot when she reported to a store employee that she had slipped on a banana peel and
injured her leg, knee and ankle. Harris subsequently retained counsel to represent her in a lawsuit against Save A
Lot totaling $225,000. Detectives later obtained video surveillance footage in the Save A Lot store of the date
and time of Harris’ alleged fall which reportedly showed that Harris had not fallen or been injured as she had
claimed. [OTN: T7557465]
On February 4, 2016, from a referral received from the United States Postal Service, Office of Inspector General, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed a Criminal
Complaint charging 60 year-old Henry Dowdy of Blackwood, NJ with Insurance Fraud, Theft by Unlawful Taking-Moveable Property and Theft by Deception-False Impression. According to the complaint, Dowdy was employed as a tractor trailer operator since September 2000. On December 10, 2011, Dowdy injured his upper and
lower back while pushing items into the trailer of the truck and was placed on workers’ compensation on a total
disability status. Dowdy was subsequently ordered to return to work on a light duty status on January 27, 2012.
Dowdy worked on light duty status until April 20, 2012, and on May 3, 2012, he filed a notice of recurrence for
his back injury and complained of pain. Dowdy’s treating physician deemed Dowdy unable to lift or carry more
than five pounds and unable to stand for more than five minutes at a time. Dowdy subsequently, in September
2013, obtained a second opinion by a different doctor who had reportedly determined that Dowdy’s condition
had been completely resolved and that he was able to return to his job at a full-duty status; however, Dowdy
again visited the first doctor who reported that Dowdy was unable to bend, lift, stand for prolonged periods of
time, walk, reach, push, pull, twist, turn, stoop or squat as all of these activities aggravated Dowdy’s discomfort.
According to the complaint, from February 4, 2015 to May 29, 2015, Dowdy was observed via video surveillance
footage performing activities inconsistent with his total disability status to include standing, walking, climbing,
kneeling, twisting, pushing, pulling, and driving for extended periods of time. Reportedly, Dowdy later admitted
to detectives that he had embellished his injuries and that he should have not been entitled to receive workers’
compensation benefits. The complaint states that Dowdy had received $32,242.64 from the start of surveillance
through October 23, 2015. [OTN: T7556872]
Bogus Slip-andFall Claim at
Save A Lot
Page 6
On February 6, 2016, detectives of the Allegheny County Police Department arrested 58 year-old John W.
White of Pittsburgh, PA and charged him with Insurance Fraud and False Reports. According to the Criminal Complaint, on July 28, 2014, White reported to Pittsburgh Police and his auto insurer, Farmers Insurance Company, that his 2011 Ford Taurus had been stolen on July 27, 2014 sometime between 9:30 AM
and 9:00 PM. The vehicle was recovered with extensive front-end damage on July 28, 2014 at 10:10 PM by
officers of the Pittsburgh Police. Reportedly, White later admitted that his vehicle had not been stolen as he
had claimed, but rather that he had crashed the vehicle and fled the scene as he did not want his insurance
rates to go up. The complaint states that Farmers had paid White’s claim totaling $27,168.84; $8,834.85 to
White and $18,333.99 to the vehicle’s lienholder, Ford Motor Credit. The case is being prosecuted by the
Allegheny County District Attorney’s Office. [OTN: G6937976]
On February 8, 2016, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 28
year-old Theodore T. Gaines of Philadelphia, PA and charged him with three counts each of Insurance
Fraud, Forgery, Tampering with Records, Conspiracy, Securing Execution and Unsworn Falsifying. Accord-
West Chester
Woman Uses
Mother’s-in Law
Identity to
Obtain
Fraudulent
Prescriptions to
Support Drug
Habit
ing to the Criminal Complaint, it is alleged that Gaines registered vehicles with fraudulent American Independent, Sentinel and 21st Century Insurance Company financial responsibility identification insurance
cards. Detectives obtained the PennDOT history of Gaines’ 2003 Pontiac and learned he had registered the
vehicle with an American Independent financial responsibility identification insurance card on April 23,
2012. Detectives contacted a representative of Omni Insurance Group, which is affiliated with American
Independent, and learned that Gaines’ listed policy number was not valid. Detectives then obtained the title
history for Gaines’ 2006 Buick which showed that Gaines had registered the vehicle with a Sentinel Insurance Company financial responsibility identification insurance card on November 30, 2012. Detectives
contacted a representative from Hartford Insurance of which Sentinel is a subsidiary. The Hartford Insurance representative stated that his company never insured Gaines or his 2006 Buick. Finally, detectives
obtained the title history for Gaines’ 2008 Chevrolet Impala which showed that Gaines had registered the
vehicle with a 21st Century Insurance Company financial responsibility identification insurance card on
September 9, 2013. Detectives contacted a representative from AIG Insurance Company, of which 21 st
Century is a subsidiary, and learned that the listed policy number was not valid. [OTN: N9962993]
On February 8, 2016, Office of Attorney General special agents filed a Criminal Complaint in Chester
County charging 30 year-old Jennifer Anne Burns of West Chester, PA with four counts each of Insurance
Fraud, Acquire or Obtain Possession of Controlled Substance, Criminal Use of Communication Facility,
Forgery, Attempted Theft by Deception-False Impression and Prohibited Acts. According to the complaint,
it is alleged that Burns used the identity of her mother-in-law to obtain prescription drugs. The fraud was
revealed when Burns’ mother-in-law contacted Cigna Insurance Company to report that an unknown person had stolen her identity in order to obtain four Vicodin prescriptions. Burns reportedly admitted while
being interviewed by special agents that she had a drug problem and that she had used her mother’s-in law
information to phone in and obtain the prescriptions. [OTN: T7566591]
On February 9, 2016, Office of Attorney General special agents filed a Criminal Complaint in Bucks County charging 30 year-old Derek J. Calista of Bensalem, PA with two counts of Insurance Fraud and one count
of Attempted Theft by Deception-False Impression. According to the complaint, on August 29, 2015, the
Bensalem Police Department was dispatched to an abandoned vehicle. Upon arrival, the police officer reportedly determined that the abandoned vehicle had struck an unattended parked vehicle and the operator
had fled the scene on foot leaving the vehicle blocking a driveway. The officer ran the information on the
vehicle and determined it was owned by Calista and he discovered an outdated Safe Auto Insurance Com-
Page 7
pany insurance card. According to the complaint, after several phone calls, Calista finally called the officer back
and admitted that he had been driving the vehicle. The officer subsequently contacted Safe Auto and was informed that the policy number on the outdated insurance card had been canceled for non-payment and that
Calista had obtained a new policy on the same date as the hit-and-run accident. Further investigation revealed
that Calista called Safe Auto after the accident to apply for insurance coverage for the vehicle and reportedly
lied when questioned about whether the vehicle had any damage. Additionally, after the owner of the other
vehicle contacted Safe Auto to make a claim, Calista was not forthcoming to the insurance company as to when
the accident had occurred, which was before he had obtained coverage. The complaint reflects that Safe Auto
denied the claim made by the owner of the vehicle Calista struck. An estimate to repair the damage to his vehicle totaled $3,603.02. [OTN: T7574840]
On February 10, 2016, from a referral received from Progressive Insurance Company, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint in Luzerne County charging 40 yearold Maria A. Hartman of Benton, PA with two counts of Insurance Fraud and one count of Attempted Theft
by Deception-False Impression. According to the complaint, on July 5, 2015, Hartman applied for an auto
insurance policy with Progressive Insurance to insure her 2009 Arctic Cat Prowler XTC 4X4. The policy became effective on July 5, 2015 at 4:53 PM. Hartman contacted Progressive on July 7, 2015 to report that she
had been involved in an accident with the vehicle on July 6, 2015. In support of her claim, on July 9, 2015,
Hartman sent photos to Progressive that reportedly showed that the date the accident occurred was July 4,
2015 which is before she had obtained the Progressive policy. According to the complaint, Progressive estimated the damages to be $761.89 minus Hartman’s $500 deductible, but denied Hartman’s claim. [OTN:
T7579390]
On February 10, 2016, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 25 yearold Uche Nwani of Philadelphia, PA and charged her with Insurance Fraud, Forgery and Unsworn Falsification. According to the Criminal Complaint, It is alleged that Nwani registered her 2003 Acura with fraudulent
American International Insurance Company and American Independent Insurance Company financial
responsibility identification insurance cards. Detectives confirmed with representatives of each company that
the policy numbers listed on the financial responsibility identification insurance cards were not for valid policies. [OTN: N9965373]
On February 10 and 11, 2016, detectives of the Delaware County District Attorney’s Criminal Investigation
Division filed two Criminal Complaints charging 29 year-old Kristina Brittany Walker of Garnet Valley, PA
and 31 year-old Kevin Scola of Ridley Park, PA each with Insurance Fraud, Prohibited Acts, Conspiracy and
Criminal Use of Communication Facility. According to the complaints, it was alleged that the defendants obtained prescriptions for Adderall by utilizing Walker’s Keystone First Insurance prescription card and would
then sell the scripts for a profit. [OTN: T7588011, T7588055]
On February 11, 2016, Office of Attorney General special agents filed a Criminal Complaint charging 53 yearold David Matthew Smith of Lancaster, PA with Insurance Fraud and two counts each of Theft by DeceptionFalse Impression and Forgery. According to the complaint, it is alleged that Smith, a licensed insurance producer, misappropriated some $31,741 in premium payments from March 2009 through October 2010 to make it
appear that Lanco Lawncare’s owner and employees had valid workers’ compensation coverage when in fact
they did not. Further alleged is that Smith purported to obtain life insurance policies for three employees of
Waste Oil Recyclers. Each employee signed policies for coverage through Genworth Life Insurance and Waste
Oil Recyclers paid the premium payments totaling $7,114.98 directly to Smith on behalf of its three employees
Insurance
Producer
Collects
Thousands in
Premium
Payments—
Fails to
Provide
Clients with
Valid Workers’
Compensation
& Life
Insurance
Policies
Page 8
for policies that allegedly did not exist. According to the complaint, Smith had also forged signatures on a
Broker of Record form for Waste Oil Recyclers. During a December 2015 interview with special agents, Smith
reportedly admitted that he had accepted payments from the owner of Lanco Lawncare and employees of
Waste Oil and then cashed the checks for his own personal use without obtaining the insurance policies, and
further admitted to forging the Broker of Records form signature for Waste Oil and creating falsified workers’
compensation documents so that Lanco Lawncare’s owner and employees believed they had workers’ compensation coverage. [OTN: T7583892]
On February 12, 2016, Office of Attorney General special agents filed a Criminal Complaint in Lehigh County charging 28 year-old Jason Michael Blanski of Reading, PA with Insurance Fraud and Attempted Theft by
Deception-False Impression. According to the complaint, on July 11, 2015 at 9:55 AM, Blanski purchased a
Progressive Insurance Company auto insurance policy to insure his 2011 Hyundai Accent, and subsequently
on July 12, 2015, filed an accident claim to Progressive stating that he had been involved in a two-vehicle accident on July 11, 2015 at 1:00 PM. Blanski’s vehicle was towed to Saucon Collision where an estimate to repair
Blanski’s vehicle totaled $2,293. Saucon Collision provided Progressive with an invoice which showed they
had been dispatched to tow Blanski’s vehicle on July 1, 2015, which contradicted Blanski’s claim that the
“...Progressive
investigators had
reportedly learned that
accident occurred on July 11, 2015. Further investigation revealed that the accident had actually occurred on
July 1, 2015 at 7:20 AM before Blanski had obtained his Progressive auto insurance policy, and it is alleged
that Blanski misrepresented the date and time of the accident in an attempt to have Progressive pay his claim.
[OTN: T7589982]
Robinson had posted the
On February 17, 2016, from a referral received from Progressive Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 29 year-old Justin Robinson of Philadelphia, PA and
“stolen” motorcycle online
charged him with Insurance Fraud, Attempted Theft by Deception and False Reports. According to the Criminal Complaint, on October 2, 2013, Robinson called the Philadelphia Police and reported that his 2006 Suzu-
for sale; later confessed
that the bike was never
stolen.”
ki motorcycle had been stolen on September 30, 2013. Robinson then contacted Progressive to file a theft
claim for the allegedly stolen bike. During their own investigation of the claim, Progressive investigators had
reportedly learned that Robinson had posted the “stolen” motorcycle online for sale. Progressive investigators
confronted Robinson about this advertisement during an examination under oath and Robinson confessed
that he had sold the motorcycle and that the bike was never stolen. [OTN: N9973294]
On February 17, 2016, detectives of the Allegheny County Police Department filed a Criminal Complaint
charging 24 year-old Jawan Lynn Bryant of McKeesport, PA with Insurance Fraud. According to the complaint, Bryant added comprehensive and collision coverage to his auto insurance policy with Geico Insurance
Company on October 18, 2015 at 8:58 AM. The following day, Bryant filed a claim with Geico claiming that
his Cadillac was damaged in a hit-and-run at approximately 10 AM or 11 AM on October 18, 2015. However,
Bryant’s neighbor reportedly stated to investigators that he had seen the damage to Bryant’s vehicle on October 17, 2015 and stated that Bryant had told him the damage had occurred in a parking garage. Geico did not
pay Bryant’s claim. [OTN: G7355902]
On February 18, 2016, Office of Attorney General agents filed a Criminal Complaint charging 30 year-old
Janine Michel Robichaud of Montville, PA with Insurance Fraud and Attempted Theft by Deception-False
Impression. According to the complaint, on July 13, 2012, Robichaud’s automobile insurance policy insuring
her 1998 Ford F-150 with Nationwide Insurance Company was canceled. On November 19, 2012 at 9:18
AM, Robichaud reinstated her Nationwide auto policy, and subsequently at 10:26 AM, reported that she had
rear-ended another vehicle. According to the complaint, the investigation revealed that the accident had actu-
Page 9
ally occurred at 8:49 AM, prior to Robichaud reinstating her policy. Nationwide did not pay the $1,362.50
claim. [OTN: T7606605]
On February 19, 2016, Office of Attorney General special agents filed a Criminal Complaint in Berks County
charging 27 year-old Breann Katrice Flagg of Reading, PA with two counts of Insurance Fraud and one count
of Attempted Theft by Deception-False Impression. According to the complaint, Flagg’s auto insurance policy
with Safe Auto Insurance Company was canceled on September 26, 2013. Flagg contacted Safe Auto on
October 1, 2013 at 4:00 PM to obtain another policy to insure her 2005 Mazda 3, and subsequently on October 2, 2013 at 9:10 AM reported to Safe Auto that she had been involved in an auto accident on October 1,
2013 at 7:00 PM. The complaint states that further investigation revealed the accident had occurred on October 1, 2013 at 2:45 PM, approximately one hour and fifteen minutes prior to Flagg obtaining the new policy.
The complaint reflects that the claim totaled approximately $8,851.89; however, the claim was denied by Safe
Auto. [OTN: X0026143]
On February 22, 2016, Office of Attorney General special agents filed a Criminal Complaint in Butler County charging 56 year-old Mary Ann Knechtel of Butler, PA with two counts each of Insurance Fraud, Acquire
or Obtain Possession of Controlled Substance and Forgery. According to the complaint, between August
2012 and April 2014, while employed as a Certified Nurse Practitioner at UPMC Montefiore Hospital in the
Anesthesia Department, Knechtel began calling in unauthorized prescriptions for Schedule II Vicodin/
Hydrocodone pills for herself and under her husband’s name to various pharmacies in Butler County.
Knechtel obtained the prescriptions by utilizing the DEA registration numbers of physicians at a UPMC pain
“...Knechtel called in
clinic where she was, at one time, a patient of the clinic. Knechtel had suffered severe neck pain for several
years due to previous surgeries and used all of the Vicodin/Hydrocodone for herself. The physicians from the
prescriptions for Vicodin
pain clinic confirm that they did not prescribe nor authorize the prescriptions for Knechtel. Knechtel also
worked as a temp nurse in the Fall of 2012 for three months at a Butler County medical office while a nurse
pills by using the practice
from the office was on maternity leave. While employed at the office, Knechtel called in prescriptions for
Vicodin pills by using the practice physician as a prescriber without his authorization. Knechtel paid for the
fraudulent prescriptions with her insurance coverage with Highmark PEBTF, in which she was covered under her husband who is a retired Commonwealth of Pennsylvania employee. The complaint states that Highmark paid $1,097.65 for the prescriptions. [OTN: T7617842]
On February 22, 2016, from a referral received from Donegal Insurance Group, Office of Attorney General
special agents filed a Criminal Complaint in Lancaster County charging 36 year-old Ryan David Shebelsky of
Elizabethtown, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to
the complaint, on May 10, 2012, Shebelsky contacted Donegal to report a potential claim, and asked the
Donegal representative if his bicycle would be covered under his homeowner’s policy as it had been damaged
when his garage door came down on it. On May 11, 2012, Shebelsky, in a recorded statement to Donegal,
changed his version of events and claimed that the bike was damaged when he backed over it with his vehicle
on May 5th. He later provided a receipt for the frame in the amount of $3,299.99 as well as a repair estimate
in the amount of $5,049.99. On May 18, 2012, Donegal discovered that Shebelsky was a top amateur cyclist
in Pennsylvania, and that he had been in a race on May 5, 2012. On May 29, 2012, Shebelsky withdrew his
claim, advising that he had received notification that his team sponsor would be purchasing him a new bike
frame. On August 19, 2015, special agents interviewed Karl Woitas, President of Chester County Cycling
Foundation. Woitas stated that he was aware that Shebelsky had been involved in a bad accident while participating in a race on May 5, 2012. He reported that he did not observe the actual accident, but did observe that
Shebelsky’s bike was inoperable. On January 8, 2016, Donegal confirmed that Shebelsky’s bicycle would have
physician as a prescriber
without his
authorization.”
Page 10
been covered under his homeowner’s policy if he had backed over it with his vehicle as he had claimed; however, as Shebelsky allegedly misrepresented how the bicycle had been damaged, Donegal did not pay Shebelsky’s claim. [OTN: T7620874]
On February 23, 2016, from a referral received from Progressive Insurance Company, Office of Attorney
General special agents filed a Criminal Complaint in Cambria County charging 39 year-old Stephanie Lynne
Dennison of Ebensburg, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, in June 10, 2015, Dennison obtained a full comprehensive and collision policy
from Progressive Insurance Company for her automobile. On June 11, 2015, Dennison submitted a claim
with Progressive stating that she had been involved in an accident at a local high school parking lot. Video
surveillance footage from the school parking lot showed that the accident had actually occurred prior to Dennison obtaining her new coverage from Progressive. Progressive denied Dennison’s claim. [OTN: T7624142]
charging 22 year-old Egypt Nurae McKeithen of Pittsburgh, PA with two counts of Insurance Fraud. Accord-
Auto Insurance
Fraud Keeps
Fraud Fighters
in Business
ing to the complaint, McKeithen’s auto insurance policy with Progressive Insurance Company had been
canceled on October 9, 2015 due to non-payment of premiums, and was reinstated on October 27, 2015 at
10:58 AM. Subsequently on October 27, 2015, McKeithen contacted Progressive and filed a claim stating that
she had been involved in an auto accident earlier that day at around 11:00 AM or noon, when she was attempting to make a left turn and collided with another vehicle. According to the complaint, it was alleged that
McKeithen’s accident had occurred during the time in which her Progressive policy was canceled and that
McKeithen reinstated her policy a short time after the accident occurred. It was further alleged that when
McKeithen filed a claim with Progressive she misrepresented that the accident occurred after she’d reinstated
the policy in an effort to have her claim paid by Progressive. Progressive did not pay McKeithen’s claim.
[OTN: G7361034]
On February 24, 2016, detectives of the York County District Attorney’s Office filed a Criminal Complaint
charging 35 year-old Larryesha Lorraine Oden of York, PA with Insurance Fraud and Attempted Theft by
Deception-False Impression. According to the complaint, it was alleged that Oden had been involved in an
auto crash before she had obtained an insurance policy with Safe Auto Insurance Company, and further that
in filing a claim with Safe Auto, had misrepresented the actual time of the accident in an effort to make it
appear the accident occurred after she obtained a valid insurance policy with Safe Auto. [OTN: T7629786]
On February 24, 2016, from a referral received from Nationwide Insurance Company, detectives of the
Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint in Carbon County charging
35 year-old Vishal Satyanan RaJu of Albrightsville, PA with two counts of Insurance Fraud and one count of
Attempted Theft by Deception-False Impression. According to the complaint, it is alleged that RaJu, in applying for an auto insurance policy with Nationwide Insurance, had provided an Albrightsville, PA address as his
primary address and garaging location of his vehicles when in fact, his primary address was that of New Jersey.
[OTN: T7633894]
On February 24, 2016, from a referral received from Pennsylvania Assigned Risk Insurance, detectives of the
Lehigh County District Attorney’s Office filed a Criminal Complaint charging 62 year-old Irene P. Moreira of
Brooklyn, NY with two counts of Insurance Fraud and one count of Attempted Theft by Deception-False
Impression. According to the complaint, it is alleged that on several occasions, Moreira applied for an auto
insurance policy to insure her vehicles and provided an Allentown, PA address as her primary address and
Page11
9
Page
garaging location; however, investigators found that Moreira’s primary address was that of Brooklyn, NY.
[OTN: T7632402]
On February 24, 2016, detectives of the Bucks County District Attorney’s Office filed a Criminal Complaint
charging 40 year-old Brian Allen Wenhold of Sellersville, PA with Insurance Fraud. According to the complaint, on December 14, 2015, Wenhold obtained an Erie Auto Insurance policy to insure his 2001 Ford
Focus. On December 25, 2015, Wenhold filed a fire claim reporting that after parking the vehicle in his driveway, a neighbor had alerted him that his car was on fire. During the course of the investigation, it was revealed
that Wenhold had an extensive arrest record that included bad checks, failure to register with state police,
terroristic threats, indecent assault, corruption of minors and theft – all of which he failed to disclose when
applying for his auto policy with Erie. The complaint states that Erie rescinded Wenhold’s policy as he had not
been forthcoming as to his prior arrest records. [OTN: T7632704]
On February 24 and 29, 2016, from a referral received from Erie Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 56 year-old Bernice Byrd of Drexel Hill, NJ and 54
year-old Verelena B. Jackson of Philadelphia, PA. The defendants were each charged with Insurance Fraud,
Attempted Theft by Deception and Conspiracy. According to the Criminal Complaints, on February 10, 2013,
“During the course of the
investigation, it was
Jackson and Byrd claimed they had been injured when a Wash and Lube car wash employee mistakenly backed
into Byrd’s 2009 Nissan Rogue. Both defendants reportedly retained counsel to represent them in a personal
revealed that Wenhold
injury claim against Erie Insurance, which insures the Wash and Lube; however, the investigation revealed that
neither defendant had been inside the vehicle when it was struck and therefore neither had been injured as
had an extensive arrest
they’d claimed. The complaint reflects that 21st Century Insurance Company, Byrd’s auto insurer, had paid
medical bills of the defendants which totaled $8,392. [OTN: N9981882, N9988274]
On February 26, 2016, Office of Attorney General special agents filed a Criminal Complaint charging 40 yearold Aaron Allen Sealey of Pittsburgh, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on November 19, 2014, Sealey purchased an automobile policy from
Progressive Insurance Company and approximately six hours after obtaining the new policy, Sealey filed a
claim stating that he was traveling to his work site when he collided with a deer that ran onto the roadway.
Sealey’s vehicle sustained front end and right side damages, and Progressive estimated the damages to Sealey’s
vehicle to be $4,863.59, less a $500 deductible. According to the complaint, the investigation revealed that
Sealy’s accident occurred before he had obtained coverage from Progressive. Sealey reportedly later admitted
that in making the claim with Progressive, he misrepresented the time of the crash in an effort to have Progressive pay for his vehicle’s damage. [OTN: T7640570]
charging 50 year-old Verna V. Vaughn of Pittsburgh, PA with Insurance Fraud. According to the complaint,
Vaughn applied for and obtained an auto insurance policy with Donegal Insurance Company on March 13,
2015 to insure her 2004 Ford Mustang. On April 15, 2015, Vaughn’s Mustang was involved in an accident
while allegedly being operated by her son and was deemed a total loss. Reportedly, Vaughn had not disclosed
on the application that her 24 year-old unlicensed son resided with her or that she allowed him to operate her
vehicle. The complaint reflects that Donegal paid Vaughn $2,290.81 to settle her claim. [OTN: G7363510]
On February 26, 2016, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 32 year
-old Andrae Salmon of Philadelphia, PA and charged him with two counts of Forgery, two counts of Insurance
Fraud and two counts of Unsworn Falsifying. According to the Criminal Complaint, it is alleged that Salmon
record that included bad
checks, failure to register
with state police,
terroristic threats,
indecent assault,
corruption of minors and
theft—all of which he
failed to disclose when
applying for his auto
policy with Erie.”
Page 12
registered his 1997 Nissan Maxima with a fraudulent GEICO Insurance Company financial responsibility
identification insurance card. On March 5, 2013, Salmon was involved in an accident with his Maxima. Detectives retrieved the police report for the accident which stated that Salmon had an insurance policy with
GEICO. Detectives contacted a representative from GEICO who confirmed that the policy number was not
valid and later retrieved the title history for Salmon’s Maxima which stated that the car had been registered
with a different GEICO policy on December 6, 2012, which was also not a valid policy. [OTN: N9984892]
The Penalties:
The following dispositions of cases previously reported on were obtained via
the web portal of Pennsylvania’s Unified Judicial System.
“...Johnson began taking
medications to include
Dilaudid and Demerol that
he had diverted from
patients. And by
fraudulently documenting in
patient charts that he had
On February 2, 2016, Brian Michael Buchko of Johnstown, PA pled Guilty to Theft by Deception-False Impression and was sentenced to serve 12 months' probation and was ordered to pay court costs totaling
$1,217.35. On October 9, 2015, Office of Attorney General special agents filed a Criminal Complaint in
Cambria County charging Buchko with two counts of Insurance Fraud and one count of Attempted Theft by
Deception-False Impression. According to the complaint, Buchko obtained an auto insurance policy with Safe
Auto Insurance Company on November 21, 2014 at 6:47 PM. The following day, Buchko filed a claim alleging that he was involved in a two-vehicle accident on November 21, 2014 at 7:30 PM; however, the driver of
the other vehicle reportedly stated that the accident occurred at approximately 5:30 PM which was prior to
Buchko obtaining the Safe Auto policy. According to the complaint, damage to the other driver’s vehicle was
$900. [OTN: T7124950]
On February 3, 2016, a New Cumberland, PA man was granted ARD with six months’ probation and was
ordered to pay $812.50 in court costs. On October 6, 2014, from a referral received from Erie Insurance
patients, various patients’
Company, detectives of the Cumberland County District Attorney’s Office had filed a Criminal Complaint
charging the defendant with Insurance Fraud, Forgery, Tampering with Records and Deceptive Business Practices. According to the complaint, an Erie Insurance Company’s insured was involved in a crash while operat-
insurance companies were
ing his 2005 Ford Explorer on July 9, 2013. The vehicle suffered primarily front-end damage. The vehicle was
taken to Leahy’s Auto Body, where Erie’s insured was provided a loaner car to use while they made repairs to
billed for medications they
his vehicle. It was alleged that the defendant, Leahy’s body shop manager, had provided three fraudulent
receipts in which he had hand-written dollar amounts on vendor receipts for parts purchased to repair the
administered the drugs to
never received.”
Explorer. According to the complaint, Erie’s claims adjuster obtained the actual vendor receipts, and was able
to confirm that the defendant had altered the receipts he submitted to Erie for payment by inflating the actual amount Leahy’s paid vendors by a total of $384.98 for the Explorer’s replacement parts. [OTN: T5745806]
On February 3, 2016, Gregory M. Johnston of Ellwood City, PA pled Guilty to Insurance Fraud and was
sentenced to serve two years' probation and was ordered to perform 50 hours of community service and to
pay $2,600.50 in court costs. On May 28, 2015, Office of Attorney General special agents filed a Criminal
Complaint charging Johnson with Insurance Fraud and Acquire or Obtain Possession of Controlled Substance. The complaint states that Johnson was employed as a registered nurse at Ellwood City Hospital, and
beginning in June 2014, Johnson began taking medications to include Dilaudid and Demerol that he had
diverted from patients. And by fraudulently documenting in patient charts that he had administered the
drugs to patients, various patients’ insurance companies were billed for medications they never received.
[OTN: T6584104]
11
Page 13
On February 3, 2016, from Negotiated Guilty pleas to Insurance Fraud and Conspiracy, Kevin Dabney of Philadelphia, PA was sentenced to serve five years' probation and was ordered to perform 50 hours of community
service and to pay $3,600 in restitution and court costs of $1,059. As reported by the Philadelphia District Attorney’s Insurance Fraud Unit, Kevin Dabney, Darya Hart (AKA Darya Golatt) and a third individual were all
arrested in mid-September 2015 for charges including Theft by Deception, Criminal Conspiracy, Insurance
Fraud and False Reports. The defendants all falsely claimed to have been involved in an auto accident with a
deer. The unnamed defendant claimed that she was driving her vehicle on Fort Mifflin Road on April 15, 2011
when a deer ran in front of her car and caused her to lose control and strike a guardrail. Hart and Dabney
claimed that they were passengers in the car during this accident. All three then retained Stuart Doctorvitz as
their personal injury attorney and filed claims with Nationwide Insurance Company. When approached by
Insurance Fraud Unit detectives, the unnamed defendant stated that she told her cousin of her car troubles and
he said he could have her vehicle fixed if she made an accident claim and filed a police report. She said she was
told to report that she had struck a deer and that she had two passengers with her at the time of the accident.
However, she never met these passengers (Hart and Dabney) until her cousin brought her to Doctorvitz’s office.
Hart and Dabney were also recruited to be part of this fraudulent accident claim. Nationwide paid $66,497 to
settle the claims filed by the defendants. Court records reflect that the case against Hart remains an active investigation. On February 17, 2016, the unnamed defendant in this case was granted ARD with six months’ probation and was ordered to pay $1,000 in restitution and court costs of $510. [OTN: N9783653, N9791180,
N9783686]
On February 3, 2016, a Millerstown, PA man was granted ARD with 12 months’ probation and was ordered to
pay court costs of $1,120.33. Detectives of the Cumberland County District Attorney's Insurance Fraud Unit
had arrested the defendant in October 2013 and charged him with Insurance Fraud, two counts of Theft by
Deception and Tampering with Physical Evidence. According to the Criminal Complaint, on March 7, 2013,
the defendant notified Erie Insurance that he'd hit a deer on March 4, 2013 and then an embankment with his
Chevrolet Trailblazer. The defendant’s Erie auto insurance policy covered collision losses, with a $500 deductible, and comprehensive losses such as damage done by hitting a deer, with a $250 deductible. The defendant,
in March 2012, had hit a deer and his vehicle’s damages had been paid by Erie with the defendant paying his
$250 deductible. On March 8, 2013, an Erie damage appraiser, finding the Trailblazer to be a “total loss” as it
was valued at $7,391 and had damages of $9,854, saw no deer hair, tissue or blood on the heavily damaged
vehicle. The defendant was informed that Erie would settle the claim as a collision loss, with the defendant
paying his policy’s $500 deductible. On March 12, 2013, the defendant contacted Erie’s appraiser to report that
he’d found deer hair behind a “V8” emblem on the left front fender of his Trailblazer. On March 13, 2013,
the appraiser again examined the Trailblazer, seeing that there was indeed deer hair “behind” the emblem. The
claim was referred to Erie’s special investigators, who learned from police officers who'd responded to the
accident scene on March 4, 2013, that the defendant had said that he'd hit an embankment after swerving to
avoid hitting a deer. The officers had reportedly seen no evidence that a deer had been hit. Special investigators, viewing the claim file’s photographs, believed that deer hair had been placed on the Trailblazer between
March 8th and 13th to support the defendant’s claim of having hit a deer. On March 20, 2013, interviewed by
special investigators, the defendant reportedly maintained that he had hit a deer. The complaint noted that
Erie had paid out $237.69 as reimbursement of a rental vehicle used by the defendant, but that the claim’s
total loss value less the defendant’s $500 policy deductible had not been paid. [OTN: T3886551]
On February 4, 2016, Dr. Richard Scott Lenhart of State College, PA pled No Contest to charges of two counts
of Indecent Assault and one count of Insurance Fraud and was sentenced to serve a maximum of nine years'
State College
Doctor To
Serve Nine
Years
Incarceration
& To Pay
$71,557 in
Restitution
Page 14
confinement and was ordered to pay $71,557 in restitution, a $1,000 fine and court costs totaling $867.50.
Office of Attorney General special agents, in August 2014, had arrested and charged Lenhart with Aggravated
Indecent Assault, Involuntary Deviate Sexual Intercourse, Sexual Assault, Indecent Assault, Criminal Use of
Communications, Insurance Fraud and Theft by Deception. According to the Criminal Complaint, Lenhart
allegedly used the guise of treatment to sexually assault two female patients who were under his care, prescribing “touch therapy” that at times involved sexual contact. The complaint reflects that Lenhart, between January 2008 and November 4, 2011, had fraudulently billed insurance companies for these services by utilizing
claim codes associated with more traditional psychological services and treatments. Reportedly, nearly 700
such claims were presented to Highmark Insurance Company for payments totaling more than $71,500.
[OTN: T5548970]
On February 4, 2016, Wesley A. Dejesus-Sierra of Harrisburg, PA pled Guilty to Insurance Fraud and was
sentenced to serve two years' probation and was ordered to perform 50 hours of community service and to pay
a $250 fine and court costs totaling $2,460.15. In December 2014, Office of Attorney General special agents
had arrested Dejesus-Sierra and charged him with Insurance Fraud and Criminal Attempt Theft by DeceptionFalse Impression. According to the Criminal Complaint, Dejesus-Sierra was involved in a two vehicle accident
A
ccelerated
R
D
ehabilitation
on July 3, 2012 while operating his 1995 Acura Integra and allegedly contacted GEICO Insurance Company
after the accident to add comprehensive and collision coverage to his auto insurance policy. According to the
complaint, Dejesus-Sierra subsequently contacted GEICO on July 4, 2012 to file a claim for the loss and reported that the accident had occurred earlier that day. The complaint reflects that GEICO had confirmed
with Swatara Township Police that the accident had occurred on July 3 rd, before he added additional coverage
to his policy. [OTN: T6013346]
On February 5, 2016, a Morgan, PA woman was granted ARD with two years' probation and was ordered to
perform 250 hours of community service and pay a $500 civil penalty to the Insurance Fraud Prevention Trust
Fund and court costs of $2,986. On November 6, 2015, the Allegheny County District Attorney's Office re-
iversion
ceived a case for prosecution regarding the defendant who was charged by Bridgeville Boro Police Department
with Insurance Fraud, Forgery, Unsworn Falsification to Authorities, Tampering with Evidence, Obstruction
Administration of Law, Furnish Authorities with Information Without Knowledge, Driving Unregistered
Vehicle and Operating Vehicle Without Insurance. According to the Criminal Complaint, it was alleged that
the defendant was involved in an auto accident while her vehicle was not insured. The complaint states that
she contacted GEICO Insurance to obtain a valid auto insurance policy on May 25, 2015 and subsequently
filed a claim with GEICO and misrepresented the actual time of the accident to reflect the accident occurred
after she had obtained the GEICO policy. [OTN: G7143706]
On February 10, 2016, a Philadelphia, PA woman was granted ARD with 12 months' probation and was ordered to pay $500 in restitution and court costs of $418.50. On November 16, 2015, from a referral received
from American Independent Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested the defendant and charged her with Insurance Fraud and Forgery. According to the
Criminal Complaint, the defendant was involved in an accident when she hit a property and it was alleged
that the defendant provided the owner of the property with a fraudulent American Independent policy number. The complaint states that when the property owner tried to file a claim with American Independent, the
property owner was advised that American Independent did not insure the defendant or her vehicle. [OTN:
N9868471]
On February 10, 2016, from a Negotiated Guilty plea to Insurance Fraud, Dante Black of Philadelphia, PA
was sentenced to serve 23 months' confinement followed by two years' probation and was ordered to pay $500
in restitution and court costs of $743.50. On February 28, 2011, detectives of the Philadelphia District Attorney's Insurance Fraud Unit arrested Black and charged him with Forgery and Insurance Fraud. After Black's
2002 Dodge was impounded by police, Black attempted to reclaim his vehicle by showing impound officials
an American Independent Insurance Company financial responsibility identification insurance card. The
card appeared suspicious and further investigation by detectives found that Black had obtained a Pennsylvania motor vehicle registration for his Dodge on January 8, 2010 by providing Pennsylvania Department of
Transportation representatives a GEICO Insurance Company insurance identification card as his proof of
required insurance. Allegedly, both insurance cards were forgeries. [OTN: N7297743]
On February 10, 2016, a Tobyhanna, PA woman was granted ARD with six months' probation and was ordered to pay $1,477.94 in restitution and court costs of $1,640.50. On November 25, 2015, detectives of the
Lehigh County District Attorney’s Office had filed a Criminal Complaint charging the defendant with Insurance Fraud. According to the complaint, on April 10, 2014 at 12:40 PM, after renting a 2014 Dodge Dart, the
defendant struck an object and sustained a flat tire, left the roadway and came to a stop in the median. The
Dodge was towed at 2:08 PM. At 3:17 PM, the defendant contacted Progressive Insurance to reinstate her
auto insurance policy which had reportedly expired on March 20, 2014. The complaint states that the defendant, in filing a claim with Progressive, misrepresented the actual time of the accident to reflect that the accident occurred after she had reinstated her expired policy. [OTN: L9845334]
On February 14, 2016, a Whitehall, PA man was granted ARD with three months’ probation and was ordered
to pay court costs of $1,039.50. On September 17, 2015, detectives of the Lehigh County District Attorney’s
Office filed a Criminal Complaint charging the defendant with Insurance Fraud. According to the complaint,
on September 24, 2013, the defendant purchased an auto insurance policy with Donegal Insurance Group to
insure a 2000 Ford Focus and 1997 Mercedes-Benz C230. On the application, the defendant listed only himself and his wife as drivers on the policy and as the only household members. On June 12, 2014, the defendant’s son was driving the 1997 Mercedes-Benz C230 and was involved in an auto accident. The defendant had
reportedly admitted that he had not listed his children on the insurance application because it would have
increased his premiums. [OTN: T7033806]
On February 16, 2016, from Negotiated Guilty pleas to Insurance Fraud, Conspiracy and Attempted Theft by
Deception-False Impression, Jillan Pazdan of Bristol, PA was sentenced to serve 23 ½ months' probation.
Court records reflect that all costs were waived. In October 2015, from a referral received from Infinity Insurance Company, detectives of the Bucks County District Attorney’s Office filed two Criminal Complaints
charging 39 year-old Jillann Pazdan of Bristol, PA and her 70 year-old father of Croydon, PA with Insurance
Fraud, Conspiracy and Criminal Attempt Theft by Deception-False Impression. According to the complaints,
on April 21, 2014, the defendants reported to Infinity Insurance Company that Pazdan’s 2000 Nissan Sentra
had been involved in a two-vehicle accident in the parking lot of a Wawa. Both reportedly claimed that Pazdan’s father had been operating the Nissan at the time of the accident and that Pazdan was a passenger in the
vehicle. On April 22, 2014 during an interview, the driver of the other vehicle involved in the accident reportedly stated that Pazdan was operating the vehicle when she backed into his vehicle and that the only other
passenger in her vehicle was a small child. The investigation revealed that the policy holder of the Nissan was
Pazdan’s father and that Pazdan did not have a driver’s license and was listed as an excluded driver on the
Infinity policy. According to the complaint, on April 30, 2014, both defendants reportedly admitted that
Pazdan had been operating the Nissan when the accident occurred, and Infinity did not pay the claim. According to court records, the case against Pazdan’s father remains active. [OTN: L9739402, L9739380]
Page 15
Page 16
On February 16, 2016, David W. Barnes of Central City, PA pled Guilty to Attempted Theft by DeceptionFalse Impression and was sentenced to serve three years' probation and was ordered to perform 50 hours of
community service and to pay $1,500 in fines and court costs totaling $1,178. Office of Attorney General special agents had filed a Criminal Complaint in Somerset County on June 19, 2015 charging Barnes with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression. According to the complaint, on March
13, 2014, Barnes added comprehensive coverage to his Nationwide Insurance auto insurance policy insuring a
2002 Dodge Neon at approximately 2:32 PM. He subsequently, at 3:20 PM, filed a claim for fire damage to the
vehicle and reportedly stated that the fire occurred after he had obtained additional coverage. According to the
complaint, Dallas Volunteer Fire Department was dispatched to Barnes’ vehicle fire at 2:07 PM on the same
day prior to Barnes having added the additional comprehensive insurance coverage. Nationwide did not pay the
claim. [OTN: T6673973]
On February 17, 2016, from a Negotiated Guilty plea to Insurance Fraud, Sharif Davis of Philadelphia, PA was
sentenced to serve two years' probation and was ordered to pay a $1,000 fine and court costs of $1,040.50. On
December 29, 2014, from a referral received from Progressive Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 53 year-old Eleanor Smith and her son, 32 year-old Shar-
Mother Son
Duo Get
Probation For
Filing Bogus
Vandalism
Claim in
Effort to
Make a Quick
Buck
iff Davis, both of Philadelphia, PA and charged them each with Insurance Fraud, Theft by Unlawful Taking
and Conspiracy. According to the Criminal Complaints, on October 7, 2013, Eleanor Smith called Progressive
Insurance Company to report that her son’s 2006 Mercedes Benz had been vandalized on October 6, 2013. A
Progressive investigator contacted the owner of a business that was located in front of where Davis allegedly
parked the car and obtained surveillance footage that reportedly revealed no evidence of vandalism to Davis’
vehicle; in fact, the vehicle was not parked where Davis had claimed the vandalism occurred. Detectives retrieved phone records from a state prison where Shariff Davis was incarcerated and in recorded conversations
from October 1, 2013, the two defendants discussed a third party intentionally vandalizing the vehicle in an
effort to receive insurance money for the loss. Eleanor Smith was sentenced in June 2015 to serve two years'
probation and was ordered to pay $1,000 in fines and court costs totaling $1,349. [OTN: N9458595]
On February 18, 2016, from Negotiated Guilty pleas to Insurance Fraud and Attempted Theft by DeceptionFalse Impression, Dwayne E. Young of Peach Bottom, PA was sentenced to serve five years' probation and was
ordered to perform 100 hours of community service and to pay a $200 fine and court costs totaling $4,028. On
June 8, 2015, from a referral received from Infinity Insurance Company, Office of Attorney General special
agents had filed a Criminal Complaint charging Young with Insurance Fraud and Criminal Attempt Theft by
Deception-False Impression. According to the complaint, Young applied for and received an Infinity auto insurance policy to insure his 2004 Ford F-150 on November 9, 2012. Young’s prior auto insurance policy had expired on May 25, 2012. On November 12, 2012 at 10:42 AM, Infinity received a report that Young had sideswiped another vehicle as he was exiting I-95 in Maryland, and according to the complaint, the date of loss
listed on the claim was November 8, 2012 - one day prior to Young’s application and receipt of his Infinity auto
insurance policy. The complaint further states that Young, on November 12, 2012 at 10:37 AM, contacted
Infinity and fraudulently reported that his vehicle had been involved in a hit-and-run while parked in a parking
lot overnight from November 11 – 12, 2012, resulting in damage to his vehicle’s front fender, mirror, bumper,
headlight, good and grill. The investigation revealed that the damage to Young’s vehicle was the result of the
November 8, 2012 incident. Infinity had not paid Young’s claim. [OTN: T6623853]
On February 19, 2016, from Negotiated Guilty pleas to Arson and Conspiracy, Joshua Richard Dinger of Temple, PA was sentenced to serve 23 months' confinement followed by two years' probation and was ordered to
Page 17
pay court costs totaling $658. Dinger’s co-defendant, Melissa Ann High of Womelsdorf, PA was also sentenced on January 22, 2016 to serve 23 months’ confinement followed by two years’ probation and was ordered to pay court costs totaling $658. Office of Attorney General special agents filed two Criminal Complaints on February 11, 2015 charging Dinger with two counts of Conspiracy, and one count each of Arson
and Reckless Burning or Exploding. High was charged with three counts of Conspiracy and one count of
Criminal Attempt Theft by Deception-False Impression. According to the complaints, on December 28,
2011, High’s estranged husband who had been in possession of their jointly owned 2006 Jeep Wrangler,
contacted Infinity Insurance Company to file a theft claim reporting that the Jeep had been stolen. Mr.
High, during his filing of the theft claim, stated that there were two factory keys to the Jeep; he obtained a key
and Ms. High had the other. The vehicle was found burned on January 22, 2012, and was determined a total
loss. According to the complaint, further investigation revealed that payments to the Jeep’s lienholder, AmeriCredit were not being made and on December 28, 2011, Ms. High reportedly contacted Ameri-Credit to
arrange the Jeep’s voluntary repossession. Ms. High was reportedly instructed at that time that it was her responsibility to gain possession of the Jeep and as Ms. High was legally barred from entering Mr. High’s property where the Jeep was being kept, it was alleged that Ms. High provided Dinger with her key so he could
remove the Jeep from Mr. High’s property without his knowledge, drive it to a field and dispose of the Jeep by
burning it. Infinity had reportedly hired an outside investigative firm to perform a forensic examination of
the burned Jeep. The firm concluded that the fire had been intentionally set, and that the Jeep’s anti-theft
system had not been defeated as the Jeep had been driven by someone who’d used one of the two original
transponder keys. Infinity had not paid the theft claim, valued at approximately $17,000. [OTN: T6205511,
T6205640]
On February 19, 2016, a West Mifflin, PA man was granted ARD with 12 months' probation and was ordered to perform 250 hours of community service, pay a $3,000 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs totaling $1,584.56. On July 7, 2011, detectives of the Allegheny County
Police Department had filed a Criminal Complaint charging the defendant, owner of a used car dealership,
The Auto Gallery, with Insurance Fraud. It was alleged that after a vehicle owned by The Auto Gallery caught
“...as Ms. High was
legally
barred
entering
Mr.
from
High’s
property where the Jeep
was being kept, it was
alleged that Ms. High
provided Dinger with her
key so he could remove the
Jeep from Mr. High’s
fire and burned, the defendant attempted to unlawfully profit by inflating an insurance claim with Peninsula
property
Insurance Company. On June 2, 2010, the defendant filed a claim with Peninsula after a 2007 Cadillac Escalade owned by the dealership caught fire and burned on May 25, 2010 in the parking lot of a Leetsdale, PA
knowledge, drive it to a
Giant Eagle supermarket. The defendant gave Peninsula claim adjusters an invoice showing that the Escalade
had been purchased for the wholesale price of $40,000 by The Auto Gallery from "Hanks Auto Sales". The
field and dispose of the
defendant also gave Peninsula a list of items that had supposedly been in the Escalade when it burned, including a $2,500 Apple Mac Book I7 Pro laptop allegedly purchased an hour before the fire from a Best Buy store
Jeep by burning it.”
and a $450 Apple iPhone. Detectives alleged that the sales invoice fraudulently inflated the value of the
burned Escalade, as the Escalade had been purchased by the defendant from Charrap Ford North for
$31,000. In addition, Best Buy had not carried the laptop model that the defendant claimed had been lost in
the fire at the time of the fire loss. [OTN: G5341814]
On February 22, 2016, Ryan T. Blumling of Moon Township, PA pled Guilty to Prohibited Acts and was
sentenced to serve a maximum of ten years' confinement and was ordered to pay $117.74 in restitution and
court costs totaling $949. Office of Attorney General special agents had filed a Criminal Complaint in December 2012 charging Blumling with Insurance Fraud, Criminal Attempt, Prohibited Acts and Forgery. According to the complaint, Blumling allegedly obtained 1,400 Oxycodone prescription pills from area pharmacies in Center Township via bogus prescriptions written to Blumling and Terri Blumling, neither of whom
was a patient of the doctors shown on the prescriptions. When agents questioned Blumling, he reportedly
without
his
Page 18
stated that he would obtain a legitimate prescription from a doctor and then “wash” the paper with acetone in
order to make copies and change the drug and quantity. Blumling reportedly used his Health America insurance benefits to pay for prescriptions. Blumling was also sentenced to serve ten years’ confinement and ordered
to pay $444.28 in restitution and court costs of $1,020 in a separate case which involved passing fraudulent
prescriptions by fraudulently using the names of doctors and presenting his UPMC Express Scripts prescription
card as well as another individual’s Highmark prescription card to pay for the scripts. [OTN: G5802005,
G6820030]
On February 23, 2016, David Thomas Young of Indiana, PA pled Guilty to Insurance Fraud and was sentenced
to serve a maximum 23 months' confinement followed by two years' probation and was ordered to pay
$168,699.46 in restitution, a $300 fine and court costs totaling $1,151.70. On October 28, 2014, from a refer-
Indiana, PA
Man Pleads
Guilty to
Insurance
Fraud;
Sentenced to
Serve 23
Months’
Confinement &
To Pay
$168,699.46 in
Restitution
ral received from Highmark Financial and Provider Review, detectives of the Cumberland County District Attorney’s Insurance Fraud Section filed a Criminal Complaint charging Young with Insurance Fraud and two
counts of Theft by Deception. Young, according to the complaint, is owner and licensee of Indiana Spine Center. The complaint reflects that Indiana Spine Center had allegedly billed for services not rendered to include
ultrasounds and extra spinal/extremity manipulation and reportedly assigned inaccurate billing codes to raise
the level of the spinal manipulation. Further, the Spine Center reported time based therapies and procedures
for patients that required 45 to 60 minutes or more; total services reported on specific dates exceeding 17 to 28
hours per day. According to the complaint, detectives conducted telephone interviews of eight patients. Most of
the patients reportedly stated that their visits were approximately 30 minutes in length and consisted of 15
minutes sitting in a massage chair, 15 minutes of electrical stimulation performed by the Center’s unlicensed
secretary, and spinal adjustment. According to the complaint, records reflect that Indiana Spine Center had
billed Highmark a total of $2,626,612, and the complaint reflects that although it was difficult to estimate a true
loss figure, a comprehensive analysis showed a total loss due to fraudulent billing from 2009 through 2011 of
$168,669.46. [OTN: T5824442]
On February 23, 2016, a York Haven, PA man was granted ARD with 12 months' probation and was ordered to
perform 35 hours of community service and pay court costs of $1,238.25. On October 26, 2015, detectives of
the York County District Attorney’s Office filed a Criminal Complaint charging the defendant with Insurance
Fraud and Criminal Attempt Theft by Deception-False Impression. According to the complaint, on July 15,
2015 at 4:55 PM, the defendant purchased a Progressive Specialty Insurance auto insurance policy to insure his
vehicle. The complaint alleges that approximately 40 minutes prior to obtaining the Progressive policy, the defendant had been involved in a two-vehicle accident on Interstate 83. The driver of the other vehicle involved
reportedly photographed the damage to his vehicle immediately after the crash and according to the photographs’ metadata, the photos were taken at 4:17 PM. Damage to the other vehicle involved was estimated to be
$1,205.22; however, Progressive did not pay the claim. [OTN: T7185382]
On February 26, 2016, a Philadelphia, PA man was granted ARD with 12 months' probation and was ordered
to pay $1,642.98 in restitution and court costs totaling $1,019. On January 8, 2016, from a referral received
from the Southeastern Pennsylvania Transportation Authority (SEPTA), detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested the defendant and charged him with Insurance Fraud, Theft by
Deception-False Impression and Criminal Attempt Theft by Deception-False Impression. According to the
Criminal Complaint, on July 19, 2014, the defendant was a passenger on a SEPTA bus when the bus made
minor contact with a Progressive Insurance Company insured Dodge Durango. As a result of the incident, the
SEPTA bus was scratched and the side view mirror of the Durango was broken. The defendant subsequently
filled out a SEPTA claim form stating that he sustained injuries to his back, neck and arm as a result of the
Page 19
accident and retained a personal injury attorney to represent him in the lawsuit against SEPTA and Progressive. The complaint reflects that although the defendant did not seek medical treatment immediately following the accident, he later sought chiropractic treatment and medical records reflect that the defendant sought
treatment on 53 separate occasions between July and December 2014. The total cost of the defendant's medical bills exceeded $15,000 and were submitted to SEPTA and Progressive. According to the complaint, Progressive paid in excess of $1,642 towards the defendant's medical bills. Detectives viewed surveillance video
footage aboard the SEPTA bus taken at the time of the accident which reportedly shows that the defendant
remained in his seat throughout the minor accident and that he had not been injured as he had claimed.
[OTN: N9928133]
On February 26, 2016, a Philadelphia, PA woman was granted ARD with two years' probation and was ordered to pay $13,000 in restitution and court costs of $419.50. On October 26, 2015, from a referral received
from GEICO Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit
arrested the defendant and charged her with Insurance Fraud, Attempted Theft by Deception and False Re-
“According
to
the
ports. According to the Criminal Complaint, on December 8, 2012, the defendant reported to both the Philadelphia Police Department and GEICO that her 2011 Dodge Charger had been stolen. Insurance fraud
complaint, GEICO had
detectives reportedly retrieved the Philadelphia Police Investigation Report which stated that the defendant's
vehicle had been stolen at approximately 3:30 AM on December 8, 2012. Insurance fraud detectives also
paid
reportedly retrieved a Philadelphia Police Non-Reportable Accident Report that stated that the defendant's
vehicle had been involved in an auto accident just three hours prior to having been stolen. According to the
$13,000 for the loss of
complaint, GEICO had paid the defendant $13,000 for the loss of her vehicle; however, she later admitted in
a recorded statement to GEICO that her vehicle had been in an accident, but that it had never been stolen as
she had originally claimed. [OTN: N9840994]
the
defendant
her vehicle; however, she
later
admitted
recorded
in
a
statement
to
GEICO that her vehicle
had been in an accident,
but that it had never been
stolen
as
she
originally claimed.”
had
Page 20
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*April 7—8, 2016 — PA 2015 Insurance Fraud Conference — Hershey Lodge & Convention
Center, Hershey, PA
*September 11—14, 2016 — IASIU Conference — Red Rock Resort, Nevada
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Page 21
Who to Call
Insurance Fraud
Allegheny County DA’s Office, (412) 461-2328
Allegheny County PD, (412) 473-1254
Attorney General’s Office, (717) 787-0272
Bucks County DA’s Office, (215)348-6344
PA INSURANCE FRAUD
PREVENTION
AUTHORITY
6 Kacey Court, Ste. 101
Mechanicsburg, PA 17055
Phone: 717-691-1828
Fax: 717-697-1013
Cumberland County DA’s Office, (717) 240-7764
Delaware County DA’s Office, (610) 891-4700
Erie Bureau of Police, (814) 870-1258
Lehigh County DA’s Office, (610) 264-8758
Montgomery County DA’s Office, (610) 278-3472
NE Insurance Fraud Task Force, (570) 963-5177
Philadelphia DA’s Office, (215) 686-8723
York County DA’s Office, (717) 771-9600 x 329
www.helpstopfraud.org
Arson
Dauphin County DA’s Office, (717) 255-2770
PA State Police-Fire Marshals, (717) 346-4597
Anti-Fraud Compliance
PA Insurance Department, (717) 705-4199
IFPA Staff
Thomas Donahue,
Executive Director, [email protected]
Joan Dockery,
Associate Executive Director, [email protected]
Christine Cassel,
Grants Administrator, [email protected]

Pennsylvania Fraud Stories - Pennsylvania Insurance Fraud

Transcription

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